I Wasn’t Paid to Think, But I Did Anyway
And I saved my patient’s life
“You’re a nurse. You’re not paid to think. Just do what you’re told.”
My patient was an elderly lady who would be returning to the operating room in the morning for an extensive debridement of her abdominal wound. The chief resident told the intern to make sure she had nothing to eat and to switch her oral (PO) meds to the intravenous route (IV).
The intern did what he was told and switched her Inderal 60mg PO order to Inderal 60mg IV.
I was a new graduate nurse. Back then, we had all the medications in a supply cupboard, and I dug around until I found a vial of Inderal. The concentration was 1mg/ml.
My first thought was, “I’m going to need a bigger syringe.” My second thought was, “I’d better clarify the order.”
I found the intern writing progress notes and said, “About that order of IV Inderal, I think that….” He interrupted me and snapped “You’re a nurse. You’re not paid to think. Just do what you’re told.”
Embarrassed and doubting myself, I walked back to the supply cupboard and opened the dog-eared medication reference book. I saw the standard IV dose was 1–3mg and that care should be taken when converting the oral form to IV.
I took a deep breath and returned to the intern, holding the book in my shaking hands. He rolled his eyes. “You again? Another comment about my order? I went to Johns Hopkins; where did you go to medical school?”
I quietly replied, “I don’t know how they give Inderal in Baltimore, but apparently if you give 60mg intravenously patients can die.” I showed him the reference book.
His eyes widened and he modified the order without comment.
As I look back, I think of all the medication safety processes that weren’t in place. There wasn’t a unit pharmacist or pharmacy review of medication orders before they were administered. The order was handwritten; computerized order entry use wasn’t widespread. Medication dispensing cabinets weren’t in use. There wasn’t even a dedicated medication room.
That shift in the ICU was so close to being a disaster. Every news story or media post about Radonda Vaught and her conviction for a fatal drug error brings back this memory and I realize how close I came to harming a patient.
Part of me wishes I had told that intern this:
“I am paid to think, and I just did.”