NP2BE

well I actually got dressed on monday but couldnt stand up straigt, I was so dehydrated, My girlfriend overruled me , you know like I do, this is my dream, as im sure it is yours, and I couldn'et let it be ruined, anyways, the fluid and phenrgan and antibiotics helped a lot. I still felt bad but MUCH better. I told them I guess I just got an early tour of the Hospital! I live in MS so I had to change my flight plans and all, turned out to be an expensive meal!!!

Ill be seeing you In february! I couldnt make the interview because I got food poisoning and went to the ER instead, so they interviewed me on tuesday! How cool!!!

Hey Everyone, I had my interview scheduled for last Monday. Sunday night at the hotel, I ordered room service. I got the worst case of food poisoning, I was wishing I was dead so it would all end by morning. Instead of an interview, I ended up in the ER. In any case, The kind folks at the Anesthesia school allowed me to come the next day and my interview turned out really well! I just got accepted to a CRNA program in Florida. I start in Spring. I am very excited and nervous at the same time! I have been a nurse sine may of 2005. Anyone have any words of wisdome for me? How does this compare to undergrad ( i think i know I wont see the light of day but just in case im wrong and someone tells me I will be watching a lot of TV i'd welcome that LOL). NP

i used to work weekend program at Baptist, I made darned good money for a new nurse! Its the only way to go, everything else is a ripoff. Actually, big hospitals are exploiters of nurses, especially new ones in general. Thats why i have left. Now i make $35 an hour and have a much more reasonable workload, and the company i work for, unlike the liars at baptist and St d, openly state that they are for a profit, which is at least honest.

all I can say is GOOD LUCK, U will need it!

i always end up staying late.

Re: are you born a nurse or do the nursing instructors make you a nurse? I Was BORN A NURSE AND THEY MADE ME GOTO NURSING SCHOOL ANYWAYS! ARRRRGGGHHHHH

Just because You have always done something a certain way doesnt mean its right. Its the one time that it can hurt someone we are concerned about. And pushing undiluted ativan is not recomended by anyone, most importantly the maufacturer which is what you would be facing in court

why in the world are you in nursing school?

think about it more and more everyday. Nurses are treated like disposable rags by hospitals. Many time i see nurses treating each other extremely poorly as well. I love the job of being a nurse, but dont like the way we are treated, especially by each other. I wish nurses were (at my hospital at least) would act outwardly as professional as the docs do. I may like my job a lot better then.

every critical care iv drug guide I have looked up haldol has me administering within safe dosing guidleines providied all parameters are montored for, several have me at a fraction of the max daily dosage, do your own homework

im not Collective years of experience tell you, A- you werent there b- lots of literature to support what i did, nothing in writing suggest i did anything wrong. I do agree however that next time, i will cal a doc when i have to use that many times his PRN order, that is where my lack of expereince hurt the most. Other then that I beleive the memebers of this board would probably feel differently had they been there as well

now you are getting the picture

So a hotshot doc wants me fired and his partner tells me as much, and I should ignore that and try not to get fired under thos circumstances, whose missing the bigger picture???? Lets just say we agree to disagree on the dosing and administration of haldol.....

