Got fired for changing fluid rate

Nurses General Nursing

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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?

Something does not add up with the story we have been given.

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Specializes in LTC, med/surg, hospice.

I do not follow this story one bit. I have never heard of,anyone being fired over such a thing especially during orientation.

How would anyone even know you had changed the fluid rate? You should not have documented any rate change until you had an order unless there is a protocol. What was your preceptor doing? How long did the patient get fluids at the higher rate?

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Specializes in Emergency Room, Trauma ICU.

I'm just confused about your work timeline. Plus you other post you were wanting to go part time and they already knew you didn't like it there. Sorry to say but you didn't get fired for a fluid change. Back to the OP did you try other things first like trendelenberg?

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You know how there's two sides to every story? I bet the other one makes a lot more sense....

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Specializes in Pediatrics, Emergency, Trauma.
Something does not add up with the story we have been given.

^...and in some previous posts as well...

OP I have a few questions...

Have you stayed long enough in a position to get a great base in your nursing practice??? I say this because one of your previous posts you worked in LTC and had a pt fall and several other issues happen during that position. You also state in another post that you work in ICU, another post Tele within a few months apart. I read your responses from your posts in this thread, including the "totally unrelated" post, where your NM referred you to counseling.

I'm asking these questions, because, my nursing critical thinking tingles want to know if you are having issues with your nursing practice, your desire to be a nurse vs a desire to be a biochem/pre-med student desiring to become a MD? You also said that you had "no support" in going to med school, however, if that is what you want, why are you in a profession where you are not enjoying or practicing to the standards, which could further risk your eventual licensure as a doctor because of potential failure to rescue or unsafe practice on a previous license, if your actions ever lead to that point and someone decides to report you.

I'm not saying this is going to happen or if this will happen in your practice. I'm concerned about your previous incidents and posts, and I wouldn't want you to run the risk of potential setback if you desire a career in healthcare which includes a license and, because of your "desire," your actions because you have not sought out that said desire, you actions may put a patient in harms way.

A few points I want to share with you; this is strictly my opinion, and it is strictly the best intentions for it to be positive:

1. You stated that you have "no support" in terms of having a career in medicine, or do you have "no support" at all? I don't know what you mean by this statement; I also understand that you may not want to answer my question. I hope that you have some form of a support system in your personal life-a confidant, another nurse as a mentor, etc. A former professor or clinical instructor to reach out to?

Find a healthy support system to ensure your success as a nurse, and in medicine, if you choose to go that route...

2.If you still desire medical school, you do have an opportunity to utilize your practice as a nurse if you decide to go that route. I suggest if you are having theory and practice based issues to try a nursing-refresher course, one that has simulation, a relaxed atmosphere where you are able to exercise your critical thinking skills, as well as give you opportunities to recognize, and intervene comfortably, without the risk. Utilize the refresher course as an opportunity to ask questions, gain confidence in handling situations, etc.

3. Review what areas of nursing you will feel comfortable in. What do you like in nursing??? Be honest with yourself. If it is a specialized area, I would still suggest getting a strong base in med-surg, then finding out what additional classes for that specialty. Look up important techniques on the Internet. This site has valuable stickies and even threads with ways to get valuable information in order to provide safe, effective care.

I also suggest getting this book: Critical Thinking and Clinical Judgement. I was given this book many years ago as a PN student. I continue to utilize this book as a RN. I live by this book. I have used this book for 8 years, and still enjoy refreshing my critical thinking skills, especially in a new environment.

If you are still able to utilize the referral from your management to go to counseling, I suggest you take that suggestion as well. It has the chance to provide support, as well as assist you in ensuring future success in the endeavor that you choose.

OP, wishing that you are able to find success beyond you career setbacks.

:up: :up: :up:

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

No. But your preceptor needs to wake up.

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Specializes in Pediatric Critical Care.

Ok, so I read the rest now. Um I have nothing important to add, except that this sounds like an ICU nurse move, bumping the rate before calling the doc :) (I'm in ICU, not slamming anyone)

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her blood pressure was 70/40's... she had fluids going at 100 ml/hr... I increased her IV rate to 200 ml/hr and called the physician immediately.
I don't understand why you would make a meaningless change like 100 to 200... a bolus I would get... "freely running," or "wide open" as I more often hear, makes sense but 200/hr?

In report the ED nurse said to run the fluids freely so what initially prompt you to change it to 100/hr? Typically, I'd let the ED bag finish running wide open since it was probably ordered as a 1000 cc bolus. Then I'd implement the 100 with a new bag... of course, even if I'd been foolish enough to take the patient, I'd have been on the horn with the doc before that bolus ever finished.

What were the historical BPs from the ED and for how long?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Pt on a Med/Surg Floor comes with a BP of 70/40 and no Rapid Response is called? you should be fired.

Just FYI.......Not all facilities have rapid response.

OP......Did you actually get fired? Did your hospital say they were reporting you to the board?

You were recently graduated in 2011...you stated in Feb that you have 3 years experience. You worked at an LTAC (Long Term acute care) which have ICU units.....is this where you worked in ICU? So you work telemetry now....right?

It is very difficult to say if getting fired was wrong or not for there is always 2 sides to every story. My first concern is about the ED transporting an unstable patient with a fluid bolus still infusing....that is a dump in my book...... by any standard.

Why was your preceptor not concerned about the low B/P? To me..it sounds she was setting you up to fail....however as an experienced nurse, of three years, this situation shouldn't have thrown you. How long did the IVF infuse until the MD was notified? Why was a patient with a UTI and a B/P of 70/40 admitted anywhere except ICU...something isn't right.

You have experienced other conflicts and seem to have some significant growing pains which you may need to honestly reflect upon and see what you may change within yourself to grow as a nurse. Acclimating to nursing is hard. Conforming can be even harder. In nursing the patient don't deserve less if you are tired and don't feel well....you still have to perform at top form.

You started this job recently and since you have started you have wanted to go part time, argued/refused the flu shot had complaints from families and

responded with a harsh/abrupt manner.

I don't think as a nurse with 3 years experience a fluid bolus and calling an MD should throw you for a loop..however you preceptor was inappropriate in abandoning you when clearly you were concerned. Where was the charge nurse?

There are more question than answers ......I wish you the best.

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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.

Right, not all have a rapid response team. My hospital does, but the entire time I was in orientation, NO ONE ever mentioned rapid response to me. Ever.

For a while I was uncertain about when it was appropriate to call them, but I've since been told that any time I want a second opinion or I am unsure about something or whatever, give them a call.

Our local hospital doesn't have rapid response.

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Specializes in Neuro ICU and Med Surg.

This was a totally inappropriate admission to a med surg floor from the ER. Where was your preceptor? Why on earth weren't they concerned regarding the BP? Something just isn't right about this whole story.

For those who do have the rapid response team I encourage you to call if you are uncomfortable with a patient for any reason. Sometimes you just can't explain it but there is something off. Being a rapid response nurse this patient is a for sure call.

Others to call for HR 130, RR 30, SPO2 180, acute mental status changes, anytime you feel something just isn't right. If you see us rounding don't be afraid to stop us and ask questions. We are there to help out.

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Specializes in Acute Care Cardiac, Education, Prof Practice.

70/40 after a gravity bolus. I wouldn't have rechecked the BP over and over, I would have just called the doc right away to see if they wanted another bag in.

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