I just landed my first job in an ICU and I'm struggling to fit in. Last week the charge nurse asked me to administer I.V. adenosine. When I explained that I'd never given this medication, she handed me a drug book and told me to look it up. I was shaken when I read that this drug can cause transient asystole. I told the charge nurse I wasn't comfortable giving it and asked her to do so, which she did. (The patient responded well.) But now the charge nurse seems disappointed in me. She says adenosine is commonly ordered in the ICU and I'd better get comfortable administering it. How should I handle this? -L.H., MICH.

Your patient's rights and safety were compromised if your charge nurse expected you to give him an advanced cardiovascular life support (ACLS) drug you're not prepared to administer safely. If, as a new ICU staff nurse, you weren't assigned to work with a preceptor during your orientation, your organization is placing you, patients, and itself at risk.

Safety and best-practice standards require that a preceptor educate you about your responsibilities and monitor your clinical competence. By putting you on the spot, not providing a preceptor to guide you, and potentially endangering a patient, those involved become party to quality-of-care violations and myriad ethical and legal pitfalls, including harassment.

It also sounds as if you aren't trained in ACLS. Intravenous adenosine is a common antiarrhythmic used to treat reentry supraventricular tachycardia, and every nurse trained in ACLS should be knowledgeable about its indications, administration, and potential adverse effects. For example, to give this drug safely, you need to follow a specific administration protocol. Find out when the next ACLS training class is being offered at your facility and sign up for it. You're ethically obligated to take the initiative and get the education you need to care for your critically ill patients.

Talk with your nurse-manager about this experience and insist that you get the education and support you need.