IV push failure - how I am failing

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I am new to the hospital environment and brand new to IV meds so when my preceptor said it was a mistake not to pause the heparin drip before doing an IV push dose of morphine I expressed understanding and told her I never knew that. I honestly don't remember learning that in nursing school so she told my boss and now they've added another week of orientation for safety concerns.

I am terrified they're going to fire me. I already had an extra week of training to hone my time management skills and then I do this! I just worry that there are other deficits in my education that will lead me to endanger a patient or get fired and I'm 37 weeks pregnant so I'm about to go on leave without really being on my own. I just feel like I'm failing and the preceptor says I didn't seem to understand how serious this mistake was. She's right. I didn't. I don't know what I don't know, you know? Are there other things specific to IVs that I should be aware of before I kill someone?

Susie, the basics about setting rates and such and starting IVs and hanging secondary lines, etc. unfortunately we only got one semester of clinical in the actual hospital because of space issues and I had all PO meds for the patients I encountered so I didn't get a chance

to do hands on learning. I then went straight into hospice with no IVs so there was never another shot at it. I have been reviewing things online to try and fill in the gaps tonight. I spoke to another member of my class and she doesn't recall this lesson either. It scares me. I am trying to teach myself now to make sure this doesn't lead to a negative outcome.

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Susie, the basics about setting rates and such and starting IVs and hanging secondary lines, etc. unfortunately we only got one semester of clinical in the actual hospital because of space issues and I had all PO meds for the patients I encountered so I didn't get a chance

to do hands on learning. I then went straight into hospice with no IVs so there was never another shot at it. I have been reviewing things online to try and fill in the gaps tonight. I spoke to another member of my class and she doesn't recall this lesson either. It scares me. I am trying to teach myself now to make sure this doesn't lead to a negative outcome.

Are your preceptor and your boss aware of the above? It is not clear from your OP. If I was in your position I would be very honest with your preceptor and your boss about what I had learned in nursing school about administering IV meds/IV fluids, and about needing more education/training in order to be able to administer IV meds/IV fluids safely, and would ask for help from your preceptor with all IV procedures. Patient safety is paramount.

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Thanks. I plan to do just that.

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I remember learning S-A-S when dealing with administering drugs through a line. Saline-Administer (the intended drug)-Saline. That prevents any mixing and incompatibility issues. For a heparin gtt, I would just have a second IV since you don't want to pause the drip anyway...even for an IVP med (IMO).

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You are far from the only new nurse who didn't know this information; I don't consider it "basic nursing" myself. Compatibility is usually talked about in terms of what can run together, not related to IV pushes. When I am charge nurse, or just the most experienced nurse on the floor, or a preceptor, I get questions about this. Sometimes experienced nurses have never had anyone tell them not to do that. I see so many variations in practice every time I go to a new hospital. Things that make the nurses GASP at one hospital are standard practice at another. In one hospital we routinely drew up medication for dilution in normal saline syringes and administered them in that way, which of course is wrong (I found out later) and probably made someone wonder "what kind of nurse I was" when I started at my next place. Yet at that next hospital, they were using multi-dose vials of insulin for multiple patients... something we would never do at that same first hospital!

Just based on this story, I'd say the preceptor overreacted a bit--it was a learning opportunity, which is what you're in orientation for, she should have taught it and moved on--but I get the feeling that there's more to the problem than this one incident, right? Good for you for trying to find out "what else you don't know", but I wonder if it is significantly less than the average person who is new to acute care. Good luck, try to learn, accept criticism--you'll be better off than the last new grad I had who was significantly behind the others.

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If you are still in orientation.. any medication you administer is under the direction of your preceptor.

Your preceptor failed to teach you the protocol.

You are in orientation to learn. You are not failing, the preceptor is.

I disagree. If she passed her boards, she was taught to look drugs up before giving them. IV infusions OR pushes. You don't rely on the preceptor for this. If there is a protocol, it's written somewhere, I guarantee she was told in orientation where to find them.

When in doubt, call the pharmacy.

I disagree that the preceptor is failing.

PS: I never pushed any drugs unless you count saline when I was in nursing school. I gave pills, started IV's, hung and changed out saline, that was it. However, IV compatibility is ANYTHING in the IV line. Doesn't matter if it's an infusion or a push. You have to check.

I was given a scenario of a drug I had never heard of during a demonstration during orientation at my first job. I asked for a drug guide. The nurse running the demo handed me one. The bag that was infusing contained potassium, the drug was not compatible with potassium. I looked at her and told her this and she smiled and said, "Correct...now what would you do?" I said, "Find out if this drug can be given IM or if it needs to be given by IV, stop the infusion, clear the line with saline or start a second PIV." She said, "Correct".

Unless it was a critical infusion (which I would learn about later), if you knew nothing else about incompatibility, you ALWAYS clear the line when in doubt....and like the other poster said...you have to know what is running to see if it is safe to "bolus" what is left in the line.

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Bonniesc, they just trained me to waste half the normal saline syringe and draw up morphine into that syringe and then use a flush before and after it. They said the only error I made was not pausing the heparin. Are you saying I shouldn't be diluting the morphine in the NS syringe because they said that was a no-no to push the morphine directly without diluting.

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They haven't said anything about starting a second IV line specifically for the critical infusion but I plan to discuss today to see if that's in the hospital protocol.

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Specializes in Critical Care; Recovery.

Also with a central line like a intrajugular, subclavian, or picc line, you can give incompatible meds in different ports because they release the medications at different points in the blood stream. If it compatibility is a big enough issue and you can ask the doctor to order a picc line.

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Specializes in Behavioral Health.
We also seem to have quite a few who have to take boards several times before they pass. I worry about the quality of the schools.

The statistics don't really suggest there's any trouble. Passing rates on the first try run ~85-92% year after year. The most recent dip happened in 2013 (from about 90% passing to 85%) when they raised the passing standard. If historical data holds true, it'll go back up just in time for the next test revision. Although, interestingly, 2000 was apparently a bad year to take the NCLEX (83.8% passed their first time).

Edit: Actually, 2014 was the worst year I found in the data, at about 82%. So either that change in 2013 was bigger than usual or you really should fear all new grads. ;)

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Specializes in Emergency, Telemetry, Transplant.
Are your preceptor and your boss aware of the above? It is not clear from your OP. If I was in your position I would be very honest with your preceptor and your boss about what I had learned in nursing school about administering IV meds/IV fluids, and about needing more education/training in order to be able to administer IV meds/IV fluids safely, and would ask for help from your preceptor with all IV procedures. Patient safety is paramount.

Good point. At my school, we could hang primary infusions and piggy backs, but we were not allowed to push IV meds. Maybe I've put this out of my memory banks, but I don't remember even going over pushes in lecture, and I don't remember "practicing" them in nursing arts lab. This is a real shame considering the high volume of pushes in various clinical settings.

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index

this is actually an icu guide, but it has so much good information in it for any beginning nurse. Check it out. The peripheral IV chapter is fabulous, lots of pictures and information and is downloadable as a word document.

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