Many RN's administer IV meds wrong.

[Guest219794]

PT has a heploc. Standard IV and extension. The nurse flushes, then administers the med, lets say 1 mg dilaudid in 1 ml very slowly. We all know Dilaudid given too quickly can be problematic. (as can many drugs) The nurse than flushes the line briskly to maintain a good line.

What has actually happened here is that the nurse gave the dilaudid very slowly to the extension. That extension holds 1.5 ml (or whatever) Then by flushing it it, the nurse delivers a rapid bolus to the pt.

Spending two minutes delivering a drug to pvc tubing, only to rapidly deliver it to the pt is nuts.

I see this frequently, and wonder if others see the same.

hherrn

[Lstcats]

that's not the way it works in texas. we have a maximum 10:1 student:instructor ratio in clinicals, and believe you me, with how low instructors are paid nearly every program is at that limit.

it is interesting to learn about other hospitals and states on this forum. i am finding out terrible statistics from other states on this forum. this being one of them. in ma, the law from born is that rn ratio is 8:1 and most do 6 or 7 students. pn is higher 10:1 but most are between 7-9. and, clinical adjuncts in ma do well compared to professors. professors make yearly salary on avg. of $48-50,000 per year in community colleges. clinical adjuncts make anywhere from $50-63 per hour which includes prep time. a hospital nurse with comparable education would make $100-120,000 per year. so, there are laws here in ma as i assume there are in tx as well.

now, our instructors are good, but they can't be at 10 places at once, often on multiple floors. we aren't under the instructor's license, as is popular misconception. we learn under a provisional student license the state grants to nursing schools.

i guess that every state is different. i have to carry my own educator malpractice insurancee in addition to my regular rn malpractice ins.

the instructors are responsible to make sure we are competent in our decisions and skills, but once we are competent, we also gain a certain amount of independence. this is necessary, because were it otherwise, despite the fact i graduate in exactly four months there'd be multiple days i wouldn't get to perform even basic tasks were instructor supervision required for skills at all times.

our school's contract with the locals hospitals operates under the assumption that the nurses actually responsible for our patients are our preceptors, and should be capable and competent to perform supervisory roles as needed to ensure the best for the patients.

i am hearing this a lot especially in the educator forum and the state of fl. i have been an instructor for over 2 years in 3 different colleges and at no time were the students ever under anyone else than myself. the nurses in the hospital or ltc facilities are not responsible or do they precept any students in the clinical setting. this is the way it works in the ma colleges that i have worked at all at the community college level. and, yes the nurses in the facility are ultimately responsible for their patients.

the point i'm trying to make is that instructors are not liable for students' mistakes provided the instructor has already verified competency and proficiency in a task or role. my instructor has seen me place a half-dozen ivs in clinicals, and knows i've placed hundreds with my er tech background. it is not her fault if i am starting an iv on a patient with the supervision of my preceptor nurse and i stupidly start an a-line by accident as she has validated my competency before granting me such independence (being "checked off").

you might want to post your views on the nurse educator forum and see what they say because i think they will agree with me. do you think the student would be sued since they do not have a nursing license? how could they be? it is not possible. the hospital, the school, and ultimately the nursing clinical instructor overseeing the student would be sued in any type of negligence. check your school policies and see what they say about your remarks and check with ana re; nursing student credentials and who is responsible. it may surprise you.

[LittleWing21, RN]

:lghmky: HAHAHAHAH this is a pet peave of mine too!!!! I asked this same question during orientation but my preceptor looked at me like I had five heads!!!

If the med is a small amt, I just shove it in the tubing! THEN I flush slowly.

[MIA-RN]

I avoid this by not pushing meds too often. I never push narcs either.

I am always interested in what meds are compatible. I saw an empty IV bag in the garbage that a nurse had labeled 'toradol' and 'zofran'.

I wonder if they are really compatible?

[SunnyAndrsn]

I was taught to push the flush at the same rate as the med, for the reasons you state. In my peds rotation, I accidently pushed the syringe pump clamp down to hard (it was sticky) and inadvertantly delivered the med, a small amount, maybe a ml volume. So we just put the flush on (more carefully this time) and selected the rate at which the med would have been pushed.

[Andrew, RN]

I slow pushed some pepcid and an anesthesiologist looked at me and said "Andrew... push it!" hahahahha