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
If I had to give something 3 times, I would be very concerned. Was there no alarm going off in your head when you gave it the 8th time, the 10th time, the 16th time, the 20th time, the 26th time, the 29th time, or the 35th time?
It WASN'T BEING EFFECTIVE! At minimum, I would have been a patient advocate and called the doc to let him know what was going AND that we needed something that worked. I'm sorry, but I couldn't fathom giving that much haldol. Never. I have a hard time believing that the attitude conveyed in these posts, and others posted on this website, isn't coming through at your job either. I think that you need to humble yourself down to stopping, looking at yourself and what you know and what you need to learn (very important), and thinking about how you can practice more safely. I think you have heard, from TENS of people on this thread, that very experienced nurses (and not so experienced alike) wouldn't have practiced as you did based on the info you provided. That means something. I think that you are having a hard time because, either from inexperience or from your own personality, you are too distracted and focused on yourself to realize that you don't know everything. There's something to be said for knowing that you don't know everything... and that is something I think that you seriously lack. I wouldn't want anyone with your attitude coming near me or my family with a ten foot pole.
Well actually i think she does get it. She has acknowledged that given the situation again, she would call the doc. Isnt that what the issue was in the first place, the fact that most felt she should have contacted the doctor about the med not being effective for what it was being given for. That it only helped her rest for a short period of time, and maybe something else would have been a better option or even in addition to the Haldol. I think she does get that.
Literature or no,, she did check her books, run it by other nurses/supervisor and NOONE gave her cause to rethink her dosing. I dont know maybe they do give those doses regularly in THEIR ICU. I personally wouldnt but i cant be responsible for what another nurse chooses to do.
If she has since found the Dr in question has her in his sights, there isnt much she can do about that. Ive seen doctors do this just because they dont like someone,, and it has nothing to do with their nursing.
To the OP, i hope your interview goes well and you get past all this. If nothing else this has been one heck of a learning experience for ya and you wont let it happen again, regardless of who it is that wrote the order or why. I'm not so sure i wouldnt stick out the probationary thing because it will take a lot of fortitude for another facility to hire you if you are under a probationary period where you are coming from. Then as soon as its over,, get the heck out. If they let you swing on this,, just think of what other situations could come ahead. It's not worth the risk. You worked to hard for the license and you deserve more support from your co-workers than you got there.
So now its an evil doctor that caused you to get wrote up. Still you don't tell what this persons diagnosis was or maybe you should have assessed for pain. You still don't take responsiblity just that no harm was done. You could have killed the patient. I wouldn't want you for my nurse.
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.....
You made a mistake. You should have checked the order with the doc or at least run it by the pharmacist. You are playing the blame game and not taking responsibilty. How do you know the moaning wasn't due to pain? Why chemically restrain a patient? Sounds like you need to get fired because you didn't learn anything and all your patients are at risk with you now.
b- lots of literature to support what i did, nothing in writing suggest i did anything wrong.
I do agree however that next time, i will cal a doc when i have to use that many times his PRN order, that is where my lack of expereince hurt the most. Other then that I beleive the memebers of this board would probably feel differently had they been there as well
Your going to support this with literature? Don't you have any common sense?
That pulmonologist is obviously to blame after all he does perform percutaneous tracheostomies. That Ativan order--the pulmonologist's fault. The Haldol order again the pulmonolofist's fault. That doctor should have called throughout the night to check on his patient--they shouldnt assume a RN in the critical care unit will call him if their patient isnt responding to a medication he prescribed.
That really is how you are coming off here. You ask for our opinion then you want to argue despite knowing you were wrong then tell us we werent there so we dont know the whole situation. It doesnt matter if that doctor is the best in the world or the worst, your actions were not appropriate. I can honestly see busy nurses refusing to argue with you about something and when something does happen they will not back you. You are doing the same to us. Most are telling you not to give that much Haldol however you dont seem to care as long as you can find documentation that it was safe. Even though "moaning" doesnt sound like a reason to use Haldol. You even say you would do it again so it seems as if once you make your mind up you are going to do something regardless of others opinions. Next time would it literally take someone forcibly removing that syringe from your hand?
You failed to use the basis of our practice--the nursing process. This isnt minor--patient care was affected and that was the reason you are in trouble. I can guarantee if you had documented that the Haldol was given, there was no positive response so you called the MD we wouldnt even be having this situation. That is what any prudent nurse is going to do.
Again I cant stress it enough--medication errors are serious no matter how minor you may think they are. If everyone has it out for you then you cannot give them things like this to use against you. Be more careful.
What concerns so many of us here is that something bad could have came out of both of these situations. Trust me most of us on these boards arent going to back hospital administration unless they are clearly, obviously, 110% right (and even then it causes us chest pain :chuckle ). Take this as a learning experience, protect yourself better from bad doctors, and listen to other nurses. How many years of combined experience did your co-workers have? Didnt it strike you a bit odd that in 8 months you have a situation that possibly 10+ nurses with probably over a 100 years combined experience hadnt seen? (This of course depends on the size of your unit)
Well, the only thing constructive that I can think of at this point is to beg the OP to please do not come to my hospital when you are applying for new jobs. We don't need that kind of attitude here.
Well, the only thing constructive that I can think of at this point is to beg the OP to please do not come to my hospital when you are applying for new jobs. We don't need that kind of attitude here.
:yeahthat:
And to think, he wants to be a Nurse Practitioner.........
b- lots of literature to support what i did, nothing in writing suggest i did anything wrong.
I do agree however that next time, i will cal a doc when i have to use that many times his PRN order, that is where my lack of expereince hurt the most. Other then that I beleive the memebers of this board would probably feel differently had they been there as well
Then why would you even consult our opinions?
Also, as far as us not knowing what was going on with the patient, you're right. It was asked SEVERAL times and you neglected to answer that question as you were so busy trying to cover up your MISTAKE.
jeepgirl, LPN, NP
851 Posts
If I had to give something 3 times, I would be very concerned. Was there no alarm going off in your head when you gave it the 8th time, the 10th time, the 16th time, the 20th time, the 26th time, the 29th time, or the 35th time?
It WASN'T BEING EFFECTIVE! At minimum, I would have been a patient advocate and called the doc to let him know what was going AND that we needed something that worked. I'm sorry, but I couldn't fathom giving that much haldol. Never. I have a hard time believing that the attitude conveyed in these posts, and others posted on this website, isn't coming through at your job either. I think that you need to humble yourself down to stopping, looking at yourself and what you know and what you need to learn (very important), and thinking about how you can practice more safely. I think you have heard, from TENS of people on this thread, that very experienced nurses (and not so experienced alike) wouldn't have practiced as you did based on the info you provided. That means something. I think that you are having a hard time because, either from inexperience or from your own personality, you are too distracted and focused on yourself to realize that you don't know everything. There's something to be said for knowing that you don't know everything... and that is something I think that you seriously lack. I wouldn't want anyone with your attitude coming near me or my family with a ten foot pole.