Clinic infusions

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Hi everyone. I have a dilemma. I currently work in a headache clinic. I am currently on maternity leave and have been doing everything in my power not to go back. While on leave they got a new PA and Neurologist. I have been getting texts from the MA asking about infusions and medications. From what I've been told the neurologist wants to start giving a lot of different infusions and the other nurses in the building have been starting the IV's but refusing to give the medications. I am a former ER nurse who had policy and procedures for everything. Well coming to the clinic they have none. I was told by my old supervisor (who is a RN and currently left) that the clinic does not need any policies or procedures. So heres my concern. 1. i have no policy for starting an IV, monitoring, or even what to do if a reaction should occur. IV's are considered invasive. I have been starting IV's in the clinic (because I feared I would be fired for saying no) and had the NP (who doesn't trust me because I question her on a lot of things) tell me to keep a IV running that looked like the patient had either had a reaction to the medications I had given (NS, Toradol, decadron, and zofran) or had phlebitis. I refused to keep the infusion going and d/c'd the IV. This situation scares me, as I don't want anything to happen to the patient but also would like to keep my license. Also, what happens if they do get phlebitis? What happens if they faint while getting an IV in? How many attempts do I do for an IV? 2. I found out they want to start doing depakote infusions, DHE infusions, Mag infusion among others. I currently work in a stand alone clinic with no code team, code cart, cardiac monitoring. I have no way to monitor these patients. They do not do urine pregnancy test on patients that they are bringing in for these treatments (who are of child bearing age). Some of these meds can have serious side effects. Bottom line I don't feel comfortable giving them. Am i justified? Can I refuse to give these medications? Can they fire me if I do refuse to give them. I have talked to a couple of friends and they say the wouldn't give them and that they have policies in there clinics. I have also attempted to write policies in the past and the provider at the time (the NP) refused to sign them. Now that my old supervisor left, I have non medical personnel over me. Help!!!!!

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Specializes in Vascular Access.
Hi everyone. I have a dilemma. I currently work in a headache clinic. I am currently on maternity leave and have been doing everything in my power not to go back. While on leave they got a new PA and Neurologist. I have been getting texts from the MA asking about infusions and medications. From what I've been told the neurologist wants to start giving a lot of different infusions and the other nurses in the building have been starting the IV's but refusing to give the medications. I am a former ER nurse who had policy and procedures for everything. Well coming to the clinic they have none. I was told by my old supervisor (who is a RN and currently left) that the clinic does not need any policies or procedures. So heres my concern. 1. i have no policy for starting an IV, monitoring, or even what to do if a reaction should occur. IV's are considered invasive. I have been starting IV's in the clinic (because I feared I would be fired for saying no) and had the NP (who doesn't trust me because I question her on a lot of things) tell me to keep a IV running that looked like the patient had either had a reaction to the medications I had given (NS, Toradol, decadron, and zofran) or had phlebitis. I refused to keep the infusion going and d/c'd the IV. This situation scares me, as I don't want anything to happen to the patient but also would like to keep my license. Also, what happens if they do get phlebitis? What happens if they faint while getting an IV in? How many attempts do I do for an IV? 2. I found out they want to start doing depakote infusions, DHE infusions, Mag infusion among others. I currently work in a stand alone clinic with no code team, code cart, cardiac monitoring. I have no way to monitor these patients. They do not do urine pregnancy test on patients that they are bringing in for these treatments (who are of child bearing age). Some of these meds can have serious side effects. Bottom line I don't feel comfortable giving them. Am i justified? Can I refuse to give these medications? Can they fire me if I do refuse to give them. I have talked to a couple of friends and they say the wouldn't give them and that they have policies in there clinics. I have also attempted to write policies in the past and the provider at the time (the NP) refused to sign them. Now that my old supervisor left, I have non medical personnel over me. Help!!!!!

There absolutely MUST be policies and procedure information available to you. Now, whether that be in the form of a manual or a online printable resource is the choice of the organization.

If you were sued because of an infusion error, what would you say you followed to back up your actions???? Patient safety must be paramount and following a strict set of policies means that everyone is doing the same procedure and continuity is there.

Is this clinic receiving any type of aid from the government? I can't imagine that you are JCAHO certified. Providing Infusions to patients requires policies which include management of any and all complications should they arise. In addition, how do you know what your company wants to do in case the person has an anaphylactic reaction (much less phlebitis/infiltration, etc)?

These P&P MUST be reviewed by the organizations head, and signed off yearly and whenever changes are made. And yes, there also should be policies on how to manage a patient who vaso-vagels with line placement.

Access to emergency medication should be made available to all working in this place too. One should have to wait for a delivery in case of an emergency, unless your policy states: CALL 911 AND SENT OUT THE PATIENT STAT. But...of course, you should have a policy for that to happen.

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Thanks. I knew we needed them, but wanted to make sure I wasn't crazy. I am transferring out of the clinic and back to the hospital. I have tried bringing up the need for p&p to multiple people. They kept telling me we "are a grey area and don't need them". After that the NP started giving me a hard time and pulling me into meetings with mgmt. hopefully the next nurse realizes what's going on.

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Oh and when a patient has a reaction or vasovaguls while starting the IV, I basically was told to get the NP and see what they wanted to do. Problem was I didn't agree with what they told me to do (keep infusion going, try sticking the person again).

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Specializes in Critical Care, Education.

Wow;, you're in a real pickle. I completely agree with all your gut instincts. . . but of course, since my 'comfort zone' is Critical Care, I get nervous if patients aren't on continuous EKG monitoring. I think your decision to transfer back to the hospital setting is probably your only viable option at this time. Those are some heckova serious meds to be infusing without emergency response capabilities. My PCP is at a large clinic... they have an infusion suite. But I know for a fact (I have seen them) they have plenty of P&P and guidelines. Their 2 Infusion Suite RNs are also INCC certified.

Once you manage to cut yourself loose from that slipshod clinic, I hope you follow up with a complaint to the appropriate agency. If they are caring for Medicare/Medicaid patients, you can file a complaint with CMS. If there are medical practice issues, you could notify the state board of medicine... but if they're like ours, it will probably be ignored.

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So I am leaving the clinic. Got 2 job offers for pool pacu positions which work great with 2 young children. Thanks for the advice though :)

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