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
Hey... I haven't read the whole thread, but I can relate to the OP's situation. I started in June as a nurse. After orientation, I also had some med errors, about 3-4, one with a too high dose of Benadryl IV, and a couple of late IV meds. For a month I had to check my meds before administering, with the charge nurse or another RN. I am at the end of that month now. I was very hurt at first, but realize now it was for the pt's safety and because of how serious medication administration is. It really did help me out though I resented it at first. It was just another check to make sure the right meds got to the right patients. It does make you feel stupid and embarrassed for a while, it's very true. But in the end I realized it wasn't about me, it was about patient safety. There were a couple of times in that month that I forgot to check with someone usually for a PRN tylenol or something. ANd a few times r/t busy-ness that no one was available to check, and I went over the med very very carefully in those cases. In retrospect, before that month, I was taking med administration somewhat too lightly, not realizing it is one of the things we do as nurses that has one of the most immediate, direct effects and that once given, can't be taken back. Now while I know I won't be perfect, I'll be much more careful in the future. SOrry for the long-windedness just wanted to let you know you're not alone in this kind of situation.
i tell ya....you have seen what haldol does to the older folks.it isnt pretty when granny is now not only anxious but she now has the strength of superman and caught her second wind!color]
so many people hate giving ativan to older folks in fear that they will have a paradoxical reaction and freak out. haldol is the better drug for calming combative, or older patients out of hand no? i think the risk of haldol causing granny to freak out is less than with ativan but i can't say for sure.
So many people hate giving Ativan to older folks in fear that they will have a paradoxical reaction and freak out. Haldol is the better drug for calming combative, or older patients out of hand no? I think the risk of Haldol causing granny to freak out is less than with Ativan but I can't say for sure.
Like I said...some of the patients metabolism, livers,kidney function etc etc is so outta whack I hate giving haldola dn ativan period to older folks. If they need sedation id rather give...either plain old benadryl, ambien, or if its bad enough valium.And again.....what is the reason they were admitted?Always think about that...if they have "become " agitated dont treat it immediately...it could be...and alot of times is bc of anoxia.Esp in the post op patients....being elderly too...think clot clot clot......clot to the brain- stroke, clot to the heart-mi clot to the lung- pe....all can cause anoxic events....and agiataion can be a s/s of it.
haldol....causes eps...sometimes even with small doses. I have had 20 year old that have been left with life long eps that severly damages them for life by causing social isolation. This was after only receiving 20 mg(total recieved) of it in 3 seperate doses.I dont remember alot of my friends walking around smacking their lips, drooling, doing the pill rollin shuffling gait bit back when I was 20 years old....seriously it isnt something to be given lightly...esp in the elderly...
I read the whole thread; I think the problem is with brand new nurses not realizing how much is out there that is not specifically written down along with trying to fit in and not annoy coworkers or docs. Many many times I have come across a new nurse doing high acuity interventions with the best of intentions, but not realizing how fast and hard a disaster could come on.
On one hand a new grad in the ICU should have an old cronie to ask questions of, hopefully assigned in close proximity. They should be directing their questions to the most experienced nurse they can find rather than someone just as new as themselves. And all us old croonies need to take the time to answer, and explain why, and try to have supportive relationships with the new blood.
For the OP- I would never, never give a med that didn't have a time constraint. The order you had would cause an immediate call to the MD before any was given, no matter what maximum I found when I looked it up. That said, it was a mistake, and we all make them, and have to suck up the consequences. The fact that you made a mistake is much less concerning than the statement you would do it again.
Maybe some of the hostile environment is a result of coworkers hearing your defense, and wanting to get far, far away before the next mistake occurs. If you really want to continue on this unit you need to suck it up (even if you were completely in the right I would tell you this) and take your observation period with a smile on your face.
If you don't want to continue on this unit I would suggest asking to transfer to a non ICU unit in the same hospital, to avoid burning bridges. If you leave immediately it will not look like you were willing to deal with the error, or the conflict in a constructive manner. Make yourself look cooperative even if you don't feel that way, and move on in your own mind.
As an "old timer", I still think that new grads should "do their time" on med/surg, advance up through tele, etc. Nursing schools today don't teach you to be a nurse, they teach you to pass the boards. I believe that new grads should not be in specialty units. I work the ER, and have seen some pretty incredible things done by newer nurses, not just new grads.
