There is a moment after making a clinical mistake that many nurses will recognise.

Your stomach drops.

You replay what happened.

How did I miss that?

What was I thinking?

I should have known better.

And then, often before you've even had time to properly understand what happened, another thought arrives:

Maybe I'm not actually very good at this.

For early-career nurses, this can be one of the hardest parts of developing professionally.

We can mistake making a mistake for being incompetent.

I know I did.

But after many years in acute healthcare, I've come to understand something quite different.

Good nurses make mistakes too.

That doesn't mean mistakes don't matter.

They do.

Patients can be harmed. Colleagues can be affected. Nurses can carry the emotional weight of an incident for a long time afterwards.

But if we want to become safer nurses, we need to understand something important:

A mistake is an event. It isn't an identity.

The question isn't whether you will ever make one.

The question is what you do when you realise you have.

A medication error during resuscitation

One of the examples that comes to mind is medication error during a resuscitation.

Resuscitation is an environment where everything happens quickly.

There are multiple people communicating simultaneously. Someone is performing compressions. Someone is managing the airway. Someone is documenting. Someone is preparing medications. Someone is trying to establish what happened immediately before the patient deteriorated.

There is urgency everywhere.

In one situation I remember, the dose of a medication was prepared at ten times the intended dose.

The nurse involved wasn't careless.

They weren't incompetent.

They weren't someone who didn't care about the patient.

They were a nurse working in a high-pressure environment where multiple factors were interacting.

That distinction matters.

Because if we simply look at the event and say:

“The nurse gave the wrong dose.”

we have described what happened, but we haven't necessarily learned why it happened.

And without understanding the why, we make it much harder to prevent the next error.

Mistakes rarely have one cause

We sometimes talk about clinical errors as though they happen because someone wasn't paying attention.

Sometimes they do.

But often the reality is much more complicated.

A mistake might occur at the intersection of:

• interruptions

• workload

• fatigue

• unfamiliarity

• assumptions

• time pressure

• communication

• competing priorities

• cognitive overload

• unclear information

• environmental factors

None of these automatically excuses an error.

But they can help explain it.

Imagine a nurse who is preparing medication.

They are interrupted.

They answer a question.

Someone asks them to review a patient.

They return to what they were doing.

They are now trying to remember exactly where they were in the process.

The mistake that follows might look simple from the outside.

But the conditions that produced it were anything but simple.

This is why reflection needs to go beyond:

“I should have been more careful.”

That's often true.

But it's not particularly useful.

A better question is:

“What made it difficult to be careful in that moment?”

We don't always make mistakes because we don't know

This is something I think early-career nurses can find particularly difficult.

There is an assumption that if you make a mistake, you must have lacked knowledge.

But sometimes you know exactly what you should have done.

You simply didn't recognise that you needed to do it at that particular moment.

There is a difference.

You can know the correct process for a medication and still make an error.

You can understand the signs of deterioration and still miss them.

You can know that you should escalate a concern and still hesitate.

You can understand a policy and still make a decision that doesn't align with it.

Knowledge is important.

But clinical practice requires us to apply knowledge under pressure, uncertainty and competing demands.

That's a much harder skill.

The uncomfortable role of assumptions

One of the biggest contributors to mistakes I've seen is assumption.

We make assumptions because our brains are constantly trying to make sense of large amounts of information quickly.

A patient looks comfortable.

Their observations are reasonably normal.

You've looked after them before.

Someone tells you they're usually like this.

You develop an explanation.

And once you've developed that explanation, it becomes very easy to interpret subsequent information through it.

They're anxious.

They're tired.

They're always like that.

They've just had the procedure.

They're probably fine.

Sometimes those assumptions are correct.

The problem is that when they're wrong, they can influence everything that happens afterwards.

This is one of the reasons experienced nurses aren't necessarily better because they know more facts.

They become better at recognising when their initial interpretation might be wrong.

They learn to ask:

“What else could this be?”

That question can be incredibly powerful.

Sometimes the biggest barrier is simply not wanting to look like you don't know

This is one of the areas I think we don't talk about enough.

Nurses don't always make mistakes because they don't know something.

Sometimes they make mistakes because they don't want other people to know that they don't know something.

For a new nurse, asking a question can feel like an admission of incompetence.

You might worry that the senior nurse will think:

Surely you should know this by now.

So you don't ask.

You make your best judgement.

And sometimes that judgement is wrong.

This is where psychological safety becomes more than a workplace buzzword.

A safe clinical environment needs to make it normal to say:

“I'm not sure.”

“Can you check this with me?”

“I haven't done this before.”

