Phenergan & Morphine

I don't think there is anything inherently wrong with Phenergan 25 mg IV push. As long as it is diluted well or pushed with IV fluid running there shouldn't be any problem. Sounds like you assessed the IV site well while you were giving this drug. I would have been cautious about giving 10 mg Morphine IV. I am a little curious how you gave it over 10-20 minutes? Did you stand at the bedside that whole time? Did you give it in 1 mg increments? When I give this much MS usually I give it in 2 mg increments q 5 minutes or whatever the MD ordered. Morphine 10 mg IV now implies giving it all at once, not in increments. I'm a little curious how that was ordered. However, in someone who has a high opiate tolerance this would not be a significant amount to give. I agree with you the a diastolic in the 90s 1.5 hours later isn't clinically significant. If his BP was in the 90s when you gave the Morphine that would be a problem but it sounds like his BP was fine when you gave it.

I'm sorry you had such a hard time there. It sounds like you are very intelligent and feel confident in your abilities. I know that many experienced nurses feel concerned when they see a high level of confidence among new grads. Most new grads are quite tentative about their skills and insecure. Usually the first year of nursing is when a person begins to develop skills and experience that leads to confidence--usually its not the other way around. My only suggestion for you is to be receptive to all the input that your more experienced coworkers have for you. Many times experienced nurses get frustrated with new grads when they feel that they don't listen to what they have to say.

Best wishes to you!

sunshineyday,

Our organization does not allow peripheral IV administration of Phenergan - period. We have a policy that addresses this issue. There is too much documentation of risk/harm to patients. Physicians are not permitted to do so either. It doesn't matter whether the nurse is "uncomfortable" talking to the doctor - it is her/his professional responsiblity to do so. If the doc tries to insist, the nurse follows our chain of command and the Chief medical officer will intervene to follow established policy.

We also have very specific policies that address pain management & conscious sedation, including precautions that must be taken when certain dosages are administered - such as the use of pulse ox & frequency of BP monitoring. If the organization had policies related to these issues, you were obligated to follow them. Lacking policies, I agree that it would be difficult to determine what to do.

This was a hard lesson to learn. But you would be better served by engaging self-reflection in order to learn from this experience. The question is not "how can you defend yourself" but to understand that you must learn to listen and accept critical feedback without becoming defensive. More experienced/competent staff are drawing upon skills and knowledge that you do not yet posses - you could learn from them rather than dismissing their insight.

As an educator, it seems to me that you are too confident in your own limited abilities - and this is going to continue to get you into trouble. Please take it down a notch, admit to others and yourself that you are a beginner and have much to learn. Otherwise, I agree with you - a career change is probably the best decision.

I like your post

Just wanted to add that we should follow the policies of our institution and I do find that some nurses have no idea what those policies are.

The P&P Manuals are usually full of the most minute detail about what you are supposed to do at work.

Having been here on allnurses for awhile - I am still constantly amazed at how different we practice across this country. And the phenergan question has been argued for a long long time here.


steph