New Grad and scared might get fired

[NN2BVE]

Ok, here is my story:

On July 25 NOC shift we had a bad case of infiltrated IV case that is now being investigated by the management. The resident was on continuous D5 ½ NS +10 KCL for dehydration, was assigned for another nurse, LVN. At the report time the out coming RN told me that I have a new IV bag to hang (me being only RN at night). After midnight on the way to another station I stopped in the room to check when I need to come back to hang another bag. There was more then 250 cc left in the bag, so knowing it is running at 50ml/hr I wrote myself note to come back in about 4 hours. I did not assess this resident at that time since it was not my resident. I did look at the arm with IV site, it did not look swollen or red, and the IV was running without problem. But then again, it wasn't really thorough assessment.

Shortly after 1, the LVN assigned to that resident told me, you have an IV bag that you would have to hang later. She asked me to take a look at the site. I said that I already did and it looked fine. AT around 4 am my coworker called me to the resident room. The IV had infiltrated and the arm now was swollen to the shoulder and was oozing with fluids. We stopped the infusion, elevated the arm and applied warm compress to the arm. The resident had no signs of any distress. I did assessment for the integrity of circulation in the arm. All fine. I did not start new iv at that time. TO tell the truth, me being a new grad and never until that point started IV at the facility (The residents usually get to us with PICC lines or the rare PIV that I came across during my 5 month of work started during day shifts) I was really sure that I would not be successful to start IV on my own and did not want to subject the resident to being guinea pig for my practice (Last time I started IV s was in nursing school more then a year and a half ago). The LVN who was assigned to that resident did not think to restart IV either exactly for the same reason (she is IV certified). There was only one more nurse in the building and he was really busy and said it would be bad time now. So we made sure the resident is stable and continued with our med pass.

I have a very nice ADON, I have asked her many questions in the past and she was always great resource to me new nurse. She always said, if you have any questions don't hesitate to call me at any time of the night. So I insisted my college call her, just in case I missed something. She did and ADON said to try to reinsert IV any way. I did, and got in first try! That IV hydration that she got before must really have helped. I checked with new bag against the MAR (which did not have stop day. Should have alarmed me) and hanged it.

Next day my DON called me to the office. (july 26th). She said that IV infiltration probably had started long ago before 4 am and that would I assess the arm, I would catch it earlier. Truth. I felt the same way. I looked briefly, I did not properly assessed. And then the order was only for one bag. Truth again. I did not check the physician order, I only looked in MAR. I learned a lot during that meeting, but I definitely did not feel that I might be in a real trouble. The DON said that she would like to follow up with me and we set up to meet on Monday after I finish report. She called on Monday to say that she cant make it on time and that I should go home to rest after the night. We rescheduled for next day, again after I finish report. Tuesday, she called again and rescheduled for Friday. Today, I saw her coming early and going straight to the business office. That scared me so much. I heard stories of nurses getting checks at the time they are fired.( When I got to DON office, she said again she did not have time for me, and would like to set up a proper meeting. She said she will call. All this anticipation is making me very scared. I am afraid they are building a case against me and would fire me.

It gets even more complicated than that. It was not the first time I got written up. I got written up the very first night on my own after orientation. I made a med error. (no harm done ) it is a very busy sub acute center and I was having hard time. But don't get me wrong, I accept whole responsibility and really did learn from it and really check against the MAR my meds.

So do you think it is still possible that they would let me work more than a week after the incident and still fire? Any advice how to handle my self during the meeting (whenever that will be)

Thank you for sticking with this long story.

Sleepy, scared head

[Anna Flaxis, BSN, RN]

I think you're probably getting yourself all worked up over nothing. What matters most is that the resident will be okay.

[glutton4punishment]

wow, you poor thing. Sorry you are going through this.

From what you wrote, it sounds pretty harsh to get fired over this. First, you got written up over your first med error? Our policy is, the first time, you get a verbal warning.

Also sounds like your position is waaay over your head for a new grad. You are the only RN there at night? As a new nurse, we HAVE to learn. Mistakes are inevitable, and any nurse will make many over their career life. An infiltrated IV? Happens all the time, and I am certain that will be the first and last time you make that mistake.

I feel like from your side of the story, they should not have put you in a position without support from a more seasoned nurse. I mean, if you have never started an IV since nursing school......beware of these kind of places. Remember, it's all about covering your own a** in any patient care situation. No one wants to take the fall and admit wrongdoing, it's just unfortunate that you were set up for failure. You will learn that you are your own advocate, and you have to stand up for yourself. Please don't take assignments that are unsafe for patients, as us newbies (1 year for me) try to do our best, and can be naive due to lack of experience. I used to be very timid, and would say "yes" to anything. I very quickly learned that I must change or get into situations that were potentially dangerous.

Anyway, I hope you don't get fired, and I hope you recognize the lesson in your situation. You sound reasonable, and prayers that it works out for you.:heartbeat

[tyvin, BSN, RN]

As I read your post I thought "oh ouch" when you didn't go back to look at the site. Just because it wasn't infiltrated at one hour doesn't mean it can't get very bad in 1 hour. You've learned your lesson. I wish the LVN would have been a little more abrupt with you and insisted that you look when you didn't. Things change quickly. Hope it all works out for ya.

