newbie blues

What in the H#LL are you doing in an ER already? It is no place to start!!!!

Of course you are going to make errors. you need to apply what you have learned for quite awhile before you can be expected to function in a critical care setting.

Your employer knows this. They put you there because that's where THEY needed you, with disregard for you and your license.

Talk to your manager and nursing ed... get somewhere where you can gradually and safely learn and apply your skills.

I agree that the ER doesn't seem like a fair place to start you out. The MD makes a med error and its *your* fault? That's crazy, you're a newbie. . how are you supposed to catch that! Honestly, if you are worried about your career and your license, you need to ask to be transferred to another unit. There's no shame in that. When I first graduated I went to a unit that I did NOT have a comfort level with at all. .and I asked to be transferred. I transferred and it was the best move I ever made. You can always go back to the ER after you get a few years of experience under your belt. Good luck!!

How were you written up for following the doctors order? If the doctors order stated "Toradol 60mg IV" and that's what you gave how is that a med error? Unless the ER dictates that only certain doses are allowed to be pushed IV or that Creatnine clearance must be under a certain amount to get the dose IV. With the Rocephin did you not give it? Your post says you gave it and then that it slipped your mind, so I'm unsure how to counsel you on that one.

I think the OP means that they gave Rocephin 2gm IV push. Is that right?

I think the OP means that they gave Rocephin 2gm IV push. Is that right?

yes...fortunately the pt didnt have a reaction or anything.

Rocephin can be given as a bolus over five minutes. But that's not the point. What route did the doctor order?

Any time you give a medication that you've never given before, or even if you've given it but not very many times, or maybe it's been a while, you should look it up in your drug guide. Had you done so, you would have noticed that a standard IV dose of Toradol is 15-30mg, and maybe that would have prompted you to question the doctor's order of 60mg IV. With the Rocephin, had you looked it up in your drug guide, you would have seen different rates of administration for different concentrations (IV bolus of reconstituted med vs. IV infusion of diluted reconstituted med), and you would have noticed recommendations for IM administration as well. This might have prompted you to recheck the order to make sure you were using the right route.

It doesn't matter that the doctor wrote "IV". You are the one giving the med, so the buck stops with you. As an RN, you are expected to notice orders that don't seem right for one reason or another, and to clarify such orders with the physician. This is why they teach us the "Five Rights" in nursing school.

I'm not saying this to make you feel badly. I can tell you already feel badly as it is, and I'm not here to rub it in. I just cannot emphasize strongly enough how important it is to do your Five Rights and use your drug guide religiously, and if ever in doubt, have another RN double check with you prior to administration. It will slow you down, but it will also decrease the chances of continuing to make such mistakes.

What will you do when the doctor orders Ketamine for a pediatric conscious sedation? Rocuronium and succinylcholine followed by a Propofol gtt for an intubation? I hope your answer is that you will look it up in your drug guide and ask for help from a more experienced RN!

Welcome to the wonderful world of Emergency Nursing!

Before I give any meds I've given before, with my IV ones, I ALWAYS check the yellow bible - our big IV drug book in Oz - tells u everything on how to give all drugs, dosages, routes, times, etc. Get into the habit of double-checking everything. With drugs u haven't given before, check them on MIMS - never give a drug w/out checking it if unsure.

If the Dr ordered it as you gave it, it isn't your fault if ur new, though ur supposed to know dosages & what ur giving, etc but sounds like the Dr is liable.

One last piece of advice: DO NOT EVER GIVE DRUGS IN A HURRY, even if pressured by other nurses, NUM, family or the patient, or even if u get behind. It is better to give a drug late, than to give the wrong drug, or give it by the wrong route, etc. Always go thru your drug checks - even if u know the patient & have given that drug numerous times. I never get blase with drugs - once you inject the wrong drug, that is it. I nearly DID give too much of a drug not long ago - it was the way the chart was written, you could interpret it 2 ways. I gave 2 x of a drug when the Dr wanted it given over separate periods during the day (this wasn't written down). Also Drs ARE to blame, cos they make up their own drug shorthand, which is DANGEROUS.

You are being very hard on yourself sweetie. You are only new, you reported what had happened and don't worry re the paperwork: the hospital must follow procedure & legally report incidents. You are NOT HOPELESS - we have all made mistakes. Have a plan to follow for ur work - a cheat sheet - to help u get organised. I KNOW how hard the ED/ER is - I'm a RGN learning ED/ER as well, and there is a lot to take in. Just be a bit more assertive & take control of ur patients & your work - or it takes control of you. You won't know everything, but ask many questions & tell people ur new - they will understand.

Do not beat yourself up so much. Learning takes experience, and you won't ever know everything.

Just keep plodding along, go a bit slower & have a plan on your shift, and you should be OK.