I was fired for refusing to give injections incorrectly!

[katlpn6]

Hello, my name is Katherine. I have been an LPN for 10 years. I am an experienced clinition and have won awards for my excellence in clinical practice. I worked in an office for 10 years which gave me a vast amount of experience, from family practice,internal medicine,pre-op teaching,pediatric nursing to urgent care. I take pride in my skills and am dedicated to doing it right for the benefit of my patient. I loved my job but felt it was time for a change so I took a new job in a pediatric office, this office served patients from birth to 18 years old. When I discovered the nurses in this office were giving IM injections with a 5/8" needle I requested that they order some 1" needles, which they did. When the nurse who was orienting me told me that she "tapes syringes together" to give immunizations I almost fell over! I told her that was not clinically appropriate and I would not be doing that. I worked there for two weeks and was brought into the office managers office after work one evening and told that it wasn't working out and they would have to let me go. When I asked why she told me it was because I was too set in my ways and obviously was not willing to do things their way. As difficult as this has been for me, I feel proud that I stood my ground and refused to do it wrong to just keep my job. From what I understand the department of health got word of this and has since gone in to correct the situation. Unfortunately it was at the expence of my job but at least I know the children are being properly immunized because of my sacrifice. Now I'm off to the trenches again to find a job that appreciates a skilled and dedicated nurse!

[Spidey's mom, ADN, BSN, RN]

i am scarcely able to believe what I am reading here. Good lord the scary practices out there continue to stun and frighten me. you were told right; report, report report this. The place is beyond dangerous.

Poor little kiddos who got the shots. Always report unsafe practices.

steph

[nursemike, ASN, RN]

I do kind of wonder about the needle length, though. As I recall, older or emaciated patients may have less subcutaneous tissue, so a 5/8 inch needle could be IM. What about small children? I know they often have more fat, but they're also physically smaller. Of course, there are some whopping big peds patients out there, too. I would think you would need a variety of sizes.

[Q.]

It does make sense to give two shots at the same time, but there's a much safer way to do it. Two nurses, one on each side, giving the shots in opposite limbs on the count of three is MUCH better. That's how we do it in the NICU when we have to give our little ones their slew of vaccinations. Just like when they pierce kids' ears - they do both at the same time.

I was just going to say that. We routinely gave shots together in the NICU, but never taped together.

[kids]

I have never seen anyone tape syringes together.

I did want to comment that in MANY circumstances a 5/8 needle is appropriate for giving IM injections to infants and small children.

[JOHNGA]

Katherine-

Your professional ethics are sound.

Perhaps it would have helped to show the orienting nurse a professional reference on correct techniques of pediatric IM injections. For instance, a book on clinical skills and procedures. Sometimes if you can articulate why a certain technique should not be performed, the other nurse can modify their administration technique appropriately.

FYI: the word 'clinician' has no 't' in it.

[ERNurse752, RN]

Never heard of taping them together. We also do the two nurses, one for each injection, on opposite limbs.

"One, two, three...WAAAAAAAAAAAAHHHHHHHHHH!!!"

[katlpn6]

I have never seen anyone tape syringes together.

I did want to comment that in MANY circumstances a 5/8 needle is appropriate for giving IM injections to infants and small children.

As I said in my orriginal thread, this practice had children ranging in age from birth to 18 years old. I agree with you that in some instances a 5/8 inch needle is appropriate, that's what nursing judgement is for. My point was that they did not have any 1" needles at all in the office therefore making it immpossible to give an IM injection to an older pt with more adepose tissue. The nurses there had no problems at all with the way they were doing things, that was the scary part.

[suebird3]

Hey, Kat....gompers had a point about 2 nurses, different sites. Did that in one of our Community Clinicals. Talk to ya soon

Sue :chuckle

[Audreyfay]

It makes me petrified to think of myself or loved one going into the hospital, and not knowing. I figured that if they went into the hospital, I'd probably be the big bad family member that insists on providing all the care and being there all the time. When I worked in Hawaii, many of the Hawaiian families had at least one member with the patient around the clock.

Some people just don't get it, do they? Good for you for sticking up for yourself. The license you had to lose could have been your own.

[pediCNS]

Okay, so I've been sitting here for a while, trying to figure out what kind of utter moron thinks it's faster to tape two syringes together than simply to give two injections. Then it finally dawned on me--peds. They only want to stick the kid one time. I'm not saying it's even remotely right, but at least it makes some semblance of sense.

Anyway, congratulations on "not fitting in" with their way of doing things. That's the great thing about life--there are a million ways to do it wrong, but usually far fewer to do it right.

First of all, I would like to think that you do not consider pediatric nurses utter morons.:) Taping syringes together has never been an accepted practice in any practice area that I have been in in my 25 years of pediatrics. Certainly one wants to traumatize a child as little as possible, but if you give the injections one right after the other (in separate sites), the child's reaction is no different than with one injection. Certainly using two sites and giving the injections a few minutes apart would be more traumatizing. I have given thousands of injections and have been told I am quite good at it, even when having to give multiple injections.

The original writer should report the practice to the state regulating bodies as soon as possible. It sounds to me like the nurses in the practice are the ones who are not willing to change.

Also, try and give peds another shot (pardon the pun:rotfl: ) if the opportunity arises. Not all pediatric nurses are like the ones you encountered in that office.

[ibnrn]

I had to read the post a couple of times before I understood it. Taping 2 syringes together??? Talk about throwing the baby out with the bathwater...If one is THAT concerned about sticking the kid twice, how about using EMLA Cream? (Oh, I almost forgot...that costs $$ and that's what it's all about these days!)

Congrats for standing up and doing the right thing when it was difficult. Don't let it erode your self confidence...YOU are in the right here and still a good clinician!:balloons:

[pediCNS]

I had to read the post a couple of times before I understood it. Taping 2 syringes together??? Talk about throwing the baby out with the bathwater...If one is THAT concerned about sticking the kid twice, how about using EMLA Cream? (Oh, I almost forgot...that costs $$ and that's what it's all about these days!)

Congrats for standing up and doing the right thing when it was difficult. Don't let it erode your self confidence...YOU are in the right here and still a good clinician!:balloons:

Also, now that EMLA can be purchased OTC, you know it isn't going to be paid for. One of the concerns I have with EMLA is that for it to be truly effective, it must be on for at least one hour--though depending on the practice, this might not be a problem:rotfl: