Professional dilemma

[gdc67]

I work as an agency nurse in UK as a PACU or recovery nurse. Most hospitals have a policy that we are not allowed to give ANY intravenous medication to our patients with or without a skills certificate. I do not have the certificate but have been a nurse since 1986 and at the present hospital I have been giving IV medication until recently when we were told to follow the policy and refrain from IV meds.

My patient was vomiting and I left a student with the patient after reassuring her and located the Dr who ordered an IV anti emetic which I gave. The patient seemed sensitive to the drug which I stopped and when back to tell him and he ordered an IM anti emetic which I also gave and it helped.

A few days later my manager shows me a letter from a colleague, who had an intubated patient BEHIND a closed screen, that detailed me giving IV medication fully knowing that it was against the rules. I was a bit annoyed and shocked at the idea that someone would feel the need to forget that nursing is a caring profession and it is OK to be vindictive towards co workers. A few days before the letter came up, another patient was vomiting and very distressed and it took about 5minutes of running around for them to find someone with a IV certificate to give when we were all very skilled AND capable to do and in the end they dragged an anaesthetist out of theatre to give the IV dose.

A professional and personal dilemma....any views appreciated

[gdc67]

Haha...thats ok...enjoy ur recovery

[XB9S, BSN, MSN, EdD, RN, APN]

At the end of the day it's hospital policy, you knew that and you breached it anyway.

The managers will have implemented this as a result of assessed risk management and reduction, maybe because of increased incidence of medication errors by temporary staffing.

If I had a member of temporary staff who deliberately disregarded policy I wouldn't want them working on my unit, you don't know the reason for the change of practice but you are expected to adhere to it. If your prepared to disregard this policy what other policies and procedures will you ignore.

[gdc67]

Fair enough...a bit of background....i started the placement in April 2010 and have been giving iv meds and care in front of every senior and junior manager, the unit managers and including my present manager in 4 different recovery areas of the hopsital. Not once was I stopped or informed about a policy of any kind relating to IV and agency staff restrictions. When i called them before my placement i was told that IF YOU FEEL COMPETENT AND COMPETENT IN GIVING IV MEDS THEN IT IS FINE WITH THE UNIT.

So for over a year and a half nothing was said or done and when i moved to the present unit i continued to give iv medication and still nothing was mentioned of the policy. Then they placed a list of names with IV competent nurses who are almost never in the recovery room and still no word on agency nurses not being allowed to give IV meds.

I got a direct order from a doctor to give the injection and thinking about the patient being sick and distressed I did not think of a policy and so gave the meds. A few days earlier i watched a circus act when a patient fainted in the toilet and started vomiting and it took my present manager and a few other nurses to run around looking for someone to give an anti- emetic when we are all sitting there watching the patient cry and puke. And the other patients asked why cant we just give the injection. They had to take a dr out of OR to give the iv.

the very next day i was recovering a patient, in the main OR with an A-line, PCA and various other iv lines and my present manager walked in to show me the complaint letter but she had to wait till i settled the patient. She sat there while i checked n connected the pca. The other nurse, also agency staff had a patient in pain and he was giving PCA boluses. There were the 2 of us alone in a recovery room with 2 very sick patients and how do we implement the iv policy when there is no other staff around.

Alone in maternity recovery my patient needed PCA again, what was i meant to tell the doctor, you have to stay and recover the patient cos i am not meant to touch any IV medication. SO you see where i am going. The pettiness of it all in evident and i refuse to be made a scapegoat for bad management so i duly gave them a letter stating clearly that i acted accordingly and how i feel about the situation. The manager is well aware of the excessive cattiness among the staff but feels the complaint has to be dealt with as protocol allows. Fair enough yet again.

[XB9S, BSN, MSN, EdD, RN, APN]

In your original post you say that recently you've been told to adhere to the no agency nurses to give IV policy. You ignored that instruction and breached policy, that's a disciplinary offence in most hospitals. You may well feel competent but changes in policy happen, as employees we are expected to follow that.

I understand how frustrating it must be to have your practice reigned in but that's the policy and as such you need to stick to it. If you have a problem with the restrictions that have been placed on your practice then you should choose to work elsewhere, the hospital has vicarious liability for it's employees, if you deviate from policy then they are right to take action.

