I was written up and put back on orientation

[Kalicokats]

I am an rn at a small rural hospital 4 months in. I had a pediatric post op ruptured appendectomy patient. He was npo about 5 hrs of having him his bowel tones returned so I let him have ice chips he handled that well so I let him have a few sips of apple juice about 2 hourd after tje ice I did not call his doctor to okay this and I have been reprimanded and put back on orientation if I have any more mistakes or complaints from docs or coworkers in the next 30 days I will be terminated. I thought this was what I was supposed to do.

[JustBeachyNurse, LPN]

Now you know. You won't repeat and perhaps enlighten another newer nurse should you be in a similar scenario. The key is to learn and move forward.

[amoLucia]

You were given a second chance with the writeup & repeated orientation period. Your employer could have terminated at the time (assuming you work in an at-will state). So just learn from your mistake and proceed. Always err on the safe side re pt care; you're still learning.

Good luck.

[iluvivt, BSN, RN]

You need to do a couple of things here

1. Read the Nurse Practice Act and find out legalally what you can do and what is considered practicing medicine. I am still surprised how many nurses fail to do this!

2 Read all your hospital policies that pertain to patient care and especially in the area in which you are working.

3 Lastly once you have 1 and 2 seek out your experienced colleagues and ask them their opinion when you run into an issue like this

This will help you know your boundaries and role and then hopefully good judgement will follow.

[Kalicokats]

We don't have any policies or procedures to go over it is a bit disconcerting. I will definitely take the other advice to heart

[anon456, BSN, RN]

If the order is NPO and the parent and child are not upset about it, leave until am or perhaps offer oral swabs. It is NOT within nursing judgement/scope to advance diet without physician order.

If you advanced to ice chips & apple juice without an MD order ( especially in a post op perforated appendix child) you were wrong and could have caused significant harm to this child. You might have gotten a verbal for ice chips but advancing to apple juice without a physician order went too far. Either say no or call the MD. (Even if overnight shift, I'm sure the MD would rather get your assessment and request in the middle of the night rather than risk patient safety).

What JustBeachyNurse said. Oftentimes it's just a matter of providing education to the family about why they child must remain NPO for the time being. They obviously want to see their child get better and avoid any complications that starting PO intake might cause.

I have seen ruptured appy patients remain NPO for days and started on TPN until they are absolutely sure the patient is okay to advance to even ice chips. Or I will get very specific instructions: 2-3 ice chips every 15 minutes, not more than this.

Oral swabs are a great way to placate people who are NPO. And you get bonus points by being able to chart "oral care performed" if you use the special oral care mouthwash. ;-)

[Esme12, ASN, BSN, RN]

We don't have any policies or procedures to go over it is a bit disconcerting. I will definitely take the other advice to heart

I'll bet you do...you just need to ask where they are....the issue here is that there was no order. we all make mistakes ((HUGS)) now llearn from it and be very careful with what there order says...((HUGS))

[jadelpn, LPN, EMT-B]

We all make errors in judgments. Another thought process would be that I would also ask at report "Is the patient still NPO? Has the MD talked about advancing, or have you spoken to the MD"? (and if so "did you get an order?")

That way, when you call the MD at midnight (and always pass this by the charge nurse too--"hey the perf is starving, Mom is less than impressed, can we call the MD for ice chips?) you will not get an answer of "you are the third nurse who has called me. NO."

It is never easy to be left with a kid who is hungry, and shame on no one else for addressing this earlier. But the BIG thing you just need to take away from this is that diet advancement is an order, (as are other primary aspects of a patient's care--like activity, vitals, etc). Use this time of orientation (which is really not a bad thing!!) to fine tune your practice! It is NOT a matter of "I shouldn't be a nurse, cause I suck"!! So, go forward--you are new, you are learning, and thank goodness your unit is not going to leave you in the middle of the ocean to drown, but give you opportunity to fine tune.

Best wishes.

[dudette10, MSN, RN]

I don't know how long they wanted him npo or why it may have been a long period of time. The orders were very brief and did not include much info. I definitely should have called the doc to clarify orders and ask about the npo. My great big mistake and I didn't even realize how big of a mistake it was until everyone has shed light on it for me. Thank God no harm came to the patient.

Now you know it was a mistake, but do you know why? Do you understand why, given the patient's diagnosis and surgery, that not keeping him NPO was a mistake? If not, research the location and anatomy of the appendix, complications of appendicitis, and appendectomy. That will help your learning even more.

[LadyFree28, BSN, LPN, RN]

I'll bet you do...you just need to ask where they are....the issue here is that there was no order. we all make mistakes ((HUGS)) now llearn from it and be very careful with what there order says...((HUGS))

This.

Please use this opportunity to learn your nurse practice act and P&P as stated from iluvivt.

Also, moving forward, mouth care is a saving grace for NPO pts; it can be done every shift, every four hours, every two hours, every hour, whenever you do rounds, upon nursing judgement...the BEST part is it's a nursing order/judgement, no need for a Dr.'s order!

When in doubt, use all nursing measures (look those up as well) during the post operative phase; give your rationales to the family, if or when it gets a little hairy, you can call the provider and explained what you did-either way the family and/or provider will thank your nursing judgement and measures.

[nurseprnRN, BSN, RN]

We don't have any policies or procedures to go over it is a bit disconcerting. I will definitely take the other advice to heart

This cannot be true. One of the required elements to get a facility licensed is to have policies and procedures.

Also, the nurse practice act and the ANA Scope and Standards of Nursing (a fairly slim paperback-- ten bucks at Amazon, pick one up) will give you a better appreciation for your scope of practice than you retained from school. Nursing is lifelong learning.

[Spangle Brown]

Thank you for sharing so everyone can learn.

[Kalicokats]

You guys are great thank you for the words of encouragement but most importantly thank for the suggestions for improving my knowledge.

About the policies, there is a binder which is a jumbled up mess of policies, pages are torn missing etc. They just began the process of getting this fixed and computerized so it is currently not something I can reference while they are working on it and the binder is in someone's office.