titrating cardizem

Its really not hard to titrate a cardizem gtt . Our tele unit does not transer pts on cardizem gtts. We start them , titrate them ,and DC them . Its a lot of nursing judgement on our part and calling the docs comes after the fact. They write the orders ,but its not always clear , so we do have a standing policy on titrating ... and like i said alot is nursing judgement, but you get used to it just like everything else they throw at us!

The floor I work on, a tele floor, we hang, titrate, and manage a cardieziem drip, all while looking after normally 9 patients total. We have our HUC's watch the monitor's. It's never left unattended. Normally we tell them when we start them on a drip, or give anything that could affect a heart rate (like pushing lopressor), and they let us know if something happens. If for whatever reason, we need to put them on a frequent BP's, we throw a dynamap on them, and try to check in on them when it should be going off. Cardiziem is actually one of our very frequent drugs, so I guess we tend not to think too much about it. (We also do dopamine, dobutamine, nitro, heparin, integrillin, amniodarone, and various other critical drips.)

Hello-I work on a ortho/PCU post surgical floor. I am ACLS certified as required. Our nurses are offen required to float to ICU where we are given 1-2 of the least critical pts. The other night I floated and was told I would be getting an admission from ED. Pt. being admitted for CVA,Resp failure and rapid a-fib. She was to be on BIPAP and a cardizem drip to be titrated. I was not comfortable taking this pt. We do not have BIPAP on my floor if it is being used for rescue breathing. Also I have zero experience with titrating drips (we also do not take these pts). The charge RN understood my concern and gave me her one pt. who was basically stable. I had a RT comment to me that the pt was a DNR so I could not hurt her and why did I not want to learn new skills? I was totally amazed by the RT comment. I always want to learn new skills, BUT.....1) I do not believe I am even allowed to take a titrated drip (will clarify this tonight) 2) I am not an ICU nurse-would not this pt. be better off with an experienced ICU nurse? 3)I believe this pt. was beyond my scope of practice and accepting her would be both morally and legally wrong 4) When did it become acceptable to practice nursing skills on a pt because they are a DNR?
Your feedback would be appreciated.

I am sorry that I have no sympathy..well maybe just a very little. This is perhaps my pet peeve in nursing. ICU nurses and floor nurses take the same nursing boards and have the same nursing license, but why is the ICU held to so much more accountability and responsibility than a floor nurse. In your case you even have ACLS certification. I can understand that you may have been out of your comfort zone but without taking full responsibility you could have been involved in taking care of the patient to LEARN so that the next time you get pulled to ICU you can take care of that patient. There is too much already expected from ICU nurses without any fair compensation...for example MET Team calls. Surprise there is no magic fairy dust that falls on patients when they come to ICU...it is the knowledge skill and EXPERIENCES of the ICU nurses that make the difference and only because they have sought out the opportunities to learn instead of cowering behind it is "legally and morally wrong for me to learn." I believe every nurse has the responsibility of learning from every patient so that increase their skill and knowledge to better serve the ones they care for in the future. Too many sit back complacent and quiet in their comfort zones and administrations backs them to the point that they become disabled.

We practice nursing skills on all DNR patients...DNR does not mean that you don't take care of them just that your do not resuscitate them..BIPAP is not intubation and is not a resuscitative measure..the patient has to be breathing on their own which is a natural process. Many patients in our facility are on the floor on BIPAP what about the people with sleep apnea that use BIPAP everynight? This is not out of the scope of a floor nurse .
Many Tele units have cardizem drips and push dig and lopressor...once again not out of the scope of a floor nurse. The only difference is the setting. What are you not capable of doing..what is out of your scope?