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?

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

So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.

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Specializes in Acute Care Cardiac, Education, Prof Practice.
So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.

Wide open to me means just that. The clamp is off and the body is taking care of the pace itself. Usually when things are running wide open we are talking a litre of fluid as fast as it will go. "Bolus" is whatever the speed is the doc wants it at, but mostly it is between 250-500ml over an hour in my experience.

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So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.

In both L&D and ER it is very common to run at least a liter wide open. The "speed"or manner of bolus given depends on the floor I suppose

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

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.
I have been an ER nurse a LONG time!!!!!!!!! We run gravity boluses ALL the time......we will also place pressure bag on fluids if necessary and the vitals require it to replace volume. Open the clamp and let her rip...while the patient is monitored for failure and vitals.

However.....even if it is a liter bolus.......I wait until the bolus is infused in the ED for the floors just do NOT have the staffing capacity to monitor these patients.....

from ChristineN

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

How long does it take to really infuse and ensure that patient is stable....that was a ER dump and they should be ashamed for transporting an unstable patient to a inappropriate unit.
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Specializes in Oncology.

I believe OP said this is telemetry. In my facility, a BP of 70/40 is completely acceptable for a tele floor as we have about a 1:4 ratio and are privileged to run vasopressin, dopamine, and neosynephrine drips. Before judging that the admission was inappropriate, understand that not all facilities are run the same way.

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Specializes in Trauma Surgical ICU.

Page 2 the OP said it was a med/surg floor... Several other posts said tele, who really knows.

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

I totally agree with the sentiment you are expressing with your first question....totally disagree with your second sentence.

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Specializes in Emergency Room, Trauma ICU.

So, when they said "wide open" that means run the bolus full speed on gravity? I've asked nurses at work about bolus speed and have gotten a range of answers, mostly 250 to 500 mL/hr but never wide open on gravity.

I'm an ED nurse and bolus is always wide open. If its on a pump it's at 999 mL/hr if its on gravity it's unclamped.

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"How long does it take to really infuse and ensure that patient is stable....that was a ER dump and they should be ashamed for transporting an unstable patient to a inappropriate unit." -Esme

Yup, it walks like one, and quacks too!

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Page 2 the OP said it was a med/surg floor... Several other posts said tele who really knows.[/quote']

Because the OP also states elsewhere that he/she works tele

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

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Specializes in Neuro ICU and Med Surg.
I believe OP said this is telemetry. In my facility, a BP of 70/40 is completely acceptable for a tele floor as we have about a 1:4 ratio and are privileged to run vasopressin, dopamine, and neosynephrine drips. Before judging that the admission was inappropriate, understand that not all facilities are run the same way.

Most tele floors I have been worked on do not allow titration of Neo, Dopamine, or to run vasopressin. This was a truly inappropriate admission. The pt should have been stabilized further or sent to the ICU for further management. This was a bad judgement on those ER nurses for letting that pt go up to the floor before the bolus being finished.

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Specializes in Med-Surg, Oncology, Neurology, Rehab.

OP: You ARE NOT a lost cause!! But never ever practice outside of the nurses scope of practice. Your preceptor should not have allowed that patient to come to the unit until her BP was more stable and her bolus dosing was complete. That is why she was percepting you so that "any problems" that arise she can intercept and advise you accordingly. Did your preceptor get reprimanded? The patient should never have left the ER in her condition and I would have called the doctor and refused to take report until I knew the patient was more stable. Best wishes to you in the future!!

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