Got fired for changing fluid rate

[lolakbolak]

I was on orientation on days and then got moved to nights which is what I was hired to do. It was my first night on orientation with a preceptor and I was not feeling the best, was very tired got an admission at 2 am and was up for almost 24 hours already. This admission was somewhat unstable, her blood pressure was 70/40's and she was lethargic. She got a fluid bolus in the ED and then she had fluids going at 100 ml/hr. When she got to my floor her fluids were running by gravity. I asked the transferring nurse what the rate is he said we are just running it free right now. I wasn't sure what her meant. Told my preceptor I'm concerned about the low bp. She said she wasn't. I was rechecking her bp every half hour because I was terrified I would find her unresponsive even though it was every 4 hours. Anyway I rechecked the bp and it was still very low and patient was lethargic. I increased her IV rate to 200 ml/hr and called the physician immediately. He told me to give her a bolus of fluid and the rate would be 100 ml/hr after that.

I know I was in the wrong for changing the rate without an order first. I understand that now. Am I a lost cause? Should I just forget about this and move on?

[nurseprnRN, BSN, RN]

You're not a lost cause, but if you knew it was wrong, I can't for the life of me see why you didn't 1) ask the ER nurse what "running free"meant, 2) ask your preceptor why she wasn't concerned, and 3) call the physician sooner. You have a license, you can do that now. Some people have low BPs because they have congestive failure, and more fluid makes them worse; the physician ought to have noted an admitting diagnosis; perhaps that was the problem?

[hopefulwhoop]

I'm confused. So, what happened after you changed the fluid rate? You got fired? Reprimanded? I am glad you realize why what you did was wrong, even though it was appropriate. You did so without an order and by initiating that, you were practicing outside your scope.

[ChristineN, BSN, RN]

I am sorry this happened to you, but, honestly, as an experienced nurse, I would have done the exact same thing. I find it disturbing the BP stayed that low for long, but you were being diligent and checking it. I see nothing wrong (assuming not a renal or CHF pt) with increasing the fluids briefly while calling the doc for an order. You called the doc, he agreed with your recommendations that the pt needed more fluid. Especially when you work nights sometimes it can take docs a while to call you back, so I understand the need to do something. Honestly going up by 100ml/hr really didn't even do much, compared to a bolus

[OCNRN63, RN]

It's not so much the amount of fluid; it's that he/she was practicing outside scope of practice.

[eatmysoxRN, ASN, RN]

You were fired for that? My facility has a patient first mind frame. Assuming no CHF, I'd open up fluids too. That patients pressure needed to come up.

[itsnowornever, BSN, RN]

There has to be more to the story. Perhaps I work in "bad" hospitals, but so far the two places I've worked this is pretty much how we do business.

Posting from my phone, ease forgive my fat thumbs! :)

[lolakbolak]

Her admitting diagnosis was UTI by the way

[SummitRN, BSN, RN]

her blood pressure was 70/40's and she was lethargic. She got a fluid bolus in the ED and then she had fluids going at 100 ml/hr. When she got to my floor her fluids were running by gravity. I asked the transferring nurse what the rate is he said we are just running it free right now. I wasn't sure what her meant.

This is confusing... so the patient was getting a bolus running free, you didn't understand the lingo then didn't clarify then reduced the infusion rate to 100 in a hypotensive pt? Perhaps that is why they were mad?

For the record, running free generally means you are infusing at the max rate limited by fluid dynamics, primarily IV catheter lumen size and hydrostatic head (height of the bag above the IV/pressure from pressure infusion system).

I think a lot of the picture is missing here. Such as why a patient described as hemodynamically unstable was put on q4h vitals? If as described, the patient needed an ICU bed or the ER should have stabilized further.

[SummitRN, BSN, RN]

Her admitting diagnosis was UTI by the way

So why were her pressures low? What was the CBC and lactic?

[Sun0408, ASN, RN]

What setting was this, a BP that low on a general floor is a concern. I wonder why your preceptor didn't intervene ??

OP, learn from this and move on. You did a few things right, next time and there will be a next time, call the PCP sooner. And anything you don't understand or unsure of ask..

[lolakbolak]

Sorry that's confusing, she was finishing up her bolus from the ED that's why it was running by gravity, and then the rate was supposed to be 100 ml/hr. I agree with you though this pt was not stable enough to be brought to a new nurse on a med surg floor