New nurse here and I need a little help

anne74 · Sep 28, 2006

We don't have a hard policy on checking insulin SQ shots, but we always have 2 nurses check insulin drips.

We always have 2 nurses checking PCA's - at shift change, and during the shift if any changes are made.

As far as controlling your pt assignment, I've never had to deal with that - I worked on a specialty med/surg floor and we always had 4 pts - our charge nurses would turn away anymore admits. I would go to your unit manager and explain that what you were told during the hiring process is not being honored. Hiring is a contract - you agreed to show up the best job you can, and they agreed to give you only 7 pts! They're not holding their end of the bargain. Tell her/him that as a new nurse you're still learning things and are not as efficient as other nurses at this point, so it needs to be arranged with the charge nurses that you only get 7 patients at this time. You are not trying to shuck off work, you're trying to be safe. And don't feel guilty - feeling a little guilty or uncomfortable now is better than the feeling you'll get when you make a mistake. Protect yourself and your license. And if the unit won't budge, then quit and go somewhere else. Seriously. It's not worth it, and you're not a "quitter" if you do that. You're just promoting safe practices and protecting yourself and your pts.

I don't hang potassium drips, but I believe in our hospital the pharmacy does that. As a nurse you have too much on your plate to break out the math formulas in the middle of shift. Pharmacists are experts in that area and they should be the ones to do that. That's like calling the pharmacist to come up and pass meds to your pts.

I would question the safety and support of your hospital. Sounds scary to me. And I can't imagine taking 8-10 pts. Or even 7 pts.

mamason · Sep 28, 2006

We double checked SQ insulin. RN administering drug documented it. No double check on SQ heparin or drips for that matter.

Potassium drips were mixed in pharmacy before coming up to the unit.

crb613, BSN, RN · Sep 28, 2006

Thank you both! and I should clarify on potassium drips. We only have to mix them if we run out. We do not have pharmacy at night. Anyway I still don't think we should be doing this...If you areout then call pharm in! A few times of this & I bet we would not be out again. The answers I get is this is the way we always do it......so I guess if you always do what you ahve always done....nothing gets better, still does not make it right or safe to my way of thinking! Thanks again for your input & advice

mamason · Sep 28, 2006

I think mixing my own potassium drip would make me uncomfotable. I would still ask another nurse to double check that one with me.

crb613, BSN, RN · Sep 28, 2006

I think mixing my own potassium drip would make me uncomfotable. I would still ask another nurse to double check that one with me.

I am uncomfortable w/it....and I do get it double checked. Only thing is my name is the one on the bag & Mar. Does anyone know how to find JACO standards on all this stuff?

HyperRNRachel · Sep 28, 2006

I administer all medications using a computer MAR, with this system when I give insulin, hang PCA or CEA drugs, inject heparin or hang heparin I have to have another nurse co-sign for me in the computer or I cannot complete my administration process. I feel the computer system cuts down on theses types of issues, such as having someone question why you need a co-signer.

Yes, I guess we could just co-sign someone without questioning the reasons or asking what was the patients blood glucose, how much insulin are they getting, are the trays on the floor is the patient eating? But the computer makes us answer theses types of questions before we can co-sign someone else. It sets a standard and instills a good habit, and in my opinion it cuts down on the fear of stepping on an ego. And yes, we do check the syringe for the correct units of insulin.

If not using a computer system I would want it documented somewhere that I did have another nurse check my medications. And if I am cosigning anything I am going to always going to do the correct checks.

Rachel

mamason · Sep 28, 2006

I agree with the above poster. Documentation is very important.

Antikigirl, ASN, RN · Sep 28, 2006

We dont' have a double check on insulin injections, but typically if a nurse feels that they are tired or what not, we will gladly double check...It is a respect thing towards eachother! No looking like that person is nuts, we are all glad to help, we all need help!

PCA...because of no double checks system while putting in the syringe...I just made an error (see Live and Learn, my med error on general nursing page two). Now I will have someone double check with me! However, we have a sheet that you must do a check off every two hours, and you check at begining of shift (why my error was caught so quickly...it was end of shift when I made the error and the next nurse caught it!).

Heparin, we do double checks on that always! No matter if it is a shot or drip! Must have two signatures on the heparin administration sheet (we have a special sheet for heparin administration).

The next one takes assertiveness, which is a talent dependant on your staff/charge nurses. It is an art to say the least! I will sit down with my charge and explain that this load is too heavy for me and I am far from comfortable and can I have some assistance. I have had to call the Administration once already to get a change in assignment, now that I have done that a few times....the charge typically listens to me and knows I know my limits rationally (and not being lazy!). If I had done that the day of the error...which I didn't...my error wouldn't have happened. So back to being assertive for me!!!!!! (I do it all the time, can't believe I didn't that day!!!).

My pharmacy does all the IV's and combo drugs...I just have to double check to make sure it looks right, or I can call them to go over it to double check. Very nice pharamacy I have!

ceen · Sep 28, 2006

no hard rule on co signing SQ insulin but when you have another nurse handy we try to and both of us sign mar. same with heparin sq. For drips though a co sign is a must.

We mixed our own potassium for years until recently (about a year now). We always needed a co sign on the Potassium.

LisaRn21 · Sep 28, 2006

I work in peds so it may be a little different... well i think the saftey of all should have the same standards no matter what age .... but we

Have premixed K solution bags available 24/7 we never mix and pharmacy is available 24/7 if we run out *never has happened it comes shipped to us that way*

We double check all narcs.... every single ones needs a cosignature no matter if its a waste or not

We double check all herparin and insulin... drips we check when settings are changed, a new bag is hung, and before and after shifts...

PCA's we double check all setting before and after shift and if they need a new syringe... we also check them hourly (without a cosignature) to get the demands and injects and such...

We also check the Iv hourly to make sure it is patent... our pumps beep hourly to remind us to double check for infiltrates and if the iv is still in and not laying on the bed haha

Everything needs a cosignature... and I have never had a problem getting it from another nurse... If you feel in doubt always double and triple check something ... and if you still aren't sure always ask... patient saftey is one of jacho's biggest goals!!!