Almost fired today

Published

I have been working ICU for 8 months straight out of school. Lets not make tjis into a "new nurses should not go into ICU" thred please, that wont help me.I was called last night and told not to come in this morning to the unit. Instead I should goto nursing services and meet with my manager and her manager. Yikes.

1-Last Friday I admittedly made an error (I work ICU). A Patient was admitted from the floor and i wrote an order for ativan 1 mg q 3 hrs, it should have been PRN, i forgot to write PRN. I reported off to the night nurse about the ativan helping with pain/agitation and he realized not to give that much. The patient got several doses 8 hours apart, but the doc flipped when he saw how the order was written

2- Several weeks ago, I had an extremely agitated patient who was also 350lbs. There was an order for haldol 2 mg ivp prn, no time constraint. The nurse who gave me report said she had been moaning all night and nthing could be done, and that she had proabl;y not slept in days and her solution was to close the glass door so she couldnt hear the pt moan. I felt this to be NOT helpful to the pt. I ended up giving some 70 mg of haldol over the 12 hour shift. I looked up the safe dosage and that falls within the safe dose. Some books say 5 mg every half hour, some say 10 mg, then double until you get the desired effect every half hour stopping at 50mg. At no point did the patient have decreased resp[irations or drop her blood pressure. She fell asleep for a few hours but thats it, all in all even that much haldol was not that effective. That was several weeks ago and I guess they were reviewing the MAR and somone flipped. I also asked the other nurses on the unit, including the charge if it were ok that i give that much and noone said anything other then they had not given that much before but it didnt violate the order or the corecct safe doasge. Also They were upset that I didnt question the order for not havinga time constraint, which i will do in the future.

Fallout- Luckily I didnt get fired but now I must verify ALL medications with the charge nurse before I give them. "charge nurse, can i hang some vanc?" crap... and I am not allowed to work overtime because they felt I have worked too much and was too tired. The crazy thing is I am helping THEM out and they cut my overtime completely!!! I am thinking I will find a new job and put my two weeks in ASAP

Thougts anyone?

I didn't read the whole thread so maybe this has already been covered. I wanted to put my two cents worth in being that I am a new grad, 2 years out.

Are the nurses working on your unit supportive? I work on an inpt med surg unit and if I have problems or questions I take them to another nurse or the charge nurse. Anything I haven't done or am not comfortable with, you better believe I have another nurse, pharmacist etc in on the situation making sure that things will be done safely.

Better that people think you're stupid than your patients be in danger.

I feel supported by my coworkers so this is easy for me to do. If you work with nurses that eat their young then I bet it is difficult, if not impossible to do.

haldol is just about the worst thing in the world for the elderly. very rarely have i seen good things happen with it. granted, i work in a totally different world than the icu (i'm ltc now) but its bad stuff. i've given it on a very rare occasion and less than half of those times have i seen a good result of it. it really shouldn't be the sedative of choice. as another poster said...you'll see the results of it the next couple shifts later. the eps are very bad for the elderly too. this pt was elderly? was this pt totally out of control or psychotic or were they agitated and could have benefited from a sleeper? were they in pain too?

another consideration...if this pt was elderly...the normal adult dosages aren't always appropriate either. i do realize that pts are in an icu for very accute illnesses and sometimes the meds need to be given.

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always remeber what they teach you in nsg school....about the very old and the very young.patient safety...is your #1 priority.treatment for their initial reason for admit is your #2 priority.treatment of secondary dx/dg like insomnia and pain is always your #3 priority....you can treat them...as long as it doesnt interfere with your first 2 priorities!

I viewed a few posts and all of them had very good advise. I remember my first job in ICU (Been doing ICU for 8 years- nicu-picu-adult icu) There is alot to learn. I am still learning. I would embrace the attempt of your manager to put in place "check everything with the charge nurse" My impression they don't want to loose you they have invested alot of time and money in you to train you.. keep in mind the icu training you go through is just a simple overview. the real learning is out on the floor every day. I would agree to cut down the overtime for now- put your mind in a good place get rest and take care of yourself -fix your personal life(that can get out of balance when doing overtime) Non't let your ego get in the way.. this will sabotoge your career. take care.....

I simply wouldn't have carried through with an order that wasn't complete. I am a new RN working in a critical care unit. We do not follow orders that do not have the correct data (med, dose, route, frequency). I would have immediately did a telephone clarification with the Dr. This is pretty basic. Unfortunately, if your hospital policy is the same (orders need all the above data) as mine, then you failed policy. Regardless what the drug book says--you really should have called...and especially if the drug was not effective after a few doses. I would comply with the restrictions.

Kim--RN:)

UPDATE!

