Almost fired today

KatieBell · Jan 27, 2006

You seem more upset about the limitations your nursing supervisor has placed than you are about the fact that you made an error. Everyone will make mistakes but not everyone is humble enough to learn from them.

Excellent point. In addition, there hasn't been any mention of how this patient is doing now....

jeepgirl, LPN, NP · Jan 27, 2006

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?

are you saying that you wrote your own order for ativan?

also, i thought that all orders had to have a time (q3, q4, etc) even if they are PRN. if not i think that they MUST be clarified (at least, in my facility...).

Editorial Team / Admin · Jan 27, 2006

i was just wondering here, for clarification. you stated the patient did not improve with the increasing doses of the haldol. what was the initial rationale for the order? did his s/s become increasingly worse despite the haldol? did the s/s stay the same? what were his s/s before the haldol and during the dosing?

beannie · Jan 27, 2006

oh man, how supportive everyone is. what an incredible group of nurses that reply, i am impressed with the supportive words, air of restraint practiced in order to propel young minds to achieve the stately job of nursing. :)

hmm, my first reaction brings me to wonder if the five rights of administration were considered, the basic cornerstone of patient safety. i would not be concerned with calling the md to clarify an order. and would not be concerned with calling the pharmacist (great pharmacist) prior just to get grounded when calling the md.

but don't beat yourself up, accept the knowledge you will gain,true a lot was learned in school etc., but who knows, this charge nurse may end up to be a great mentor and resource for the future.

1. right patient

2. right time and frequency of administration

3. right dose

4. right route of administration

5. right drug

caroladybelle, BSN, RN · Jan 27, 2006

It is mentioned that the patient had been moaning.

It begs the question why was the patient moaning? If the patient was in pain, then meds should have been given for pain ...which Haldol is not.

Was the patient jerking against their restraints, trying to extubate themselves, threatening injury to themself or others? or were they merely benignly moaning?

The mere act of moaning under sedation does not generally call for giving repeated high does of a chemical restraint like Haldol. Moaning is disturbing but can be for benign issues. What else was necessitating the use of a chemical restraint?

Jerico, BSN, RN · Jan 27, 2006

It is great that you wrote in here. I am learning from this big time.

We all learn from each other's mistakes. That is why it is important to report med errors.

Nurses don't make the errors, it is the SYSTEM in place that lets nurses make errors and or keep making errors.

Administration set up a system to keep YOU from making more errors.

That is a GOOD system.

Be glad you are keeping your job.

Beginning in ICU is hard and I think it would be a mistake for you to quit now. Learn from it and be humble and thankful these supervisors have given you a way to get BETTER.

caroladybelle, BSN, RN · Jan 27, 2006

Oh man, how supportive everyone is. What an incredible group of nurses that reply, I am impressed with the supportive words, air of restraint practiced in order to propel young minds to achieve the stately job of nursing. :)
What exactly do you mean?
We are being supportive. The OP is considering a rash action of quitting a job, after an issue with correction. They ask whether such correction is appropriate. Wa are giving them experienced advice that the correction is acceptable, is warranted and that they may harm themselves by rashly quitting.
Being supportive does not mean mean telling someone what they want to hear...sometimes it means telling them what they need to hear. Though they may not want to hear it.

leslie :-D · Jan 27, 2006

i was just wondering here, for clarification. you stated the patient did not improve with the increasing doses of the haldol. what was the initial rationale for the order? did his s/s become increasingly worse despite the haldol? did the s/s stay the same? what were his s/s before the haldol and during the dosing?

you know, i was thinking that initially this female pt presented as agitated but further along, she was moaning so the nurse closed the door. why was she moaning? that doesn't sound like agitation. was she in pain? i wasn't there so i didn't see what np2b saw, but first and foremost, it was a lousy md order and would have questioned it. secondly i don't understand why she was first agitated and then, moaning.....does one give haldol for moaning? :confused:

i think they're being gracious w/you by keeping you on and giving you further opportunity to learn. keep the faith.

leslie

live4today, RN · Jan 28, 2006

..........................i think they're being gracious w/you by keeping you on and giving you further opportunity to learn. keep the faith.
leslie

:yeahthat:

nursenatalie, ADN, RN · Jan 28, 2006

ok, we have given you a list of shoulda woulda coulda's. Your reaction from now on will make a difference. Don't wait for the pulmonologist to find you, find him and explain what you are doing to ensure this doesnt happen again. None of this means you are a bad nurse, we all have or will have some doozy mistake stories. Good luck with you and thanks for sharing your mistakes that is a good way to help others be aware of the potential for error.:icon_hug:

NP2BE · Jan 28, 2006

i was just wondering here, for clarification. you stated the patient did not improve with the increasing doses of the haldol. what was the initial rationale for the order? did his s/s become increasingly worse despite the haldol? did the s/s stay the same? what were his s/s before the haldol and during the dosing?

the patient did have less agitation with greater amt of haldol. the s/s before haldol were moaning out loud and general agitation, wrestlestness, etc. the patient had been up for days with no significant sleep. the pstient did actually get a few hours sleep and quit moaning, and the family seemed please during subsequent visiting hours with improved mental status. this was two weeks ago. the patient is not doing well now, but it because of vre and not haldol.

PumpkinButt · Jan 28, 2006

I'd question any PRN I had to give 35x in a shift to keep a patient comfortable. Just my .02