Nurse manager write up, the SEQUEL

[Girlygirl69]

Then: "Question to all of the experienced critical care nurses- EEG results showed pt having seizures without any visible evidence of seizures and MD orders Versed drip. RN questions another experienced RN and the ordering MD the need for versed. Response from ordering MD is that after reading results Neuro fellow states this is the drug of choice. I hang the drip and get chewed out by nurse manager and ICU attending because this particular unit does not "like" to use versed. There is no policy in hospital showing which drugs are first and second line choices and which drugs should all together not be used. Can I be written up for this?"

Now: a week later after all this crap happened, after I spoke with another neuro attending, and after I called the UNION. The matter suddenly disappeared. Okkaay!!!

[nursej22, MSN, RN]

So, were your written up? Make sure that that there is nothing in your personnel file about this, or if there is that you add a reply. Your union rep or grievance officer should be able to help.

You want to make sure that what ever they place in your file doesn't establish some sort of negative pattern that they can use as discipline later on.

Best of luck!

[ckh23, BSN, RN]

You should tell the NM and the ICU attending if they don't like it than they should create a policy on it. I sometimes find that these situations are a communication and chain of command issue. Does everything have to go through the ICU attending or can you take orders from the Neuro?

For instance on my unit we have a resident that answers to the attending for everyone in the STICU. Other specialty's can make recommendation on what to do for the patients and most of the time we follow those recommendations, however the ultimate decision lays with the STICU Resident/Attending. For that reason we cannot take orders from the other specialty doctors. When they try to do this I direct them to the resident.

S rolls down hill so the NM was probably getting crap from the attending and then the NM in turn came down on you. I'm happy it is resolved for you. I think in the end they probably realized they were either wrong or didn't feel like getting into it with the union.

[313RN, BSN, RN]

In the Neuro ICU where I work we use Versed fro subclinical seizures/status epilepticus all the time. We usually hang fentanyl at the same time.

If they're not effective we've used pentobarb or ketamine.

What did your NM and the attending want instead? Was the attending on a medicine or surgical service? What service was the patient admitted under? Why didn't the neuro fellow communicate with the attending?

IMHO you had a valid order for a medication that was appropriate for the patient (provided they were not allergic, etc) from a licensed MD with privliges at your facility. That should mean you're covered. The rest sounds like politics.

[nrsang97, BSN, RN]

I agree we use Versed in my neuro ICU for status patients too. If no respones we go to pentobarb, then ketamine. I agree you had a valid order. No reason for you not to follow it.

[SilentfadesRPA]

Thankfully you had a union

[steelydanfan]

Then: "Question to all of the experienced critical care nurses- EEG results showed pt having seizures without any visible evidence of seizures and MD orders Versed drip. RN questions another experienced RN and the ordering MD the need for versed. Response from ordering MD is that after reading results Neuro fellow states this is the drug of choice. I hang the drip and get chewed out by nurse manager and ICU attending because this particular unit does not "like" to use versed. There is no policy in hospital showing which drugs are first and second line choices and which drugs should all together not be used. Can I be written up for this?"

Now: a week later after all this crap happened, after I spoke with another neuro attending, and after I called the UNION. The matter suddenly disappeared. Okkaay!!!

Funny how that happens, eh?