I have to be honest, the situations you describe are a huge concern. I wouldn't allow agency staff to work without supervision from a substantive member if staff in my area it's not a safe situation to put the nurses in or the patients.

[misswoosie]

Fair enough...a bit of background....i started the placement in April 2010 and have been giving iv meds and care in front of every senior and junior manager, the unit managers and including my present manager in 4 different recovery areas of the hopsital. Not once was I stopped or informed about a policy of any kind relating to IV and agency staff restrictions. When i called them before my placement i was told that IF YOU FEEL COMPETENT AND COMPETENT IN GIVING IV MEDS THEN IT IS FINE WITH THE UNIT.

So for over a year and a half nothing was said or done and when i moved to the present unit i continued to give iv medication and still nothing was mentioned of the policy. Then they placed a list of names with IV competent nurses who are almost never in the recovery room and still no word on agency nurses not being allowed to give IV meds.

I got a direct order from a doctor to give the injection and thinking about the patient being sick and distressed I did not think of a policy and so gave the meds. A few days earlier i watched a circus act when a patient fainted in the toilet and started vomiting and it took my present manager and a few other nurses to run around looking for someone to give an anti- emetic when we are all sitting there watching the patient cry and puke. And the other patients asked why cant we just give the injection. They had to take a dr out of OR to give the iv.

the very next day i was recovering a patient, in the main OR with an A-line, PCA and various other iv lines and my present manager walked in to show me the complaint letter but she had to wait till i settled the patient. She sat there while i checked n connected the pca. The other nurse, also agency staff had a patient in pain and he was giving PCA boluses. There were the 2 of us alone in a recovery room with 2 very sick patients and how do we implement the iv policy when there is no other staff around.

Alone in maternity recovery my patient needed PCA again, what was i meant to tell the doctor, you have to stay and recover the patient cos i am not meant to touch any IV medication. SO you see where i am going. The pettiness of it all in evident and i refuse to be made a scapegoat for bad management so i duly gave them a letter stating clearly that i acted accordingly and how i feel about the situation. The manager is well aware of the excessive cattiness among the staff but feels the complaint has to be dealt with as protocol allows. Fair enough yet again.

You know and we know this is a ridiculous situation which is compromising the nursing care of post -op patients.

To be quite frank I don't think the hospital has it's head screwed on the right way. Seems like they use agency staff a lot and yet refuse to allow them to give IVs in areas where it's essential to be able to do so.

Basically they're protecting themselves against litigation and don't give a stuff about patient care. If I was a patient and I had to wait all that time for a drug when I was in severe pain or vomiting I would be complaining loudly.

If I was you I would speak to your local MP about the situation. Which trust/geographical area is the hospital in?

Makes me laugh when we are supposed to have moved away from the extended scope of practice and should be deemed big enough girls to be able to decide what we are capable of doing as RNs.

Could you imagine them telling Doctors what they could and couldn't do?

And they talk about making nursing an all degree profession.

[gdc67]

Totally frustrating that all the recovery nurses are from the agency and the there are 2 hopsitals in the same trust. They each have different set of rules and policies for iv drugs and for agency nurses. And in both I was not stopped from giving iv meds. Even after the policy was mentioned i was allowed to give iv drugs when there were no capable staff to administer the meds.

The letter i gave them distinctly points put the fact that there are many flaws in the system and yes some of the full time staff do have a chip on their shoulders about the agency staff doing less and getting paid more. The co worker who reported me works 2 days a week and often takes over the post op care and always gives patients the impression that the agency nurse is just a by stander. The manager is quite aware of that too as I had informed her. But thats another issue.

I felt bad for writing the letter and had doubts about giving it to my manager but i thought if someone could overlook the care of a patient in lieu of a policy then i am fully justified to protect my livelyhood by giving them a rundown of the flaws in the idea of how to run a hospital and dept. I have years of experience from working in many different depts of various hospitals and no nurse is going to get that taken away. If i go down I take them all with me..:-)

In the same hospital and in another recovery area, the students were told by one full time memebr not to be taught by agency nurses. So you get the idea about how they feel about us and after I heard her teach the student soemthing, I waited a few hours and loudly informed the student about the various ways in which to approach the problem while everyone listened in silence, just to make them aware that agency nurses do their part time work for a reason and some of us do have a mast amount of knowledge, yet sadly treated worse than the patients we care for.

