How much trouble am I in?

[Tropicalsun]

My husband has been a frequent flyer in our facility. I've been there 8 years and float a lot so my face is familiar to about everybody. Issue is this during his last hospitalization, both of his IVs infiltrated. He was getting IV fluids and IV Dialudid. I pointed the infiltration out at 1800. At 1930 when the nurses rounded for report I pointed it out again and said I'm turning this off. "Oh okay" At 2030 I asked again for a restart. 2100 the student and preceptor came student tried once unsuccessfully. I asked if the preceptor would try, " no I want her to." I asked can I do this? Oh we don't know the policy on that.. 2130 "we're getting the veinFinder" 2200 "oh I forgot. Just a minute" 2230 I have to ask again. 2315 I ask if I can start it he's in a lot of pain. No we're coming right now. 2400 i started his PIV. Not saying it was my best decision, on no sleep and with no apparent nursing care for my husband it was done. Six hours of having no access pain 8/10 and they have access. Nobody saw me do it. However I'm called at home that I'm being investigated as a safety risk. The joke is it was still in an being used for the IV pain meds! I wasn't on the clock and my husband asked me to do it. How much trouble am I in?

[SororAKS, ADN, RN]

I do think I'd be looking for a lawyer, but this could go either way. You were off duty, but still an employee. As long as there was a valid order for that IV signed by your husband's physician, I'm not sure whether there's liability for that. I'd say it depends on facility policy, which I hope you have taken the time to look up. You did try to get the IV restarted via the usual channels. I think I would have involved the chain of command, however, up to and including your husbands doctor. I would do some research into exactly what your state nurse practice act includes, I would be willing to bet that there's at least a sentence or two about the nurse being the patient advocate and doing procedures with a valid physician order. Had there not been an order for an IV and you started one, things might be different. But I'm inclined to think that the worse thing you did was do something off the clock and not involve the charge nurse, house supervisor, or VP of nursing.

At any rate, be prepared. Get a lawyer, play hardball and don't let them bully you. Do your research, have copies of all relevant hospital policies and your nurse practice act, and know exactly what's in them. Keep adequate notes on the situation, from start to finish, observations and what you did to try and resolve the situation. Keep a written log about who contacts you, dates, times, what they say. Take pictures of your husbands IV sites. Do let them know that if they try to hang you out to dry you will not only call the State Board of Health on them, but you will consult an attorney, take your husband's care elsewhere, and show them a copy of a written complaint you will send to their insurer if they try to fire you.

That said, I don't think it was the best decision to not involve the charge nurse or supervisor, but I think most of us would have done the same thing. If you aren't fired, be prepared for some resistance and resentment. Stick to your guns. What happened with your husband was unacceptable nine ways from Sunday.

[brandy1017, ASN, RN]

I hope you're not in trouble. They should be apologizing to you and your husband for leaving him in pain and no iv access for hours! I would defend myself they were in the wrong. Of course they will probably slap you on the wrist for putting the IV in. Perfect example why it's best to not go where you work for care. Did the nurse make a scene after you put the iv in and report you? Should have thanked you instead and looked the other way, but some people must do everything by the book and make an issue when all you were doing was caring for your husband. I hope it turns out ok for you and that your husband is getting better.

[brandy1017, ASN, RN]

I suspect there's more to this story, as there usually is.

I'd fire the OP in a heartbeat if I were the boss. If I were the OP, I'd expect to be fired.

There were so many other avenues that could have been utilized. I have 80 year olds that know enough to call the ER or the nurses' station dozens of times, until they get what they want.

I get that the OP was in a bad place. Husband nagging, no sleep, no response from his nurses, not wanting to rock the boat where you work... I get it. I've made equally dumb decisions.

There are always consequences.

As an aside, my name and the reason I came to AN was a question like the OPs.

I got fired as I expected to. But I also was reported to the BON. I hope that doesn't happen to the OP.

That is very harsh! They should have fixed the IV hours ago! Next time if there is a next time I would go to another hospital where I didn't work.

I guess I'm not the management type or the by the book type. I would have looked the other way, thanked the nurse, and apologized for not getting the IV fixed in the first place.

Thankfully where I work we have various resources and if we aren't able to get an IV we call the IV team in for a midline or PICC line, we don't just ignore the patient!

[martymoose, BSN, RN]

dumb question- why didnt the pt's nurse get an order for IM or SQ dilaudid, or at least PO??? usually when I have some one who is having acute pain we have a backup available. If not, we call the doc ,explain the situation, and they rarely give us a hard time about modifying the order , or giving a 1x order until access is reestablished.

I really wonder about the competency of the pts assigned nurse. "oh, I forgot?????"

Im sure we'll start seeing more of this as hospitals drive nurses away and have to rely on new grads to staff them.

unless I am wrong , and the pt insisted on IV only. well thats a different story.

[imintrouble, BSN, RN]

That is very harsh! They should have fixed the IV hours ago! Next time if there is a next time I would go to another hospital where I didn't work.