UPDATE! As it turns out, I am guilty of very little except pissing off a hotshot pulmonologist who like to percutaneously trach people when he should leave that to the surgeons. This patient is 350 lbs, and this doc messed her up bad and is looking at getting his pants sued off. He reviewed charts/ mar and found where I had given that haldol and lost his ..... Anyways I have run this by pharmacist and other docs, and they say as long there were no signs of ekg changes/hypotension, decreased respirations, or NMS, which I assesed for as the drug admin guides said, i was WELL under the upper level dosing guidelines. And thus haldol was ordered for anxiety/agitation. So I administered correctly, and yes, I did run it by my coworkers and the charge nurse that day and they all agreed that the guide and order were correct, they were also familiar with the patient and everything we had tried previuosly on her ( which everyon on this board is NOT, but thanks anyways). So then this morning another pulmonologist in his group pulls me aside and reasures me that I didnt really do anything wrong, and that this guy has sicked my manger on me, and they asked her (the friend pulmonologust) questions about me. She says I think they are trying to get buuld a real case against you, you have pissed dr so & so off, I think it is BS, I have seen this before, I am so sorry etc etc. I think this is not fair and I hate to see them to this to you. My coworkers said they stuck up for me when all this went down last week too. I felt awful today having to ask other nurses to give meds to my patients and I realized, built into many of our protocols are statments like" adjustments may be made when considering additions of this and that etc etc) in other word use your jusgement for lets say titrating insulin when considering TPN and and steroids. Well My judgemnet could easily be considered an error and i could be fired. I cant work like this for 60 days. Another point was brough to me by my coworker- if you made a med error, there is ahospital policy for dealing with that. It invloves classes and videos etc etc, why are you not int that program? Why, because you made no med error. The only error I made was pising this doc off, by not knowing he would not like me giving his patient this much haldol. I realize many of you think its alot. but you didnt see what WE saw, didnt see what we tried, and didnt see how it effected this patient. That is why noone said anything on that day. And that is why there is such a wide variation of haldol dosing administration in the ICU setting. I am a good nurse, and i am not going to let this keep me down. I did my homework and assesed correctly. Today my patient that i transferred tothe floor grabbed me and hugged me, that why i am in this. I have an interview at another hospital tommorrow, and im going to take the job at another ICU if offered, until then, I will do my best to cross my t's and dot my i's . NP (not really gonna be an NP) :)

And like I said, if you can give me a real contraindication for giving that amt of haldol besides the esatblished fact that the order was improper, or you have not given that much, id love to hear it. I havnt heard anything that makes me think its too much . "we have never given that much before" doesnt mean anything to me. I gave the drug, observed for s/s of hypotension/decreased resp,. and ekg changes, noted none, and gave more, all way under some of the dosing guidelines I have seen which inculde a ceilinge single iv dose of 200 mg and uo to 700 mg a day in some literature. I am trying to understand. But I cant yetr

well i beleive I said what the problem was. The pat had okay abg's, the patient had been up for days and was getting icu psychosis. They were generaly agitated and i beeleiev they were given ativan and it made her worse , as ativan tends to do sometimes with older patients.

went into work this AM and left after a half hour saying i was sick. Leaving two coworkers to triple, and i dont care. I have been the one to triple, I have never called in, i have been stepping up. I have been the one to help out others even when I am behind. Its not appreciated. Last weekend was horrible. I had a charge nurse and a group of people make me feel like crap all weekend, then i had a nurse assistant yell at me for asking her to help me move a 300 lb patient close to the time she was leaving, and when i complained about it, the charge nurse shut me up. She then wrote me up for the ativan. Then I get called off yesterday and am reprimanded, told I have to verify my meds. Sorry, i dont feel that unsafe... I looked the meds up, and gave them with the appropriate dosing guidelines. administering within recomended dosaged while wathcing for s/s of adverse effects. My mess up was of course the time constraint, again I feel like only an"outsider" me and a few others would have to answer for that. My drive to be a good employee there is gone. It doesnt make a dofference. People call in left and right and look out for themselves and get along better then i do. I need a new job, and quick. I have an interview Tuesday.

thanks for all the input. In light of OTHER circumstances at work such as a hostile work environment etc, I think its best for me to put my two weeks in and find another job (not in that order). When you find yourself being challenged by the ntechs, and the charge nurse shuts you up when you complain about it, and then is all to happy to write you up, then I think its likely I wont be having an easy time. especially with my having one foot back in orientation. It may not be but it sure feels like a punishment. I dont see how verification of antibiotics, eye drops, scheduled PO's is going to help me. But whatever.

I would, what would be the harm. i cant see nay reason not to and I cant see that you would get in trouble for getting lpaperwork unless there is a specific policy against it.

http://docmd.com/files/pocket4.pdf This is one of the sources i read that day, one saying 5 mg Q 30 min, this one saying up to 200 mg in a single dose, in light of that, it didnt seem liike a lot. Urcina, her people- her little clique

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

; just think of it as a safety net for you. 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.

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.