[chulada77, ADN, BSN, MSN, APRN]

I know that each state is different but the LVN can be focused assessments in my state and an IV site assessment would've been a focused assessment. Naturally that nurse couldn't do an intake or full-on assessment but an IV site....Regardless, infiltrations happen in acute settings so that couldn't have been a shocking occurrence.

At this point there is nothing you can do but take your lumps. I'm sure you learned a huge lesson and it seems like those are the lessons that stick with you and make you an even better nurse. No worries, Girlie!

[FlyingScot, RN]

I think you've learned the hard way and I hope it sticks with you. If someone, anyone, has a concern about a patient you absolutely must assess the patient and document what you find. This will go far to protect you in the future. This is your take away lesson and when you meet with your ADON you need to address it. Medication errors happen because systems aren't perfect but essentially ignoring a concern from another staff member is on an entirely different level and is inexcusable. I doubt you will be fired but you are going to need to be able to verbalize what you are doing to make sure nothing like this ever happens again. This should be your focus now. Best of luck to you.

[brandy1017, ASN, RN]

The problem began when you said it wasn't your patient, but actually it is even if the LVN is assigned you are responsible for the LVN and ultimately responsible for the patient and what happens.

The LVN should have been watching the IV and certainly should know if an IV is infiltrated. That said this happens and at least the IV fluids weren't vesicants like dopamine which could have a very bad outcome of skin sloughing off. This patient should recover ok.

It sounds like the DON is too busy to talk with you and you will be ok, just be careful in the future!

[Been there,done that, ASN, RN]

Why are you responsible for an LVN that is certified in IV's? It is her responsibility.

They are running on a skeleton staff, because their bottom line is PROFIT.

Don't let them make you responsible for the entire unit, because they are cheap.

Infiltrated IV's happen all the time.You treated it properly.

There is no way we can check orders to the MAR for each med/IV. Whoever transcribed the order made the mistake. It should have been clearly indicated on the MAR that only one bag was ordered.

Highly doubt they are going to fire you, they're too busy using and abusing you.

[tballsRN]

I feel for you because I am a new grad in a position that is a little over my head... Im starting off in the ER. I am still on orientation, but reading your story is a valuable lesson for me, so thank you for posting. I gotta be honest... sometimes getting fired is a blessing in disguise!

[pixie120]

I know that each state is different but the LVN can be focused assessments in my state and an IV site assessment would've been a focused assessment. Naturally that nurse couldn't do an intake or full-on assessment but an IV site....Regardless, infiltrations happen in acute settings so that couldn't have been a shocking occurrence.

At this point there is nothing you can do but take your lumps. I'm sure you learned a huge lesson and it seems like those are the lessons that stick with you and make you an even better nurse. No worries, Girlie!

Having been LPN and now RN, couple concerns here. LPN assigned to patient, should have been assessing all along (I assume this is a SNF?) and you as the RN, with the bigger scope of practice, should have done the assessment at the beginning of the shift, which includes check the order. If I were your DON, I would send you to IV training and I want to hear that you KNOW you failed to do a complete assessment at the beginning of your shift, as the RN and that you DID tell the LPN to assess and report any findings. I would NOT want to hear "Because it wasn't my patient", it IS your patient, at least the arm with the IV is....

Infiltrations happen fast, the DON is just suggesting toyou that you are not being truthful but she can't prove it, don't own that, own what you did do which is assess and have LPN report. I am also concerned about that other nurse who was "too busy" to restart an IV. What is more important than hydration? PLEASE learn to triage priorities. PO MEDS ARE NOT THE MOST IMPORTANT PART OF LTC/SNF's!! Safety, hydration, mentation and the ABC's trump PO meds.

[NN2BVE]

Thank you everyone who replied to my post. I definitely learned my lesson here. When I meet with the DON I will accept the responsibility for my part in what happened. I will also ask for full clarification from DON of my responsibility as an only RN in the facility during NOC shift concerning assessments and monitoring of residents with IV therapies assigned to LVN. I wish I thought about this in the beginning. The orienting me nurse explained that we only hang the medication for LVNs. But I should have known better to clarify. Lesson learnt.

Anyway, thank you again for everybody. This board provided me with a lot of support during my nursing school and now as a new nurse. I am greatfull for that.

[Oprn54]

I agree with Pixie. A lot of balls were dropped that night which I'm sure none were intentional, or done with malice towards the resident. First of all...if you're the only RN on that shift...they are ALL your residents. You are in charge whether you want to be or not...or whether you feel ready to be. I think they did you a great diservice by putting you in that position at least not without a more experienced nurse on hand. The lvn should have been checking on the resident, and the fact that it wasnt noticed til 4 AM suggests she wasn't very viligent. Also the nurse you asked to start the IV should have at least gone to the room and done her own assessment before stating she was too busy. If I was DON I wouldn't fire you, but everyone involved would be written up and educated. If you end up getting fired over this you probably are better off cutting your losses and finding a facility more in tune to new grads and what they are and arent capable of. Critical thinking is a skill and not one that comes when you get your liscense. It takes time, and experience to develop. I think in the situation you were in you handled it welll. Best of luck to you :)