RANT: Unsafe Assignment? Am I being dramatic?
Hi everyone,
I know this a new grad nurse subreddit and I've been a nurse for 2 years now, but this community has been super helpful and knowledge. I work in a Level IV NICU and started there a few months ago. Before this, I worked in a Level III NICU for about two years. I just got home from work and I’m honestly really upset because I made my first medication error tonight. Thankfully, nothing happened to the patient, but it’s still weighing heavily on me.
I’m currently still on orientation and was given a two-patient assignment. One of my babies was on seven drips, including two cardiac drips. The baby had TPN running through a bag, milrinone, morphine, precedex, nitroprusside, a TPN syringe, a SMOF syringe, and a med line. I personally felt like this was an unsafe and unreasonable assignment, especially while I’m still orienting.
I ended up hanging my TPN and drips at 10:40 pm, even though they were supposed to be hung before 10 pm. While I was trying to manage all of those infusions, my other patient had eight bradycardic episodes. We ended up getting an X-ray, holding feeds, and venting that baby.
From my perspective, the first baby should have been a 1:1 assignment. Respiratory-wise the baby was stable, but he had pre- and post-ductal sats, was tachycardic, and had high MAPs, in addition to being on multiple vasoactive drips. At my previous Level III NICU, any baby on three or more drips automatically became a 1:1 assignment, so this situation felt very different and honestly unsafe to me.
My preceptor told me that I need to learn how to take care of two unstable babies at the same time. I understand that learning to manage a busy assignment is part of orientation, but it feels wrong to be expected to manage two unstable patients simultaneously—especially without someone temporarily covering the other patient when things escalate.
To make things worse, in the middle of all of this I made my first medication error. One of the drips wasn’t running at the correct dose, so the baby was underdosed instead of receiving the correct amount. Thankfully there was no harm to the patient, but I’m really frustrated and disappointed in myself.
I guess I’m looking for some perspective.
Is this considered a safe or reasonable assignment, especially for someone still on orientation?
Should I realistically be expected to manage two unstable NICU patients at the same time?
Any advice or reassurance would really mean a lot right now.