Got fired for changing fluid rate - page 4

I was on orientation on days and then got moved to nights which is what I was hired to do. It was my first night on orientation with a preceptor and I was not feeling the best, was very tired got an admission at 2 am and was up... Read More

  1. 0
    Ok, so I read the rest now. Um I have nothing important to add, except that this sounds like an ICU nurse move, bumping the rate before calling the doc (I'm in ICU, not slamming anyone)

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  2. 2
    Quote from lolakbolak
    her blood pressure was 70/40's... she had fluids going at 100 ml/hr... I increased her IV rate to 200 ml/hr and called the physician immediately.
    I don't understand why you would make a meaningless change like 100 to 200... a bolus I would get... "freely running," or "wide open" as I more often hear, makes sense but 200/hr?

    In report the ED nurse said to run the fluids freely so what initially prompt you to change it to 100/hr? Typically, I'd let the ED bag finish running wide open since it was probably ordered as a 1000 cc bolus. Then I'd implement the 100 with a new bag... of course, even if I'd been foolish enough to take the patient, I'd have been on the horn with the doc before that bolus ever finished.

    What were the historical BPs from the ED and for how long?
    sapphire18 and nrsang97 like this.
  3. 9
    Quote from RoyalPrince
    Pt on a Med/Surg Floor comes with a BP of 70/40 and no Rapid Response is called? you should be fired.
    Just FYI.......Not all facilities have rapid response.

    OP......Did you actually get fired? Did your hospital say they were reporting you to the board?

    You were recently graduated in 2011...you stated in Feb that you have 3 years experience. You worked at an LTAC (Long Term acute care) which have ICU units.....is this where you worked in ICU? So you work telemetry now....right?

    It is very difficult to say if getting fired was wrong or not for there is always 2 sides to every story. My first concern is about the ED transporting an unstable patient with a fluid bolus still infusing....that is a dump in my book...... by any standard.

    Why was your preceptor not concerned about the low B/P? To me..it sounds she was setting you up to fail....however as an experienced nurse, of three years, this situation shouldn't have thrown you. How long did the IVF infuse until the MD was notified? Why was a patient with a UTI and a B/P of 70/40 admitted anywhere except ICU...something isn't right.

    You have experienced other conflicts and seem to have some significant growing pains which you may need to honestly reflect upon and see what you may change within yourself to grow as a nurse. Acclimating to nursing is hard. Conforming can be even harder. In nursing the patient don't deserve less if you are tired and don't feel well....you still have to perform at top form.

    You started this job recently and since you have started you have wanted to go part time, argued/refused the flu shot had complaints from families and
    responded with a harsh/abrupt manner.

    I don't think as a nurse with 3 years experience a fluid bolus and calling an MD should throw you for a loop..however you preceptor was inappropriate in abandoning you when clearly you were concerned. Where was the charge nurse?

    There are more question than answers ......I wish you the best.
    Last edit by Esme12 on May 8, '13
    sapphire18, hiddencatRN, jtmarcy12, and 6 others like this.
  4. 1
    Quote from Sun0408
    That's a little harsh, this is a new nurse, still learning. The OP was concerned but her preceptor was not. Also not all facilities have a rapid response team.

    OP, your gut was right, follow it. If you find yourself in a similar situation, go to your charge. For something like this, call the Doc.
    Right, not all have a rapid response team. My hospital does, but the entire time I was in orientation, NO ONE ever mentioned rapid response to me. Ever.

    For a while I was uncertain about when it was appropriate to call them, but I've since been told that any time I want a second opinion or I am unsure about something or whatever, give them a call.

    Our local hospital doesn't have rapid response.
    nrsang97 likes this.
  5. 3
    This was a totally inappropriate admission to a med surg floor from the ER. Where was your preceptor? Why on earth weren't they concerned regarding the BP? Something just isn't right about this whole story.

    For those who do have the rapid response team I encourage you to call if you are uncomfortable with a patient for any reason. Sometimes you just can't explain it but there is something off. Being a rapid response nurse this patient is a for sure call.

    Others to call for HR <50 or symptomatic. HR >130, RR <10 or >30, SPO2 <90 or frequent increases in oxygen (ex going from RA to 2l to 4l to venti mask in a short period of time), Respiratory distress, chest pain, SBP <90 or >180, acute mental status changes, anytime you feel something just isn't right. If you see us rounding don't be afraid to stop us and ask questions. We are there to help out.
    J.A.B.,SN, squidbilly, and Sun0408 like this.
  6. 1
    70/40 after a gravity bolus. I wouldn't have rechecked the BP over and over, I would have just called the doc right away to see if they wanted another bag in.
    nrsang97 likes this.
  7. 0
    Quote from ChristineN
    I am an ER nurse and we always run our boluses "wide open" and will often bring pts to the floor with a bolus still infusing. The difference is I would never send a pt to med-surg bed with a pressure like that
    So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.
  8. 0
    Quote from CrazierThanYou
    So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.
    Wide open to me means just that. The clamp is off and the body is taking care of the pace itself. Usually when things are running wide open we are talking a litre of fluid as fast as it will go. "Bolus" is whatever the speed is the doc wants it at, but mostly it is between 250-500ml over an hour in my experience.
  9. 2
    Quote from CrazierThanYou

    So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.
    In both L&D and ER it is very common to run at least a liter wide open. The "speed"or manner of bolus given depends on the floor I suppose

    Posting from my phone, ease forgive my fat thumbs!
    hiddencatRN and nrsang97 like this.
  10. 5
    Quote from CrazierThanYou
    So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.
    I have been an ER nurse a LONG time!!!!!!!!! We run gravity boluses ALL the time......we will also place pressure bag on fluids if necessary and the vitals require it to replace volume. Open the clamp and let her rip...while the patient is monitored for failure and vitals.

    However.....even if it is a liter bolus.......I wait until the bolus is infused in the ED for the floors just do NOT have the staffing capacity to monitor these patients.....
    from ChristineN
    I am an ER nurse and we always run our boluses "wide open" and will often bring pts to the floor with a bolus still infusing. The difference is I would never send a pt to med-surg bed with a pressure like that
    How long does it take to really infuse and ensure that patient is stable....that was a ER dump and they should be ashamed for transporting an unstable patient to a inappropriate unit.
    canoehead, joanna73, nursel56, and 2 others like this.


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