Need help/advice!

[Mebzone05, BSN]

I work in a medical ICU. This will be a little vague because I know other nurses I work with that post here. Yesterday, I had an issue where an order was never placed. There should have been labs drawn every 2-4 hours because the patient was on a drip that made these labs necessary. I didn't notice until 1800, I work normal day shift hours. The drip was started the previous day shift. So there were no labs drawn on the previous day shift as well as over night. I am not a huge fan of questioning orders. When I noticed, I brought this up with the provider. The provider was shocked and ordered the lab stat. I placed the order then went to gather supplies to draw the lab. After leaving the supply room, I witnessed the provider making fun of me with a nurse in the nurses station.

I am not a MD, PA, or NP. The reason I even asked the provider without just drawing the lab is because the order needs to be for timed labs Q2 or Q4 and I wasn't okay with entering such an order without getting permission first. I didn't know if there was a reason that this order was intentionally not placed. This environment has seemed toxic for awhile and this is simply the latest example. I have been a nurse for 5 years and am currently working on my 4th unit. I do not want to continuously job hop but I don’t know what to do.

This is the only unit where I have ever felt the need to constantly question other nurses and the providers. Is this normal? This is also the only unit that I have ever worked on where I feel as though my patients have been put in harms way. I hate this feeling and I am at the point that I am uncomfortable going to work. This is my first ICU job. Most of my experience is ED. Is it my job to search the orders for mistakes? Is this normal in an ICU? Also, the only reason I am in an ICU is for experience to get into an ACNP program that I want to attend. I simply don't think like an ICU nurse. My year experience that I need will be completed in May. Should I tough it out?

Any advice would be greatly appreciated

[Kitkat7985, BSN]

Yes, it is your job to check orders. If the 12 hour chart checks had been correctly done by both day shift and night shift, this may have been caught earlier. You did exactly the right thing, and had to notify and clarify with the provider since they need to know if something like that is missed! Regarding making fun of you, totally unprofessional. Good job on catching the error!

[John2018]

You did what should be done, and that is to check with the provider first and have the documentation of the order in place before you act. Their making fun of you because they don't want to make what you noticed and did a big deal which is actually a pretty big deal. Glad that your unit has a nurse like you. Continue what you are doing, patients in your ward need some they can count on. 

[MaxAttack, BSN, RN]

You did the right thing. Is there a protocol in place? If so you could have just entered the orders under the protocol. If not maybe it's a good moment to approach management about the need for one?

Without knowing the entire situation - another thing to consider is that protocols can vary pretty drastically from hospital to hospital. I like to think most places should go by guidelines and sources like UpToDate but this isn't always the case. Also things are adjusted based on condition - orders that you might get in the initial resus phase like you'd see in the ER don't always stay that way. 

 

You're almost to May. Unless it's a terrible place to work I don't see this as a reason to leave. I probably would have just confronted the provider when I heard the comment but then again I don't always play well with others..