As it turns out, I am guilty of very little except pissing off a hotshot pulmonologist who like to percutaneously trach people when he should leave that to the surgeons. This patient is 350 lbs, and this doc messed her up bad and is looking at getting his pants sued off. He reviewed charts/ mar and found where I had given that haldol and lost his ..... Anyways I have run this by pharmacist and other docs, and they say as long there were no signs of ekg changes/hypotension, decreased respirations, or NMS, which I assesed for as the drug admin guides said, i was WELL under the upper level dosing guidelines. And thus haldol was ordered for anxiety/agitation. So I administered correctly, and yes, I did run it by my coworkers and the charge nurse that day and they all agreed that the guide and order were correct, they were also familiar with the patient and everything we had tried previuosly on her ( which everyon on this board is NOT, but thanks anyways).

So then this morning another pulmonologist in his group pulls me aside and reasures me that I didnt really do anything wrong, and that this guy has sicked my manger on me, and they asked her (the friend pulmonologust) questions about me. She says I think they are trying to get buuld a real case against you, you have pissed dr so & so off, I think it is BS, I have seen this before, I am so sorry etc etc. I think this is not fair and I hate to see them to this to you.

My coworkers said they stuck up for me when all this went down last week too. I felt awful today having to ask other nurses to give meds to my patients and I realized, built into many of our protocols are statments like" adjustments may be made when considering additions of this and that etc etc) in other word use your jusgement for lets say titrating insulin when considering TPN and and steroids. Well My judgemnet could easily be considered an error and i could be fired. I cant work like this for 60 days.

Another point was brough to me by my coworker- if you made a med error, there is ahospital policy for dealing with that. It invloves classes and videos etc etc, why are you not int that program? Why, because you made no med error. The only error I made was pising this doc off, by not knowing he would not like me giving his patient this much haldol.

I realize many of you think its alot. but you didnt see what WE saw, didnt see what we tried, and didnt see how it effected this patient. That is why noone said anything on that day. And that is why there is such a wide variation of haldol dosing administration in the ICU setting.

I am a good nurse, and i am not going to let this keep me down. I did my homework and assesed correctly. Today my patient that i transferred tothe floor grabbed me and hugged me, that why i am in this. I have an interview at another hospital tommorrow, and im going to take the job at another ICU if offered, until then, I will do my best to cross my t's and dot my i's .

NP (not really gonna be an NP) :)

Specializes in Vents, Telemetry, Home Care, Home infusion.

Sorry to see that you are missing the bigger picture and continue to make excuses that what you did was accurate. 60 days out of a lifetime is not a lot. Please learn from this and not sweep under the carpet for it will make you a better nurse and patient advocate in the long run.

Sorry to see that you are missing the bigger picture and continue to make excuses that what you did was accurate. 60 days out of a lifetime is not a lot. Please learn from this and not sweep under the carpet for it will make you a better nurse and patient advocate in the long run.

So a hotshot doc wants me fired and his partner tells me as much, and I should ignore that and try not to get fired under thos circumstances, whose missing the bigger picture????

Lets just say we agree to disagree on the dosing and administration of haldol.....

Specializes in Onc/Hem, School/Community.
Its not the overtime issue that has be most concerned actually, while it is somewhat of a concern. I don't like the idea of having to "verify" ALL medications before giving them. Its a recipe for disaster. and yes, it is my attitude. I work under some not so friendly and sometimes racist people and I really like not having to ask people if its okay to take care of my patients. Its like pulling teeth to get someone to help me turn a patient even though I am the first to help someone else. It kills me that I need help to turn a patient for that reason, now I have to ask if I can give a med.....

Sorry about your tough time. Look, not to sound harsh, but I would be happy they cut me a break; do what they say and learn from your mistakes. So what if you have to validate orders? Swallow your pride and use this as a learning experience. You should be able to regain your confidence by confirming meds accurately. They will regain their confidence in you as well. I always like to say...Patients come before your pride. Hang in there and good luck. :)

Specializes in Med/Surg, Geriatrics.
Sorry to see that you are missing the bigger picture and continue to make excuses that what you did was accurate. 60 days out of a lifetime is not a lot. Please learn from this and not sweep under the carpet for it will make you a better nurse and patient advocate in the long run.

Ditto.

And I don't care what your drug guides said, you did NOT administer that Haldol correctly. Did NOT. True you didn't overdose the patient this time (lucky you) but next time????? Good luck, because you will surely need it.

Sharon, a hotshot nurse who has 15 years of experience to back her up.

Specializes in ICU.
So a hotshot doc wants me fired and his partner tells me as much, and I should ignore that and try not to get fired under thos circumstances, whose missing the bigger picture????

Lets just say we agree to disagree on the dosing and administration of haldol.....

UGGGGGGGG! Well everybody, we are just wrong. We might as well through out our collective years and years of experiance and listen to OP because she knows it all. Haldol for everyone! :rolleyes:

UGGGGGGGG! Well everybody, we are just wrong. We might as well through out our collective years and years of experiance and listen to OP because she knows it all. Haldol for everyone! :rolleyes:

now you are getting the picture

Specializes in ICU.
now you are getting the picture

UHHHHH, I was being sarcastic. :rolleyes:

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