In future, I will stick to any rule thrown at me and so i would be doing even less work if i follow the existing rules, IF i am still a nurse after all this. Will keep you guys up to date.

thanx for the posts....off to bike it around town...enjoy ur day and shifts.

[misswoosie]

In your original post you say that recently you've been told to adhere to the no agency nurses to give IV policy. You ignored that instruction and breached policy, that's a disciplinary offence in most hospitals. You may well feel competent but changes in policy happen, as employees we are expected to follow that.

I understand how frustrating it must be to have your practice reigned in but that's the policy and as such you need to stick to it. If you have a problem with the restrictions that have been placed on your practice then you should choose to work elsewhere, the hospital has vicarious liability for it's employees, if you deviate from policy then they are right to take action.

I have to be honest, the situations you describe are a huge concern. I wouldn't allow agency staff to work without supervision from a substantive member if staff in my area it's not a safe situation to put the nurses in or the patients.

Would you say the same thing if it had been an "emergency" situation?

That the agency nurse should not have breached the policy and given an IV drug?

You say that if she breached this policy then which other policies is she likely to breach, which ,to me isn't realistic at all.

She breached the policy because it's a ridiculous policy which compromises patient care in a dangerous way.

Take for example the drowsy post anesthesia patient with severe nausea and vomiting. We all know that one of the risks for post op hypotension is movement and we don't want to risk losing IV access (especially when it takes so long to get a Dr into the recovery area!-wonder if the agancy nurses are allowed to cannulate?).

Can you imagine waking up from anaesthesia in pain and feeling nauseous and the wretching increasing the pain to boot?

I am betting that in this unit because the anaesthetists know that the permanent staffing levels are low, they will reduce analgesia before the end of the op to make sure that the patient is "completely awake" when they arrive in recovery.

I've had that experience after C section and it was horrific, especially compared to another occasion following a GA for major abdo surgery when my pain was well controlled and the ET tube was still in situ when I arrived in recovery.

She chose to give the IV drug, and whether the hospital has vicarious liability or not, she has ultimate accountability for her actions as a RN. I would have done exactly the same in the situation.

I wonder who was actually "in charge" of the unit when the incident happened?

Blanket policies such as these are crazy and although the managers are aware of the policy they knowingly allow the nurses to breach it, although I wonder if they would stand up and be counted when it came down to it.

I also wonder why it makes any difference whether it's an agency nurse or permanent staff member who breaches a policy. If policies are there to be inflexibly stuck to, as you say, then it shouldn't matter.

Many agency nurses have more experience than permanent staff and are seen as valuable members of nursing teams, and this is how it should be. They shouldn't need to be "supervised" at all times- they're RNs , just like the the permanent staff!

[gdc67]

I have been supposedly breaching this policy for over a year and a half and giving much more potent stuff than an anti emetic and not once was I stopped.

In the UK and in most hospitals we cannot perform most nursing invasive duties without a competency or proficiency certificate NO matter how many years of experience you have. Most of our operating practitioners are NOT nurses and therefore cannot give any iv drugs. I am nurse since 1986 and a recovery and anaesthetic nurse since 1999. Been cannulating since year dot but I am not allowed because yet again certificate or not we are not allowed as per policy when it suits them.

One day a doctor tried to take a manual blood gas from the patient while i held his hand. She tried twice and so i said may i do it. We were both S African and i was a bit annoyed she let the side down as i withdrew the sample without much fuss. Thats experience for you and no certificate needed. But i am not boasting just to make a point that some agency nurse skills are lost in the policies of various hospitals but some are very happy to do little and get a lot of money.

I will not let them classify me as a bad nurse when I did what was good for the patient but some petty part timer only saw a policy in front of her and nothing of the patient puking thick green bile and distressed. Mostly the full time want to be seen doing the good stuff of nursing while we sit back and look pretty or stupid so thats another take on the pettiness.

