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 ever see an order that does not include the frequency I ask to get a frequency. The order itself was incomplete and nothing should have been given until it was a complete order.
We all make mistakes. But like others have said, don't let your pride get in the way of learning to be a safer, more effective nurse.
I'd question any PRN I had to give 35x in a shift to keep a patient comfortable. Just my .02
:yeahthat: And then I would question the thought process of the nurse that gave it. Everyone has made some great points. I think that in your posts alone you have made it sound as if you are not experienced enough for an ICU position. I would get over the fact that you have to clarify med orders with your charge and that they took away your overtime (no one is guaranteed OT, even if they are not under disciplinary action) You are lucky you didn't get booted to a lower level of care or fired. At my facility you would have had to go before the Peer Review Committee and more than likely be placed back on orientation since you are so new.
I don't understand why Haldol was given to this person for her "moaning"? Why was this person moaning? What s/s was the patient exhibiting that you called agitation? Why was this person not sleeping? There are too many why's in this situation to just decide to gork this person just so that she can get some sleep. Surely there must have been a more appropriate drug that could have been given.
Just take it as a learning experience, move on and be humbled. Everyone makes mistakes, it's what you take out of it that's important. The reason why everyone is being hard is because they're being a patient advocate. Months from now you wouldn't really be worried about how you were reprimanded, but you will come out as a better nurse.
:yeahthat: And then I would question the thought process of the nurse that gave it. Everyone has made some great points. I think that in your posts alone you have made it sound as if you are not experienced enough for an ICU position. I would get over the fact that you have to clarify med orders with your charge and that they took away your overtime (no one is guaranteed OT, even if they are not under disciplinary action) You are lucky you didn't get booted to a lower level of care or fired. At my facility you would have had to go before the Peer Review Committee and more than likely be placed back on orientation since you are so new.
I don't understand why Haldol was given to this person for her "moaning"? Why was this person moaning? What s/s was the patient exhibiting that you called agitation? Why was this person not sleeping? There are too many why's in this situation to just decide to gork this person just so that she can get some sleep. Surely there must have been a more appropriate drug that could have been given.
Well, my thought process was haldol must be a pretty damned safe drug if a dosage of 5 mg every 30 minutes is published as safe, as long as side effects arent noticed. the drug guide says 5 mg ivp every half hour is a safe dose, and that seemed to be helping the patient chill out some. If I am sitting in a bed moaning, i would hope someone would address it too. You know sometimes doctors dont really care about patiient comfort because they are not at the bedside watching the patient or hearing their complaints , so they dont really care what happens because overall I suppose it would be safer if noone ever got meds for pain or agitation. And i thought, hey I have an order, and a safe dosage , and ill run it by somone with more experience, and no objections, ok, ill continue.
I have seen a lot of "bootlegging" going on, and pleanty of people in ICUS in the hospitalS (yes plural) at least around here do a lot of chady stuff, people with much more experience then i have. That is a big part of why these docs probably dont realize what their patient's need because some other nurse is pulling phenergan or whatever else from a stash somewhenre and illegaly sedating a patient and the docs come around and see, oh, so and so look pretty confortable to me, ill just write 2 mg haldol prn..... not knowing that some jerk is giving them whatever else so they can read cosmo in peace.
The more I think about it: The only thing I think i did wrong with that haldol order, is not get a time constarint. If the order read 2 mg q 15 min for agitation, Id feel justified in doing it again, UNTIL THE DRUG BOOKS ARE MODIFIED AS SUCH!!!!!!! I WILL GO BY WHAT THEY SAY; and if i have a moaning agitated patient with haldol aloowed to be given in 2 mg increments evry 15 minutes, id give 70 again if thats what it took.
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.
My first year out of school, I worked on a peds floor but we often got adult orthopedic overflow. Well one night, I had a gentleman who was a right AKA, 2nd day postop and the poor man had been having issues with pain control according to report. There was an order for MSO4 2-10 mg IVP or IM q3h for pain. Well I gave him 4 mg and naturally he was still in pain 1 hour later so I have him 10mg when he could have his next dose a couple of hours after that. The older nurses I was working with congratulated me on being the first one to get him quiet but when they heard that I have him 10mg IVP, they darn near choked on their coffee. I felt terrible. This was before everyone had PCA pumps and before pain was considered the 5th vital sign. Of course now I know the poor dear was terribly undertreated for pain but according to the standards of the time, I had made a terrible error....
The first year of nursing is the hardest and you will make many, many mistakes. But you must be careful not to hurt or kill anyone. You have a pattern going here and you have to think of how bad you would feel if you made a mistake that killed or hurt someone. You are taking this personally and you shouldn't. Just take it as a learning experience and one day you will kick butt at this. I think restricting your overtime was a stellar idea, I can definitely trace many of the errors I have made in my career to fatigue and being overwhelmed; that is why I learned early to turn down that extra shift or that double shift. I certainly would not quit just because I didn't want to verify my meds with the charge nurse; just think of it as a safety net for you.
