cardiac/bp meds- giving against policies/non-tele unit

[smartynurse]

Hi! this is my first time here in the forum. In fact, I just got my computer hooked up today in preparation for school (RN to BSN). I have been an RN for 9 plus years-worked in many different units and hospitals- was an agency nurse. I have always prided myself on being a prudent nurse,practicing w/in my scope and being a pt.advocate. For the past year I been employed at a major "top hosp" . The unit I work on is a med surgical unit. It's a busy place- of course acuity is high. The nurses give a lot of iv push bp meds, even though the policy for our unit states otherwise. My manager says they ( risk man.,pharmacy,nsg) are rewriting the policy to be more lenient, but supported me in my refusal to give the meds. She also said that other nurses could give the drugs if they want, which I think is wrong! Basically these meds are ordered EVERY DAY on many of our patients. We are not telemetry certified. Some nurses may have ACLS although I doubt they are current. We do up to 24 hour monitoring-but are not responsible for reading strips. Soooo- every day I go in there I have the possibility of having to deal w/this....it's embarrasing to me, and I have had some negative feedback....one of my nursing colleagues said that she gives it because "she is comfortable w/it"-I think many of these nurses think the reason I won't give the drugs is because I'm not competent which is wrong! I am more worried about legal prob. I am going to EAP for some emotional suppport. I am wondering what your opinions are and do you have these issues. Many nurses just give a lot of these drugs, don't even know the policy, I am not happy...:imbar

[allele, LPN]

Any patient in our facility who needs certain IV cardiac meds, such as lopressor or cardizem, MUST be on continuous monitoring. We get medsurg patients on our unit all the time if they're NPO and need cardiac meds. I would never give a med against policy, nor do I think it's wise to make the policy more "lenient" in giving these meds. How do you know if your patient isn't in a rhythm that may contradict giving these cardiac medications? What type of medications are the nurses you work with giving? Although I'll admit it's infrequent that something goes wrong after these meds are given, that doesn't mean it doesn't happen. Good for you for standing your ground! CYA as they say!

[UM Review RN, ASN, RN]

We have to be tele certified before giving IVPs of certain cardiac meds. Our patients are on continuous monitoring as well.

Don't go against the policy to give these meds, smartynurse. If anything happened, it'd cost you your license.

[Rapheal]

I agree with the previous poster. The policy is there for a reason. One patient goes bad and you will be out of a job and risk your license. The hospital will not back you up because you went against policy.

Don't worry about the negative feedback you have been receiving from other nurses. It is your license you need to protect.

[RNKPCE]

The only cardiac med that I think of that can be given on med/surg at my hospital is digoxin

[zacarias, ASN, RN]

. The unit I work on is a med surgical unit. It's a busy place- of course acuity is high. The nurses give a lot of iv push bp meds, even though the policy for our unit states otherwise.

How frustrating!! Great that your NM is backing you up but if the policy is not rewritten yet, no wonder it's concerning to you.

The nurse who says "she feels comfortable with it" may love to boost her own ego but the fact is the policy says no so she's in the wrong currently.

Do you have a STAT/resource nurse (a super nurse that floats around the hospital in emergencies or deals with practice questions)? Also, many units have local practice commitees that deal with practice issues and this situation seems appropriate to mention there.

The fact that you're going to EAP shows how much it is affecting you. I would encourage your manager to address this policy ASAP that you can feel better and other nurses will actually know what's going on (whether to give the med or not).

At our hospital, the policy was that certain BP meds could given IV by a nurse on that floor if its purpose was for lowering pressure. If the purpose of giving it was to convert to sinus rhythm, then we had to have a resource/STAT nurse there for first push. And these patients were monitored.

[dlmickley]

I agree ............... Stick to your principles !!! The patients deserve it !!

[ascnbe, ADN, RN]

I prefer to have a policy stating what drugs of this nature can be given and the route of administration. I would definitely not give the medication regardless of my "comfort level" if there is a policy that states it is not to be given. If any problem would arise, I can guarantee the hospital will not stand up in court and say we were thinking about changing the policy, or we allow the policy to be ignored if the nurse feels comfortable giving the med.

[cori.d]

I'm strictly a critical care nurse, but I occasionally (rarely) get floated to step-down/telemetry. I stick by the policies, because even though I know the meds and what side effects to anticipate, I'm busy with 5-6 other patients and don't have the time to do the proper follow-up. There are reasons the policies are made to be unit-specific...patient safety. If I can't do the appropriate monitoring and follow-up of an intervention or med, that patient should be on a different unit. Even if I'm competent in the intervention and monitoring. Way to go for sticking to your guns - a lot of nurses I know don't do that.