Mistakes to Avoid as a New Grad Nurse

In this week’s article, I want to discuss some of the most common mistakes new grad nurses make and how you can avoid making them. Of course, some of these avoidable mistakes will seem obvious, but others may not be…or they may be more practical in nature. So read along, follow through to the end, and help your new grad nurse self avoid these common mistakes. We’ll start with a few practical mistakes to avoid first, and then we’ll work towards the more in-depth mistakes, explanations, and steps on how to avoid making them.

Practical Mistakes to Avoid:

• Not wearing eye protection when performing interventions (like emptying a Foley catheter or suctioning a patient) that may result in splashes or splatters of bodily fluids to your mucous membranes. Wear goggles, glasses, or a face shield to protect yourself because you never know what your patient may have or how contagious it could be. You don’t want to be emptying a Foley for a patient with ESBL to the urine, have that splash into your eyes, and then end up with an eye infection! That will cost you time, money, and effort in treating the consequences of your lack of action.
• Sending anything liquid through the tubing system (Ex: urine specimen being sent to lab). Not only does it have the potential to leak, but this also unnecessarily exposes other healthcare professionals to bodily fluids and can contaminate the entire tubing system. I suggest taking the specimen to its destination, in-person, as well as double bagging the specimen.
• Not clamping the secondary tubing before disconnecting it from the primary tubing set. If you forget to clamp the tubing, you could lose quite a bit of the volume of whatever medication you were supposed to be administering. In this scenario, you should waste that dose and pull a new dose to ensure the patient is receiving the full dose of the prescribed medication.
• Similarly, not unclamping the secondary tubing after programming it to run with the IV pump. Depending on your pump’s manufacturer, not unclamping the secondary would cause the same programmed volume to be given from the primary fluid rather than from your secondary fluid. This would result in a delayed or potentially missed dose of whatever medication you were trying to administer.
• Being messy or disorganized. Having an organized room and a tidy patient can come in handy especially during an emergency situation. This means you should clean up the room and patient at the beginning of your shift when assessing your patient. Spend 5 minutes putting supplies in drawers, picking up and throwing away trash, removing old food trays, clearing walkways, etc. This is also a safety factor!
• Not practicing fall risk safety interventions. You should be rounding on all your patients at least hourly. In addition to this, you should make sure you have a working bed/chair alarm that is turned on, your bed is in its lowest position, the call bell and belongings are within reach, and if necessary, you are nearby as much as possible or they are assigned to a room close to the nurse’s station.

Now let’s move on to discussing some additional potentially avoidable mistakes that may or may not be as practical or obvious to the new grad nurse!

• Not charting your assessments, interventions, or medications administered as you go throughout the shift. The longer time passes by, the higher chance there is that your documentation will be less accurate.
• Making a medication error. One of the easiest ways to make this mistake is to be distracted. When administering meds, make sure you are not interrupted, you don’t take phone calls or send messages, don’t multitask, etc. Follow your rights of medication administration and double check everything. If it’s required or you think it may be necessary, have another nurse or the supervisor double check the medication with you. This is a crucial intervention when handling high risk medications such as insulin, anticoagulants or thrombolytics (Ex: heparin, TPA), vasopressors, antihypertensives, etc.
• Allowing your drips or fluids to run dry. In the critical care setting, this can be a life or death situation. Set your pump to deliver a volume to be infused (VTBI) that leaves you with 1-2 hours leeway to obtain new bags of the medications. Also, don’t be THAT nurse that transfers patient care to the oncoming nurse without having ordered new medication bags. Set your oncoming nurse up for success, even if they didn’t do that for you. It’s the patient’s care that matters most in this situation and doing that intervention promotes their health.
• Not seeing your patient when you take report. Once you take over the patient’s care, their current status, infusing medications, etc. become your responsibility. You need to go into the patient’s room with the offgoing nurse and verify orders with IV meds that are currently infusing to double check accuracy. You need to make sure the patient is safe and appropriately situated in bed. Make sure you fix anything and everything that seems off. Be assertive with the staff you are taking over for. It’s your license on the line, not theirs, once you assume responsibility for the patient and their care.
• Relying on your monitor ONLY for decision making purposes. You need to look at and assess your patient when their monitor does not read favorable numbers. If their BP is reading low, make sure the cuff is on and sized appropriately, ask questions about whether or not they are symptomatic, etc. Another situation I can think of is when you have a soft BP reading and normal HR (Ex: 92/48 (68) with a HR of 89) and you have metoprolol scheduled for administration. Do you give the medication? Knowing the patient has a history of A-fib and has been maintaining BPs like this for the past few days, the metoprolol is likely more for HR control than for BP management. If in doubt, notify your MD and give their vitals and any other pertinent information, let them make the call, and document the encounter with the MD and the results.
• Trusting the wrong person to watch your patients for a break. You need to know and trust that the person “watching” your patient(s) is actually going to be nearby and check on your patient(s) if necessary. Be sure to tell them their code status, allergies, and any current IV medications infusing at a BARE MINIMUM. It’s also a nice addition to include their typical vital ranges, especially if their HR or BP tend to run high or low consistently. If necessary, make sure they know available PRN meds they can use if the situation escalates, where you’ll be during the break, and how they can contact you with concerns.
• Not knowing enough about your patient(s). Knowledge about your patient’s current status, their admission history, and past medical history can make the difference in what meds or interventions are ordered, which studies might be performed, and catching more subtle changes in status earlier on. Plus, if your patient codes, you’ll need to know these aspects about your patient so you can inform the MD at bedside for the most appropriate emergency interventions.
• Not asking for help. Don’t allow yourself to drown in patient care, charting, etc. Don’t try to “fake it until you make it.” And don’t guess. Suck it up and swallow your ego because it’s your patient’s life at risk if you don’t. Cockiness gets patients killed.
• No questioning a MD’s orders if they don’t look appropriate or your patient or if you don’t understand why you are doing a certain intervention. Also, on a similar note is not voicing your concerns to the MD or your supervisor.
• Making promises. Don’t tell your patient any results, anticipated dates/times, etc. unless you know for certain that they will or have occurred. This can lead to disappointment and potential disciplinary action, depending on the situation.
• Slacking off as a new grad. As a new grad, you likely have an 8-12 week orientation period where you have a preceptor shadowing and guiding you as you train for the unit you’ve been hired into. During this time, it can be tempting to have the mindset that there are two nurses for your patients and you can share the workload or lighten up. Don’t fall into this temptation because it doesn’t utilize this time to the fullest, your patients could be at risk if the preceptor isn’t aware you’re expecting them to pick up that slack, and it doesn’t help prepare you to be a nurse without your preceptor after the orientation period has passed.

I truly hope these lists of potential mistakes have been helpful and eye opening. You have the power to control your actions and reactions as a nurse. Do everything correctly and as thoroughly and safely as possible the first time to prevent making these mistakes. Think of any other common new grad mistakes that I may have missed? Leave them in the comments below! Until next time, happy studying!

Andra Alyse