Specializes in LTC, Home Care, Medical Offices, Plasma.
What about this post am I missing? I have read the original post, and everyones replys, and yet somehow... I think i'm missing somthing. Every reply i'm reading makes sense, but everytime the OP posts a reply, she makes less and less sense. I'm only an LPN, but even I clarify orders, and have had docs mad at me at 3am because i've woken them up. IMHO.. someone needs to put on her big girl panties, and deal with the fact she in essence onlyl got her hand popped, and learn from her mistakes. She is not the only one who has ever made a mistake, and she wont be the last. Heck.. I myself have made some doozies in my day! NP... Not everyone is out to get you. Your supervisors must feel you are a good nurse and worth keeping... dont prove them wrong. Good luck...
thanks, Im trying, but the other thing that bothers me is i was told if i make another mistake I will be fired right away. I cant guarnatee that I wont, noone can. So Maybe I need a fresh start. I dont know why I wasnt fired, starting to wish I was. I dread going into work tommorrow, I feel hostility on my unit. Even the unit clerk said last week she thought they were doing me wrong. That cahrge nurse gleefully wrote me up.They could have talked that doc down and pointed out that even though I forgot to write PRN on that ativan order it was not given scheduled, (I reported it correctly, PRN for pain adjunct) and the night nurse gave it a such, not scheduled. Had I been one of "her people' Im sure they would have at least tried. Ive been through too much to deal with this petty stuff. They can have this unit, they win, ill leave with a verifiable employment source as not fired.
What you stated is what I am talking about. The advice is very good. I too support staying with the job, and support the nurse who posted. The responses have been about looking what can be done to remedy the situation, not the person. B/c as it was said, yes human error but there is also the system to look at. I have seen where nurses are not so supportive on the job. It does look a bit confusing when I look at the post, I really was just meaning that I think it is great to see such analytic and supportive responses.
what was this pt's admitting dx? did you say it was pneumonia?
agitation is not always a psyche disorder....i can't help but wonder if she was in pain. there are too many gaps in the story that need addressing, but it is not aimed at you np2be.
did anyone ask her if she was in pain or did the nurses report agitation to the md and he just blindly ordered haldol ivp? did the doctor eval the pt? unless there's a blatant psyche illness going on, it's critical to find out the reason for a pt's agitation then MOANING. something just doesn't sound right. no matter how much haldol you gave her, it certainly did not sound like the drug of choice.
as a relatively new nurse, don't ever be afraid to question anything.
talk to your patients....advocate for them.
collect your data, talk w/the md re: any questionable order.
what was this pt's admitting dx? did you say it was pneumonia?
agitation is not always a psyche disorder....i can't help but wonder if she was in pain. there are too many gaps in the story that need addressing, but it is not aimed at you np2be.
did anyone ask her if she was in pain or did the nurses report agitation to the md and he just blindly ordered haldol ivp? did the doctor eval the pt? unless there's a blatant psyche illness going on, it's critical to find out the reason for a pt's agitation then MOANING. something just doesn't sound right. no matter how much haldol you gave her, it certainly did not sound like the drug of choice.
as a relatively new nurse, don't ever be afraid to question anything.
talk to your patients....advocate for them.
collect your data, talk w/the md re: any questionable order.
so.....what was her admitting dx?
leslie
The patient denied pain actually. She had some wounds that she was scrathing at with her long nails (the family would not let them be cut). she was moaning, and just looked generally uncomfortable. Like i sadi, she had not been asleep in days and proably had some psyhosis, also som mild demntia that was probably aggravated by the setting
i too have been watching this thread. i see your continued statement that the published drug guides say your giving haldol in that amount is ok.
have you done any research on your own such as sites from the fda or any other internet source? leaving a job without understanding what happened will only lead to yet another med error.
it was developed in 1957 by belgian company janssen pharmaceutica and submitted to first clinical trials in belgium in the same year. after being rejected by us company searle due to side effects it was later marketed in the us by mcneil laboratories.
now this is something i knew already. but nonetheless i have made some spectacular mistakes, and caught some in process that others made. we are only human. i say again that leaving this position to go to another facility will not work out until you realize the processes that led to the errors.
please take to heart what all the previous posters have written. they are not out to get you, they are out to save you from yourself.
Katnip, RN
2,904 Posts
If I ever see an order that does not include the frequency I ask to get a frequency. The order itself was incomplete and nothing should have been given until it was a complete order.
We all make mistakes. But like others have said, don't let your pride get in the way of learning to be a safer, more effective nurse.