Fentanyl bolus question

[Kaysmom8]

Hello,

Today in clinical a fellow classmates nurse kept taking a syringe and taking fentanyl and drawing some up extra from the iv line and giving it to the patient. She said at one point during the day she had to give the patient 300mcgs. Before the other student left she told her not to tell anyone she had been doing that all day long. Does this go on in the real nursing world or is this completely wrong?

[suga_junkie, BSN, RN]

In our school our patient assignment is our responsibility just as much as the nurses.

Well no really, its not. What a registered nurses does when practicing under their license is their responsibility. You are certainly accountable for your own actions as a student, but the RN you are assigned to has the final responsibility to both practice within her scope of practice and ensure that you do so too whilst she is supervising you. If you are not comfortable in participating in something at clinicals, then don't, but you are not culpable for what this nurse does.

[PMFB-RN, RN]

I find it amazing that she can give that much and if everyone is giving that much and these bags aren't running out early....how the pharmacy accounts for the missing narc to the DEA.

*** I don't find it amazing at all. Some places are just very careless about keeping track of these things. One hospital I work in, a large level I trauma center where nurse have a lot of autonomy anyway never seems to notice with an bag of ativan or norcatic that SHOULD have lasted 24 hours only lasts 18 hours cause RNs have been giving ordered and unordered boluses off of it. Of course I have observed the other work around where a nurse changes and empty nacotic bag and had her "buddy" waste all that narcotic that SHOULD have been in the bag with her and thus everything is accounted for from the pharmacies perspective.

I was trained by various preceptors to give such off the record boluses as a newer nurse. In my later practice I learned to more effectivly communicate to the physician what my patients needs are, or how to go over their head (usually dealing with residents) to get my patients what they needed.

As I have said before this is really a system problem. Nurses SHOULD be allowed legaly to have a much larger say in these decisions. Things need to change.

[PMFB-RN, RN]

In our school our patient assignment is our responsibility just as much as the nurses.

*** Uh, NOT! The assinged RN is the responsible party, not a student. I very often train students and feel a responsibiliety to train them the "right" way. Of course I am well aware that my fellow RNs, when operating under their own license and responsibiliety do things differently, and I practice differently when i am not teaching a student.

Do I run to managment when I know a fellow RN is doing their own thing? Of course not. One must pick their battels.

[psu_213, BSN, RN]

The intentions are usally only the best. The nurse who is at the bedside with her patient understand the patient needs more pain meds. Either she is unable to communicate this clearly to the physician, or the physician doesn't believe her, or for some other reason chooses not to order the addition pain meds.

I am still not convinced that the nurse was giving fentanyl boluses without an order. At this point, there is still no evidence that there was not an order present (and I certainly could be wrong on that). If this is the case, I think the point in question is whether the nurse can draw up and push a bolus dose instead of give it on the pump. According to the OP, the policy at this facility is the nurse has to use the pump to bolus, hence the need to not tell anyone else about it.

[Sun0408, ASN, RN]

I am still not convinced that the nurse was giving fentanyl boluses without an order. At this point, there is still no evidence that there was not an order present (and I certainly could be wrong on that). If this is the case, I think the point in question is whether the nurse can draw up and push a bolus dose instead of give it on the pump. According to the OP, the policy at this facility is the nurse has to use the pump to bolus, hence the need to not tell anyone else about it.

We have orders for all sedation ie: versed, ativan, fent etc to titrate to sedation/RASS score of 3 or as needed to maintain sedation.. Gtts are different than PCA's where I work. We can titrate gtts, give boluses through the pump etc.. PCA's we have to get an order to increase or bolus.

[Music in My Heart]

I have a hard time believing that the nurse was doing anything too wrong... seriously, what nurse with a lick of self-preservation would so blatantly violate federal law by repeatedly administering unauthorized narcotics - right in front of students and a nursing instructor?

Everybody knows that some nurses use 'nursing doses' or 'patient wastes' with some regularity, but everybody also knows that those nurses don't advertise their felonious behavior.

It's kind of like Fight Club.

There simply must be more to this than the OP is aware.

[nurseprnRN, BSN, RN]

DL has been part of the lexicon for as long as I can remember. I am on the east coast, maybe it's a local thing. PRN, ASAP, DL, BON. Isn't it great to learn new things?

Around here, "DL" means "disabled list." As in, "The Yankees have six of their usual Opening Day starters on the DL." (Hooray! Opening Day is tomorrow!)

[hodgieRN]

R.Kelly likes to keep it on the down low....nobody has to know!

[LadyFree28, BSN, LPN, RN]

R.Kelly likes to keep it on the down low....nobody has to know!

^

I was thinking the SAME thing...along with the other poster's comments...it was only a matter of time... lol lol!!!