i was just wondering how all of you administered morphine and phenergan? i was recently fired as a new grad with six months experience because i wasn't fitting in with the organization's "way of medication administration" and overall "wasn't a good fit."
first of all, the nurse educator went bananas when i administered 25mg of phenergan iv (diluted with a ns flush). i brought in research articles regarding adverse effects because she insists 12.5 is the only reasonable iv dose. however, it's ph is 4.4-5.0 and adverse effects which include necrosis of the skin occur at both 12.5 mg and 25 mg. the nurse educator clearly didn't like my rationale even though i had evidence based practice to back me up. this particular patient was young and had a large patent vein which i checked frequently to ensure there were no ae. secondly, i asked the doctor to switch the dosage from 25 mg to 12.5 mg and he said "your nurse educator isn't a doctor - give the 25." so i did! i let her know i felt uncomfortable arguing with the doctor and asked her to please have the discussion with the md and in the future i would only adminster 12.5.
next, morphine. i've done clinicals at three institutions. worked in a cvi and ed as an rn. i've seen 10mg iv morphine prescribed quite a bit. especially for "narc seekers/opioid tolerant" people that physicians seem to cater to. an md prescribed 10mg morphine iv for an opioid tolerant pt. i diluted the morphine in a flush. administered it over 15-20 minutes. just like preceptors and clinical instructors in the past have shown me. checking rr, bp, cap refill, making sure the depth of respirations were good, loc, everything.
so i was told this was a "no-no" at my former institution and that supposedly when i left that night the pts bp had dropped to 97. i'm sorry but i'm not really concerned with that. his baseline was 120's. he was still rating his pain at an "8" when left. and the bp was taken 1.5 hours after administration and he had been napping. i don't think this is very clinically significant. the pt had no renal or cardiovascular issues or diabetes. and if i was still on shift i would have placed him in trendelenberg for a few minutes or increased his miv for a little bit. i don't consider 97 "bottoming out." the pt stated he was not dizzy. i initiated fall precautions anyway. in general, what systolic level with morphine administration bothers you?
overall, i found this ed to be a viper pit of tenured nurses just looking for miniscule things to complain about to mngmt. for instance, i was told that i used gloves too much. are you kidding me? i use too much ppe i guess i'm a horrible nurse right? it's funny how i always got the most favorable pt satisfaction survey marks. i missed one 20g iv in a hand once and i was told that, "i overstated my iv abilities." even tenured nurses miss iv starts.
has anyone else ever been in such a crazy, political, negative, environment and what did you do to overcome it? how can you defend yourself without sounding defensive?
why do you think "newish" grads are viewed as incompentent and if they act somewhat confident are seen as a threat? i think we should all learn from and support each other. i know that older nurses are usually better than me. but that doesn't mean i might know something that they don't. school has changed a lot from the nurses who were educated 10-20 years ago. i'm considering a career change. i'm not going to dumb myself down to fit in somewhere.
Thanks so much. I really appreciate that. Your hospital isn't in KS or MO by chance is it? Rumor has it I need a new job LOL
Sunshiney, what I would not give to have more new grads like you on my unit!! You are to be commended for knowing your research. Many nurses know there is some controversy with giving Phen IV, but do not know why. You will usually be ok if you are very familiar with your med admin policies. However, it sounds as if you were not going to be ok in this environment regardless of what you did. Furthermore, I must comment that it seems petty that your educator reprimanded you for giving the prescribed dose of a medication. I would have been tempted to ask her where she went to med school. Plus a BP in the 90's that long after Morphine IV is so not an issue. So... that being said here is my two cents- continue on your chosen career path if that is what you want. Find another facility to work for, preferably one that has alot of in-house education or a fellowship for your specialty (we do where I work). Wherever you work- know your stuff!! Familiarize yourself with all P&P as much as possible. And... good luck!!
i was in this type of situation before......spent allot of time and energy defending my actions as competent and in good practice.....finally realized that you can't fix preconceptions or others perceptions......i left and found a job where my abilities, confidence, knowledge base and experienced was held in esteem.....and it couldn't be better!
sunshineyday
59 Posts
Thanks so much. I really appreciate that. Your hospital isn't in KS or MO by chance is it? Rumor has it I need a new job LOL