Absolute No-No's

[Drysolong]

Hi: I hope to get a lot of input from this question. As experienced nurses, what are some things especially related to medication administration, but anything else, that you would classify in red for a nurse to never, ever do? Also, what have been the consequences of nurses doing these things? Thanks, in advance!!!

[cyndilou]

Ewwwwwwwwwww!!! Yuck, and Gross!

Come to think of it, I've seen this done too. Seasoned nurses who will handle blood products, IV's (inserting), and colostomy care barehanded (I think it was the WOC nurse!!)

As if they are truly not going to get slimed? I know that tape part is problematic, but.....

:smackingf

Just to add to the Ick factor...I'v seen herpes on a colostomy site always WEAR GLOVES!!

[sharona97, BSN, RN]

I have to disagree with your comment that LPN's learn the exact same thing in school as RNs. In the state that I work in, AA trained RN's have 2 years of college and BSN's have 4 years of college, while LPN's have 1 year of college.

Not always. I graduated as an LPN with an associates degree in applied science. 2 Years.

[ociusmedinfo]

I am always cautious about pushing any IV med. Especially Lasix. I've refused to push Lasix on patients that had symptoms of cardiac or kidney failure when the dose was 40 mg. Smaller doses I'd leave to a decision based on an assessment. I've refused to push Lasix and make the resident who ordered it come up and do it. He was mad but subsequently his patient's heart failure got a lot worse and she was transferred to the ICU. Taking a verbal order and then pushing something that you, as a nurse, feel is wrong will come back to you. You might not be the most popular nurse in the place but you can go home knowing that you did your job.

I've also had docs decided that when I refuse orders that I think aren't appropriate and request that they come up and administer the med they will change their mind.

[ERRNTraveler, RN]

I am always cautious about pushing any IV med. Especially Lasix. I've refused to push Lasix on patients that had symptoms of cardiac or kidney failure when the dose was 40 mg. Smaller doses I'd leave to a decision based on an assessment. I've refused to push Lasix and make the resident who ordered it come up and do it. He was mad but subsequently his patient's heart failure got a lot worse and she was transferred to the ICU. Taking a verbal order and then pushing something that you, as a nurse, feel is wrong will come back to you. You might not be the most popular nurse in the place but you can go home knowing that you did your job.

I've also had docs decided that when I refuse orders that I think aren't appropriate and request that they come up and administer the med they will change their mind.

How would Lasix make Heart failure WORSE? If Lasix is being given for heart failure, it is obviously to remove excess fluid, so how would giving a diuretic to remove that fluid make the CHF worse??? My guess is that the patient's CHF getting worse was not caused by the Lasix.... Also, 40mg is not that big of a dose, if we're talking some serious CHF here....

Just my opinion.....

[ociusmedinfo]

In general it wouldn't. But giving a 40mg dose push is not a good idea when you have cardiac complications. The day I got the order I called the pharmacist for his opinion and he suggested a lower dose would probably be better. One side effect of that much Lasix is hypotension. Given the heart condition and the fact that her cardiac output wasn't that great to begin with the lower dose over a period of time was more prudent.

My point was really when following instructions without question or doing something that you may consider risky is never a good idea. The resident's decision not to come and push the Lasix was and my decision to call and talk to a pharmacist was probably a good intervention for this patient. Of course I got taken to task for questioning this resident. I know we've all be asked to do something that we weren't sure was the best idea given the patient's condition and that a lot of docs would blow up and complained because we just didn't get on with it, but I don't subscribe to that notion.

[pickledpepperRN]

Great advice here!

One more that we used to do in the 70s.

Don't give a placebo.

[rnparrot]

I want you to remember this statement when you have an 8 patient assignment on a floor when you are supposed to only have 5, the CNA and the Unit Clerk are out sick with a stomach virus which you know you will have tommorow. Your med pass is an hour behind, your three incontinent patients all need to be changed, two IVs just blew, one patient has a bp of 89/55 and the house intern hasn't responded to two pages.

I'm not saying you shouldn't do three checks and keep the six rights in mind, but don't say "never' until you've been there.

And I work in the ER, and I'd especially never give a med I didn't pull myself. It's too hectic. The only exception was a code when I gave tPA that was pulled up by the nurse standing next to me.

So what do I 'never' do? I never let myself get upset over a situation. I roll up my sleeves and do what has to get done. I also never put off my charting because I'll forget something important. I also never "forget" to take a break and use the ladies room. I never let a coworker flounder without help - even if I'm overloaded as well.

Blee

i would have to agree with you on this one...i work in LTC...with 21 patients, 2 cnas who have to feed them, change them (several times) and get them all into bed. no problem right? add in some one or two falls, skin tears, calling drs. and family members....and i almost forgot get out on time because OT is unheard of!!!:madface:

[FranEMTnurse, CNA, LPN, EMT-I]

i would have to agree with you on this one...i work in LTC...with 21 patients, 2 cnas who have to feed them, change them (several times) and get them all into bed. no problem right? add in some one or two falls, skin tears, calling drs. and family members....and i almost forgot get out on time because OT is unheard of!!!:madface:

When I was in training, I asked one of the staff what they do if they get behind in their work, and the staff member told me they just leave the resident in bed.:trout:

[buggal1989]

prior to about 1985, we did everything without gloves. there weren't any gloves available for us to use except the one box that was kept in the dirty utility room for the intern to use when they did a rectal exam. once you've spent a decade doing nursing care without gloves, sometimes you forget to don gloves before hanging blood, and as for starting an iv -- i learned without gloves. i have a lot of difficulty starting them with.

oh, but they weren't gloves - just finger cots (think of a condum for your finger!).

never ever not wash your hands - it takes 2 mins and can prevent infection - you and your patients!!!!! and gloves are not 100% protection - they have holes and can tear!!! not shouting - just got stuck on the cap lock key!

:welcome:

[buggal1989]

I've also had docs decided that when I refuse orders that I think aren't appropriate and request that they come up and administer the med they will change their mind.

And don't let 2 yr residents (teaching hospital) ignore the pts BP when you've called and called (ok - just twice) - and then let him gripe at you when the 4th year comes up and yells (and you know what he yelled!!!) at him over the BP when 2 yr. blames you (charting is great to show you've called and was picking up the phone to call the Medical Director when they floated into the ICU). And DON'T let him tell you how to mix Nipride when you know perfectly well the mix is WRONG and the drops per min are WAY TOO LOW to do any good. Stomping on his toes will make him leave you alone!

[buggal1989]

oh yes latex....... i once broke out so bad on my hands i actually thought i had kaposi's sarcoma. i had these big bleebs full of blood all over the backs of my hands. i was off for christmas day and the day after

employee health wouldn't accept that and made me have a titre. off the charts!!! then the told me i'd have to buy my own gloves. attorney took care of that.

but what helped more than all this is i ate some guacomole and about anaphylaxed.

related to latex sources. then they believed me when i almost needed tubing.

so to reiterate believe your patient if he says he's allergic even if the doc forgot to include it .

[[color=sandybrown]i have latex, betadine, certain narcotic, and avocados on that $40 bracelet.]

honey, you wouldn't have had that prob (buying your own gloves) when i was ic/emp health - in fact my facility was the first in the area to go "latex free" (which isn't possible maybe "latex reduced???) after a lot of screaming and yelling and holding my breath till i turned blue!!! also watch for tropical fruits - also related to latex. we had one nurse anaphlax (off duty) because she was latex sensitive and ate a lot of tropical fruit and then exercised - she had been told of the relationship. and if you couldn't figure it out, i'm latex sensitive too!!! an hey, be careful of latex fruit used for decoration - i had numb lips after i made an arrangement - dumb, dumb on my part - but i've passed it along now. the thing i miss the most is bubble gum.

now - i've finished reading this topic and will quit!!

[FranEMTnurse, CNA, LPN, EMT-I]

Heh, You should be around here where I live. The administrator was so eager to leave here she chose the quietest person she could find, then she told her everything except how to train the staff. :madface:I did that one staff member at a time. They didn't even know how to give bed baths. It was just yesterday that during my conversation with the person who created this place, and made the announcement that we're going to have to close if some kind of miracle isn't worked by the end of this month. I, the resident who is paying for this service am training the staff, because the person told the staff on the third shift to go to sleep. Now. How would you like to live here?????