I guess I'm not the management type or the by the book type. I would have looked the other way, thanked the nurse, and apologized for not getting the IV fixed in the first place.

Thankfully where I work we have various resources and if we aren't able to get an IV we call the IV team in for a midline or PICC line, we don't just ignore the patient!

It was harsh. The truth is, there is no excuse for performing an invasive procedure on a patient while you're off the clock. You can explain it. You can rationalize it. But there' s no way to excuse that lapse in judgment.

Is the sticking point here the fact that the OP was an employee at the hospital where she started an IV off the clock?

I doubt a single one of us would have turned a blind eye to a stranger starting an IV on our patient. I would have reported them to management the minute I found out. Why would we treat the OP any different?

[TheCommuter, BSN, RN]

dumb question- why didnt the pt's nurse get an order for IM or SQ dilaudid, or at least PO??? usually when I have some one who is having acute pain we have a backup available.

Yep. A couple of years ago, we received a male in his 70s who was in acute pain status post hip ORIF that had been performed two days earlier. Until IV access could be reestablished, he was receiving Dilaudid IM along with Ultram PO.

If a nurse cannot establish IV access in a timely manner, (s)he needs to come up with a viable alternative or involve any resource persons that are available to assist.

[Ruby Vee, BSN]

That is very harsh! They should have fixed the IV hours ago! Next time if there is a next time I would go to another hospital where I didn't work.

I guess I'm not the management type or the by the book type. I would have looked the other way, thanked the nurse, and apologized for not getting the IV fixed in the first place.

Thankfully where I work we have various resources and if we aren't able to get an IV we call the IV team in for a midline or PICC line, we don't just ignore the patient!

Not harsh, just realistic.

Yes, "they" should have fixed the IV hours ago. And "they" should have found another way to medicate the husband for pain while they were waiting to fix the IV. But looking the other way is not the way to go about it, either. The OP could have spoken to the charge or the nursing supervisor, called the patient's provider to try to stick him, contacted the rapid response team, been a squeaky wheel. Starting the IV herself was not smart.

[12rn]

I hate to be all holier than thou, but I would NEVER! I know it has been said time and time again, but I would have been raising hell and going through the proper chain of command.

Best of luck to you. It sounds like you were in an awful situation and did what you knew to do at the time. I hope with hind site being 20/20, you would make a better decision next time.

[Zedrek]

I hate to beat a dead horse here but there's no excuse for not going up the chain of command or at least finding someone there on the clock to fix the IV. If you've been there for eight years then you should have known how to get it done properly. Good luck to you though.

[OyWithThePoodles, RN]

I probably wouldn't have started an IV on my family member unless the charge or house sup gave me permission. That being said, I have let nurses that work in my hospital start an IV on their family if they were a hard stick.

Also, some people do not have an option to go to another facility. When I had insurance through the hospital I HAD to go there if they provided the services I needed or it wouldn't be covered.

My guess is (and this is just a guess) that the wife, even though she was only looking out for her husband's best interest, got on the nerves of the nurse by "hounding" her to pretty much just do her job. Which the nurse sucked at honestly. I would've been grateful for her starting the IV, but the husband's nurse probably wanted something to complain about to take the focus off of her negligence.

[anangelsmommy, ADN, BSN, RN]

dumb question- why didnt the pt's nurse get an order for IM or SQ dilaudid, or at least PO??? usually when I have some one who is having acute pain we have a backup available. If not, we call the doc ,explain the situation, and they rarely give us a hard time about modifying the order , or giving a 1x order until access is reestablished.

I really wonder about the competency of the pts assigned nurse. "oh, I forgot?????"]

THANK YOU!! I was wondering this myself while reading through all these posts! How do you forget for 6 hours and not at least get an order for a patch or injection or PO med???

And I have to say that I am very surprised that you allowed this to go on for such a long time. There would never be an excuse that I can think of for it to go on longer than 30 to 60 minutes, if they are really busy and had to get another nurse to stick. I have had one child who basically lived in the hospital for three years and then was a frequent flyer for the next 11 years before he died, and another that has had a few surgeries. I have had pain medication take a while before and my child was screaming in pain, and I went off "terms of endearment" style! I could never allow a family member to be in pain for a long time, I would insist that if they are not getting the meds or the IV now, that I speak to the supervisor NOW....and go from there.

Sincerely hope that you do not get in trouble, would love an update. But I agree with all those that have said that you should contact a lawyer/insurance. information is your best defense right now.

[mpier]

SHOULD you be in trouble? I would say no. WILL you be in trouble, unfortunately, probably.

I was in the ED with my mom, who was curled into a ball because of pain and nausea (mom is a cancer patient). The nurse couldn't get her port to flush, hadn't drawn up the pain meds and zofran. I said, "here, please, let me do it." Fixed the port while the nurse drew up the meds. The nurse's response: Thank you so much for helping me! I feel so bad! I have family members all the time in the hospital who often know more about making long term IV's work than any of the nurses, especially in oncology. They do this all the time.

I would have started the IV too, after asking the staff if I could. If they say no, then they better get one in STAT or I'm making a huge stink!