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?

[Sun0408, ASN, RN]

It's kinda strange the pt had a bolus in the ED and 100ml/hr IVF but they were running "wide open" at arrival, sounds like a dump and run. The ED staff knew the pt was unstable but brought them up anyways. On the floor we would not have accepted such a pt and the nursing supervisor would have been called. A transfer to a higher level of care would be in order if the pressure didn't come up..

Where was your preceptor while all this was going on?? You are still on orientation and need guidance !!

[lolakbolak]

this is a little irrelevant but I am a little anxious and being brand new I was definitely nervous. My supervisor told me that "there is something wrong with me, she knew all along and couldn't figure it out, she could tell I'm nervous and uncomfortable and she gave me a referral to a counseling service

[Sun0408, ASN, RN]

Pt on a Med/Surg Floor comes with a BP of 70/40 and no Rapid Response is called? you should be fired.

That's a little harsh, this is a new nurse, still learning. The OP was concerned but her preceptor was not. Also not all facilities have a rapid response team.

OP, your gut was right, follow it. If you find yourself in a similar situation, go to your charge. For something like this, call the Doc.

[Sun0408, ASN, RN]

OP, I'm sorry but I went back and read some of your other posts. You are not a new nurse and seem to have past issues, I think this incident was the straw that broke the camels back as they say.. You wanted to go back to school, so here is your chance.

I do wish you the best

[blondy2061h, MSN, RN]

OP, I'm sorry but I went back and read some of your other posts. You are not a new nurse and seem to have past issues, I think this incident was the straw that broke the camels back as they say.. You wanted to go back to school, so here is your chance.

I do wish you the best

Oh man, just went back. 2 years of ICU experience and this threw the OP for a major loop? That does put a different spin on things.

[ChristineN, BSN, RN]

It's kinda strange the pt had a bolus in the ED and 100ml/hr IVF but they were running "wide open" at arrival, sounds like a dump and run. The ED staff knew the pt was unstable but brought them up anyways. On the floor we would not have accepted such a pt and the nursing supervisor would have been called. A transfer to a higher level of care would be in order if the pressure didn't come up..

Where was your preceptor while all this was going on?? You are still on orientation and need guidance !!

I am an ER nurse and we always run our boluses "wide open" and will often bring pts to the floor with a bolus still infusing. The difference is I would never send a pt to med-surg bed with a pressure like that

[lolakbolak]

Im so scared, am I going to be reported to BON for this?

[kristen312]

In past posts, you have mentioned pre-med and biochemistry passions...Why does this concern you if you're trying to make a career change?

[morte, LPN, LVN]

well, if there is not more to this story, what you really got fired for was "crossing" your preceptor.

[RN-LOGIC]

I highly doubt that you were fired for such incident. Be truthful to yourself.

[itsnowornever, BSN, RN]

Hmmm....you do have two years ICU experience. In 2012 you posted that you were a pre-med student/rn and then on March 15 talk about wanting to go pre-med?? I'm completely confused. 2yrs ICU and can't call a doc to handle a low BP?

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

[lolakbolak]

you're right i have those passions but after I realized how much med school costs and how little money I have and no one to support me or my goal I went against it.