There is a confidence, a maturity, that comes with experience. No, I do not know it all...... I learn something new every time I come to work. But, I do know how things operate in other parts of the hospital. I have learned to develop a "gut"---that patient doesn't look right....that order doesn't seem right..... and that comes with experience. Hospitals today don't have the time nor the money to give you the proper orientation period that you need. By working a less acute area you can focus on developing your assessment skills. Yes, I still look up medications, I still confer with colleagues, I ask ask ask when I am unsure. That never changes.
Great posting, I will tell you I use to be a nurse who took pride of my self and never ever I would even imagine that I would make a medical mistake or any, and I did it after 6 years working at this particular hospital........I worked PCU and med surge...on that particular day I was working on women services. night shift ........all my patients were great ,no major issues that I could not take care for myself..............then at 6 am a patient was going to be admitted to women services, her diagnosis chest pain , with history CHF...she was not assigned to me; however, the nurse that the patient was assigned to, decided to pass it to the am shift, she did not even do an admission or assessment on this patient, pass it to a very new LPN to care for.........I passed report to all my patients(except one) to the incoming nurse, it was 7:15 am I was exhausted and sleepy, I told the LPN and the RN in charge that I needed to give report to my last patient so I could go home. She said she has to admit the patient that came from the ER first.........well this particular patient starting getting heavy chest pain, the morning RN ( was taking report from the other night nurse)had already prepared 2mg/ in a 10cc syringe. The LPN, she was scare, and asked the RN if she could give me the syringe to give the 2 mg of mso4 ivp, and she did she ask me to please give her the pain med.......and honestly i WAS NOT thinking the only thing I knew was that the patient was in pain, and when I went to make sure that she was/then I made my decision to give.
Mistake 1.....never never never take a syringe of med mixed by other nurse even if you know she is proficient( she told me the syringe has 2 mg/ in 10mlns). I knew I was tired I should have refused to give the drug( but I was not thinking rationally at this point), unless I mixed it myself...........it was then almost 8 am//pass my last pts report to the nurse and finally I went home.45 min later, house supervisor call me to ask me where was the rest of the medication....and I told her I gave it to the patient.......then she pointed out to me that the syringe had 10mg of mso4/10 ml of ns............I flip I could Not believed that I asked her oh no I gave all that? I knew I should have not, i was tired and I was easily convinced by the nurse to give the med (never done that in my regular days). I was told that no harm was done to the patient, her heart rate was good, blood pressure was good, resp and mental level was good, that actually the medication helped her CHF, and she was D/C two day after(I was told)..........however, no matter what they told me I was ready to quit nursing as a whole, at least at that moment..........then after counseling I realized what I have done...............and can say I will never never put my patient and my license in jeopardy again......and also not matter how much critical thinking a nurse may have, if the brain does not have proper rest bad judgment can arise..............
So take your mistakes and learn from them............
Nursestace I tend to agree with you. I personally would be concerned if working with a nurse who seems determined to NOT own up to a mistake and refuses to learn from it. I don't think I know of a nurse that has not made a mistake I would be a bit concerned if I did. The problem is it is extremely dangerous to come across a nurse who refuses to admit mistake and take the IMO generous chance the employer is giving the OP to learn from her errors. It is often a warning flag when one tends to blame everyone but themselves. This the whole world is out to get me is not a healthy outlook. You made a mistake we all do. Don't look at having to double check yourself as punishment. It is a matter of practice at my hospital. We do team nursing and be it LPN or RN we all double check our meds with one another. Takes just a second and avoids countless errors. Leaving after an incident like this will NOT look good for your future. Everyone here is trying to be supportive and helpful I encourage you to listen to the wisdom on this thread. Good Luck and best wishes
I am willing to bet that some of the attitude you feel coming at you is from the attitude you are putting out there - You made a mistake. Own it, learn from it. Don't run from the hospital. Work even harder to prove that you can make it in that unit and if, after you've proven yourself, you still want to leave, go. But don't leave now, it looks like you're running away from the disciplinary action, which is exactly what you are doing. The Haldol Rx wasn't a legal Rx, and you had a responsibility to clarify it. Just because you have a drug book, doesn't mean you get to rx drugs. When you were deciding how often and how much to give the pt., you were essentially rx'ing the med yourself.
You need to take a step back and accept responsibility for your actions and know they were wrong and learn from them. You can survive checkign with the charge nurse for 90 days. Do what you have to for pt. safety.
My unit (where I still work as a PCA - not done with nursing school yet ) hires new grads regularly. Sometimes med/surg doesn't prepare you for the actual skills you need in that ICU environment. They have a long orientation and a supportive staff and I don't see a problem with it. I know some NICUs prefer new grads because they don't have any "bad habits" to unlearn from other units.
