Got fired for changing fluid rate

Nurses General Nursing

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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 for almost 24 hours already. This admission was somewhat unstable, her blood pressure was 70/40's and she was lethargic. She got a fluid bolus in the ED and then she had fluids going at 100 ml/hr. When she got to my floor her fluids were running by gravity. I asked the transferring nurse what the rate is he said we are just running it free right now. I wasn't sure what her meant. Told my preceptor I'm concerned about the low bp. She said she wasn't. I was rechecking her bp every half hour because I was terrified I would find her unresponsive even though it was every 4 hours. Anyway I rechecked the bp and it was still very low and patient was lethargic. I increased her IV rate to 200 ml/hr and called the physician immediately. He told me to give her a bolus of fluid and the rate would be 100 ml/hr after that.

I know I was in the wrong for changing the rate without an order first. I understand that now. Am I a lost cause? Should I just forget about this and move on?

OP, I'm sorry but I went back and read some of your other posts. You are not a new nurse and seem to have past issues, I think this incident was the straw that broke the camels back as they say.. You wanted to go back to school, so here is your chance.

I do wish you the best

Me too. This whole situation doesn't quite add up.

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You know who's at fault? EVERYONE.

The OP's story doesn't quite add up and practiced outside her scope, that ER was using the M/S Floor as a dump, that preceptor did not intervene, these people on the AN forums shouldn't be critiquing the OP based on previous posts (I think post history should be disabled), and last but not least those folks who say she deserves to be fired. Shame on you. :no:

This does not represent professional nursing.

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Specializes in Med-Surg.
You know who's at fault? EVERYONE.

The OP's story doesn't quite add up and practiced outside her scope, that ER was using the M/S Floor as a dump, that preceptor did not intervene, these people on the AN forums shouldn't be critiquing the OP based on previous posts (I think post history should be disabled), and last but not least those folks who say she deserves to be fired. Shame on you. :no:

This does not represent professional nursing.

I beg to differ. Post history can be very useful. How we respond to someone with 20+ years of experience vs. a brand new grad will be different. Or if we look at their history, notice that there are 15 posts in the last month about mistakes that he/she made, well, it certainly affects the whole 'Should I have been fired?' response.

Do I think that OP should have been fired for this drip rate issue? No. Reprimanded, given in-service and stern reminders of scope of practice, definitely. BUT...given past issues about being rude to patients, unsafe practice, etc. That perhaps explains being fired a bit better.

And you know what else I just realized? Since posters started commenting that things don't make sense with post history and all, we have not heard from OP. Jus' sayin'.

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Specializes in Hospice.

I would have done that.

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Specializes in ER.

i agree here. There is usually a protocol. Especially when most MDs do not call back for a while. I worked the floor for a while and have many pt's BP drop and we just opened the fluids up and let them go. You got the order for the bolus so it was the right thing to do. its the same as saying my pt's 02 sat was low so i waited to give him/her 02 because i didnt have a MD order

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Specializes in ER.

So she was septic or heading that direction? There is usually a sepesis protocol in every hospital What she did had to be with in her hospitals protocols.

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Not all telemetry floors are the same. There's a (big) difference between a true PCU and medical telemetry. Some hospitals have both.

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Specializes in geriatrics.

Many facilities would issue a verbal or written warning for something like this. Perhaps they were looking for a reason to let you go. These days it doesn't take much.

I haven't read through all the postings, but I'm a little confused why you didn't call the Dr? Where I work, we have been known to adjust fluid rates on occasion without an order....but I work in a rural location, and we know what our parameters are.

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If I had personally been told in report that my new patient has a BP in the toilet, I would have been reluctant to accept the patient....and would have had my clinical manager get involved immediately. Now upon receipt of the patient, (if it got that far) I would have been on the phone with my clinical manager as well as the hospitalist to clarify orders, communicate vitals, etc. Did the patient's blood pressure improve after the bolus? Wish we had more information to the story...

At the end of the day, you accepted report from the ER...you accepted the patient upon their arrival...and should have consulted your clinical supervisor and the hospitalist sooner then you did.....but we are all human and all make mistakes...the important part is learning from them and not repeating them :specs:

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Th OP has apparently left the building. Perhaps to return. Or not.

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I beg to differ. Post history can be very useful. How we respond to someone with 20+ years of experience vs. a brand new grad will be different. Or if we look at their history, notice that there are 15 posts in the last month about mistakes that he/she made, well, it certainly affects the whole 'Should I have been fired?' response.

Do I think that OP should have been fired for this drip rate issue? No. Reprimanded, given in-service and stern reminders of scope of practice, definitely. BUT...given past issues about being rude to patients, unsafe practice, etc. That perhaps explains being fired a bit better.

And you know what else I just realized? Since posters started commenting that things don't make sense with post history and all, we have not heard from OP. Jus' sayin'.

Touche. Something's up. I just like to give people like that a chance, even if they mess up. There's a lesson and mistake everyone learns from. But of course, there's a limit to that.

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I just find it odd that in May of '12 the OP stated they were a new nurse that has worked one year in LTAC and one month later they posted they were an ICU nurse of 2 years in June of '12. I dunno...?

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