New Nurse - safe practice question

[burnay76]

Hi am am a relatively new nurse (less than 6 months) and wanted some feedback from experienced nurses out there regarding a safe practice issue. I was pulled aside by my nurse manager and "counseled" for administering an intermittent infusion of 40 mg protonix in 100cc NS over 15 minutes (400cc an hour) through a working and patent 22 guage IV catheter. Davis Drug guide states intermittent infusion 40 mg in 100 NS over 15 minutes. Hospital policy states a 22 guage catheter is sufficient and preferred for patients recieving intermittent infusions. No other policy exists to contradict this (I am sure many of you are used to doing this IV push iin 10cc over 1-2 minute for an effective rate of 3-600cc an hour... but we are prohibited from pushing most meds as this is a teaching hospital and apparently problems have occurred). I have been told that this was not safe and that no infusions should run faster than 200 cc an hour through a 22 guage, and it is customary to run the protonix over a whole hour. Like I said, I am relatively new, and want to know if I am in error when it comes to what are generally considered standards of the profession. I felt I acted in accordance with policy and recommendations of drug guide literature. I took the crticism as constructive and agreed that I will run it over an hour in the future and limit my infusions to 200cc or less, but I really want to know if what I did is unsafe. Any insight is greatly appreciated.

Scott

[cannoli]

protonix is given IV push where I work

[burnay76]

I am told the IV push limitations at the hospital are the result of an intern physician pushing a vasoactive drug on an unmonitored patient and crashing them. The facility just saw it as easier to limit push meds to those that absolutely need to be pushed.

It's more than just a "teaching hospital" - it is a university hospital with a medical school staffed entirely by interns and residents so the policies tend to be very conservative in order to minimize harm even if a mistake is made

In an interesting side note related to my original post. I talked with my manager again today and she brought up that the order actually read to run at 400cc an hour (this was 3 weeks ago so I don't really remember) She has backed down on the "unsafe practice" but is saying I really should have questioned the order as being too fast for the general population of our unit.

I don't mean to offend anyone with this, but Med-surg people are just crazy.... I need to go back into psych : -)

[burnay76]

It actually turns out that I am recieving an unsatisfactory six week eval (after 10 weeks on the job)- not over this incident but over a misunderstanding. I was overheard to tell a patient that "nursing sucks". This was apparently overheard by one of the medical interns/residents. It ends up being something we would typically expect of a physician - not listening. The patient was talking about her niece going to nursing school and we were having a candid conversation. She was telling me about the difficulty her neice was having. I told her that nursing school sucks (perhaps I could have chose a better descriptive) and that is is tough. The conversation was really leading into me telling her that despite the difficulty of school, it is all worth it once you move into practice. This somehow turned into me hating nursing. The patient was nervous awaiting a thoracentesis and I was sitting with her and trying to be therapeutic by diverting her from her worrying and focusing on an "everyday conversation" (I've been a psych counselor for the last 5 years and know a thing or two about therapeutic communication). Anyway, turns out that the protonix issue was pretty much part of a witch hunt as my manager was amassing enough to fail my probabtionary period. She changed her mind after we talked and felt the whole situation was misinterpreted. However, because of the physician complaint she is forced to give the unsatisfactory eval.

I am not the type of person who can walk on egg shells with what I say - though I would never say anything inappropriate or anything that would make a patient uncomfortable. I am a better counselor than a nurse - I dare say I am likely a better counselor than my peers are nurses. I am not going to say something to jeopardize the psychological safety of a patient - it just isn't going to happen. I feel like I need to keep my head down, mouth shut, and just do my nursing tasks. That's not a nurse to me though, a robot could do that. I actually do hate the task focus aspect of nursing (prioritizing, etc is necesssary but very dull to me) - it's the human interation that makes it worth while to me

Those of you who might have been in such a position, do you think this is a good time to start looking elsewhere while I am employed there rather than risk the possibility of termination in the future and have to explain myself when looking for another job?

[leslie :-D]

personally?

it sounds like you need to reflect a bit.

keep what is worth keeping and blow the rest away.

self-righteousness will not help you grow in your role as a nurse.

best of luck.

leslie

[burnay76]

Earle, wise words no doubt. I take seriously anyone who would quote the wisdom of the dalai lama. I am not trying to be self righteous, I just know my strengths. I think it is fair of me to assert my skills in interpersonal communication. I readily admit my ignorance in nursing.

I guess what I am really seeking is insight into the minds of management. I have basically given a warning and assurance all will be forgiven and forgotten. I'm not sure I should trust that.......

[leslie :-D]

Earle, wise words no doubt. I take seriously anyone who would quote the wisdom of the dalai lama. I am not trying to be self righteous, I just know my strengths. I think it is fair of me to assert my skills in interpersonal communication. I readily admit my ignorance in nursing.

I guess what I am really seeking is insight into the minds of management. I have basically given a warning and assurance all will be forgiven and forgotten. I'm not sure I should trust that.......

you take constructive criticism well. :)

you're talking to an old cynic here, who happens to have been burnt by mgmt.

if someone wants to get rid of you, they will.

as for the motives of your nm, i don't know.

but i would proceed cautiously.

don't be a robot and lose your personality.

but take good notes and as someone advised, pick your battles wisely.

i think it's safe to say with nursing, one has to cover their butt at all times.

leslie