Rae ray- this was an intersting post to read. I was curious about the checking of the meds as being instructive, but based on your feedback, I can see that it was effective in your case.
I'd also like to second the comments, what is alarming is not so much that the OP made an error, but that the OP seems to not want to own up to it and learn from it.
An unfortunate thing about going somewhere else is that things tend to follow. As a traveler, on my first assignment I ran into 2 nurses from a former workplace...it was a good thing I didn't have anything to hide because those two would have spilled it right away. I just got a new contract, and during the interview I discovered a PA-C whom I worked with on another contract was now at this hospital...was I glad that I had worked my behind off for him. You may think that changing units will solve your problem, but I can gaurentee, someone knows someone who works where you are going. The nurses from your hostile unit may even be doing secondary where you want to go. Even some MD's have admitting privilidges at several hospitals, so what has happened will probably follow you in some form or fashion.
And if you do not learn something from your mistakes, you are likely to repeat them in a variety of ways. Really, I encourage you to take some sick days if needed, sit down and think about what happened. Look at where the error happened, and why it happened, and what did you actually learn from it. How will you act in the future in a similar situation. Try to look at it objectively and think about what you might tell someone else in your situation. You might also make a list of the Possible things you could learn from having to recheck meds...be creative... you might surprise yourself if you get past the embarrassment of haivng to do it.
I'd also look at how you are interacting with people in general, you state you have recently had a breakup, believe that the unit is hostile and are responding to allnurses in a very angry and hurt manner. So I encourage you to also take some time to reflect on what is going on in your personal life.
In addition, the critical care environment is always going to be full of vague guidelines. Nothing is going to be cut into stone in each moment. One BP for one pt is cruddy but for the next patient it is right on target. It takes a long time to develop a strong ICU judgement (I never completely got it, which is why I do and Love ED), much much loger than 8 months, so why not cut yourself a break and try to learn something from this experience, instead of using all your energy to prove that you are right....
Life is too short to constantly worry about Looking good and being right.
It would be ideal if the OP found a job w/a preceptorship- if she is determined to burn this bridge. I don't necessarily think all new grads have to do their time in the trenches (med-surg) anymore, but a good preceptorship to work in a speciality area is a good idea-- where someone can mentor you, and you take competency based tests, etc. 8 mos out of nursing school is still very green & not enough experience in a critical care area to be thrown to the wolves & I think that's where we lose alot of nurses, IMO.
I totally agree. It is very true that someone always knows someone no matter where you go-- in fact I've known employees to give managers a 'heads up' re: problem nurses b/f hire thus preventing them from being hired. Unless you are moving across country, better to stay where you are & prove you can grow & learn from a bad judgement on your part. Years ago when a new grad just left a job suddenly we called it "reality shock"- if you REALLY want to do ICU, then set your pride aside & weather this storm-- you'll be that much stronger & wiser.
) hires new grads regularly. Sometimes med/surg doesn't prepare you for the actual skills you need in that ICU environment. They have a long orientation and a supportive staff and I don't see a problem with it. I know some NICUs prefer new grads because they don't have any "bad habits" to unlearn from other units..thumb.jpg.6eeb2c01c27cfd151d706238b7f6d6b7.jpg){kind=small}
perfectbluebuildings, BSN, RN
1,016 Posts
Hey... I haven't read the whole thread, but I can relate to the OP's situation. I started in June as a nurse. After orientation, I also had some med errors, about 3-4, one with a too high dose of Benadryl IV, and a couple of late IV meds. For a month I had to check my meds before administering, with the charge nurse or another RN. I am at the end of that month now. I was very hurt at first, but realize now it was for the pt's safety and because of how serious medication administration is. It really did help me out though I resented it at first. It was just another check to make sure the right meds got to the right patients. It does make you feel stupid and embarrassed for a while, it's very true. But in the end I realized it wasn't about me, it was about patient safety. There were a couple of times in that month that I forgot to check with someone usually for a PRN tylenol or something. ANd a few times r/t busy-ness that no one was available to check, and I went over the med very very carefully in those cases. In retrospect, before that month, I was taking med administration somewhat too lightly, not realizing it is one of the things we do as nurses that has one of the most immediate, direct effects and that once given, can't be taken back. Now while I know I won't be perfect, I'll be much more careful in the future. SOrry for the long-windedness just wanted to let you know you're not alone in this kind of situation.