“Something doesn't feel right.”

Those aren't signs of weakness.

They are safety behaviours.

And interestingly, I've found that the more experienced nurses become, the more comfortable many of them are with saying:

“I don't know.”

That's not a reduction in confidence.

It's often a sign of maturity.

What happens after the mistake?

This is where things get interesting.

I've seen experienced nurses respond to mistakes in very different ways.

Some completely lose faith in themselves.

They replay the incident over and over.

They question their ability.

They become frightened that they will make another mistake.

Their confidence can collapse.

Others do something different.

They acknowledge what happened and almost immediately start asking:

Why?

What happened?

What was I thinking at the time?

What information did I have?

What did I miss?

Was I interrupted?

Was I unfamiliar with the situation?

Did I make an assumption?

Did I communicate poorly?

Was I tired?

Was there something about the environment that contributed?

And most importantly:

What can I do differently next time?

That's reflection.

And there is a huge difference between reflection and self-punishment.

Self-blame isn't the same as learning

It's easy to confuse the two.

You make an error.

You feel terrible.

You promise yourself that you will never make that mistake again.

It feels like you're taking responsibility.

But what have you actually learned?

I'll be more careful.

That's not necessarily a strategy.

Reflection goes deeper.

Perhaps the error occurred because you always asked the same person to double-check a high-risk medication, even though the environment was busy and you had become comfortable with the process.

After an insulin error I experienced, for example, I changed who I asked to check high-risk medications with me.

Instead of simply telling myself:

“I need to concentrate harder.”

I changed the process.

That is a much more powerful response.

The mistake became a change in practice.

And that change became part of my future safety.

Good nurses don't become nurses who never make mistakes

This is perhaps one of the biggest misconceptions about experience.

You might look at a senior nurse during a difficult clinical situation and think:

They never seem to make mistakes.

But that's probably not what you're seeing.

You're seeing someone who has developed thousands of mental patterns from previous experience.

They recognise what matters.

They know what can wait.

They know when something isn't quite right.

They are more comfortable saying:

I don't know.

They know when to ask for help.

They recognise when they are becoming overloaded.

And perhaps most importantly, they have made mistakes before.

They have learned from them.

Experience doesn't make you immune to error.

It gives you more opportunities to understand how you make errors.

The goal isn't perfection

Healthcare sometimes creates an uncomfortable relationship with perfection.

We work in a profession where small mistakes can have significant consequences.

So it's understandable that we want to get everything right.

But expecting yourself to become a nurse who never makes a mistake isn't realistic.

And it can actually become counterproductive.

If nurses believe that mistakes are evidence of incompetence, they may become afraid to report them.

They may hide uncertainty.

They may avoid asking questions.

They may become defensive when something goes wrong.

They may focus more on protecting themselves from blame than understanding what happened.

None of those behaviours make patients safer.

We need something different.

We need nurses who can say:

“I made a mistake.”

Then:

“Let's understand why.”

And finally:

“What are we going to change?”

What makes a good nurse?

I don't think being a good nurse means getting everything right.

It means caring enough to recognise when something has gone wrong.

It means being honest about your limitations.

It means asking questions.

It means speaking up when something doesn't feel right.

It means being willing to examine your own thinking.

And it means turning experience into learning.

A good nurse can make a mistake and still become an incredible nurse.

In fact, some of the most important lessons in a nursing career come from moments we'd rather forget.

The key is what happens next.

Do we bury the mistake?

Do we blame ourselves?

Do we blame someone else?

Or do we become curious about it?

What happened?

Why did it happen?

What did I miss?

What could I change?

What will I do differently next time?

That is where a mistake can become learning.

And that learning can become safer practice.

A mistake doesn't define the nurse

If you're early in your nursing career and you've made a mistake, you may be struggling with the belief that it says something fundamental about who you are.

It doesn't.

You can be a caring nurse and make a mistake.

You can be a knowledgeable nurse and make a mistake.

You can be a highly competent nurse and make a mistake.

You can even be an experienced nurse and make a mistake.

The responsibility isn't to pretend that the mistake didn't happen.

The responsibility is to understand it.

Own it.

Learn from it.

And change something because of it.

Because ultimately, I think there is a simple distinction.

A good nurse makes mistakes and learns from them.

A dangerous nurse makes mistakes and ignores the learning.

The goal isn't to become the nurse who never gets anything wrong.

It's to become the nurse who is a little safer, a little more reflective and a little more capable because of what happened yesterday.

The best nurses aren't perfect.

They're constantly learning.

Further Reading

The drug error that changed me

Reflective practice for nurses

The knowledge we carry

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