Help/Advice Needed - KCL without pump/Oncology clinic

[AliC]

I was hired at an oncology clinic where they do outpatient chemotherapy 5 days a week. I just graduated and have no experience actually working as a nurse. It's a great M-F schedule, and it pays well. I was pretty shocked that they wanted a new grad. (This clinic is in a rural area, and certified oncology nurses are apparently scarce.)

The oncologist mixes the chemo and the RN's are responsible for administering it. The patients all have implanted ports. The problem is that there are no infusion pumps at this clinic! So, some days we are having to administer KCL infusions (20 mEq in 500 mL NS) over the course of 3 1/2 hours without a pump. Yesterday was my first day, and I just found this out. I am freaking out about this a bit.

Does anyone have any advice? Is it ok for me to be administering chemo without certification? Is it possible to administer potassium this way and still be considered a good, ethical nurse? There is not a nursing shortage where I live, and I was starting to feel pretty desperate by the time I found this job, so I don't think I want to just quit. However, I don't want to be setting myself up for disaster either. I would appreciate help from others who have been in similar situations.

[heron, ASN, RN]

I have questioned why we teach the drip rate in school since it is almost obsolete.The rationale being in case of emergency a nurse would know how to calculate a drip rate.

I have been a nurse since the 1970's and even then the standard of care was central line one must have a pump, now you are talking about chemo and KCL. On top of this the nurse who posted this is a newly licensed nurse. I personally would question the doctors who ascribe to this practice.[/quote

I've been licensed since '72. We had central lines out the wazoo and not a pump in sight outside of ICU, in a major Boston teaching hospital. I didn't see pumps in regular use outside of critical care until the early 80's.

"Standard of care" makes for pretty paperwork but it's just words on a page if the thing is physically not there.

The decision I think the OP was trying to make is whether or not she should refuse to follow the clinic's practice and thereby quit a job when she might not find another one.

The point of my post is that it is possible to give both chemo and kcl safely without a pump ... but you're right, it leaves much more room for human error and is certainly not preferable. But actionably incompetent practice? I disagree. What would be actionable would be ignorance of the drugs she is giving and how to manage an infusion without a pump.

The technology available to us is marvelous, sometimes critically necessary. But some things, like managing an iv infusion, were accomplished safely before the technology became available. I may be just an old faht, but I still think that is important to be able to function without the fancy machinery. Taking a manual BP and apical pulse, regulating an iv rate, recognizing the early signs and symptoms of hypoxia without a pulse oximeter come immediately to mind.

Technology is intended to enhance and complement our skills, not replace them.

[heron, ASN, RN]

Why didn't you mention monitoring?

[MurseMikeD]

Maybe it's a California thing then. We can't give over 10 an hour of KCl without both cardiac monitoring and a pump. Pts needing that much go to ICU.

[heron, ASN, RN]

So ... OP, are you out there? Did your question get answered?