The person in charge of the unit has seen me do IV meds for over a year and not once was there a mention of a policy. PCA, EPIDURALS, A-LINES, OPIOD INJECTIONS in 4 different recovery areas and not once was i deemed an agency nurse incapable of looking after the patients before. So why would they want to make an issue just because someone thinks its right to brand me with a label. I just followed through what was right for the patient and will stick to that. And will always do unless I am told otherwise from the start.

Even with the policy does a direct order from an anaesthetist not count to some degree even though I told him i was not allowed to give it and he said give it on his behalf as he was stuck in OR. I prepared the drug in front of him and he followed as soon as he settled the patient.

I have the experience and competency to perform my duties

[misswoosie]

I have been supposedly breaching this policy for over a year and a half and giving much more potent stuff than an anti emetic and not once was I stopped.

In the UK and in most hospitals we cannot perform most nursing invasive duties without a competency or proficiency certificate NO matter how many years of experience you have. Most of our operating practitioners are NOT nurses and therefore cannot give any iv drugs. I am nurse since 1986 and a recovery and anaesthetic nurse since 1999. Been cannulating since year dot but I am not allowed because yet again certificate or not we are not allowed as per policy when it suits them.

One day a doctor tried to take a manual blood gas from the patient while i held his hand. She tried twice and so i said may i do it. We were both S African and i was a bit annoyed she let the side down as i withdrew the sample without much fuss. Thats experience for you and no certificate needed. But i am not boasting just to make a point that some agency nurse skills are lost in the policies of various hospitals but some are very happy to do little and get a lot of money.

I will not let them classify me as a bad nurse when I did what was good for the patient but some petty part timer only saw a policy in front of her and nothing of the patient puking thick green bile and distressed. Mostly the full time want to be seen doing the good stuff of nursing while we sit back and look pretty or stupid so thats another take on the pettiness.

The person in charge of the unit has seen me do IV meds for over a year and not once was there a mention of a policy. PCA, EPIDURALS, A-LINES, OPIOD INJECTIONS in 4 different recovery areas and not once was i deemed an agency nurse incapable of looking after the patients before. So why would they want to make an issue just because someone thinks its right to brand me with a label. I just followed through what was right for the patient and will stick to that. And will always do unless I am told otherwise from the start.

Even with the policy does a direct order from an anaesthetist not count to some degree even though I told him i was not allowed to give it and he said give it on his behalf as he was stuck in OR. I prepared the drug in front of him and he followed as soon as he settled the patient.

I have the experience and competency to perform my duties

I hope you realise that I was agreeing with what you did!

[gdc67]

I FULLY UNDERSTOOD AND APPRECIATED THE RESPONSE ;-) ...which made me feel much better...i am back at work tomorrow and will see what they say after my letter...good luck to me.

different perspectives will always arise and was just trying to clarify to the harsher previous poster...am off to cycle for the evening...you have a good day.

[ZippyGBR, BSN, RN]

I have been supposedly breaching this policy for over a year and a half and giving much more potent stuff than an anti emetic and not once was I stopped.

In the UK and in most hospitals we cannot perform most nursing invasive duties without a competency or proficiency certificate NO matter how many years of experience you have.

which is generally easily achieved

Most of our operating practitioners are NOT nurses and therefore cannot give any iv drugs.

that is incorrect

an ODP is registered with the HPC and is therefore a Health professional , this has been the case for a good few years now.

as a HPC registered Health professionals ODPs can adminster medication following a Patient Specific Direction or a Patient group Direction that they are deemed competent to use.

ODPs can 'hold the keys' and can be accountable for Controlled Drugs

I am nurse since 1986 and a recovery and anaesthetic nurse since 1999. Been cannulating since year dot but I am not allowed because yet again certificate or not we are not allowed as per policy when it suits them.

again a certificate which should be easily obtainable if another employer's certificate is not deemed valid by the trust

One day a doctor tried to take a manual blood gas from the patient while i held his hand. She tried twice and so i said may i do it. We were both S African and i was a bit annoyed she let the side down as i withdrew the sample without much fuss. Thats experience for you and no certificate needed. But i am not boasting just to make a point that some agency nurse skills are lost in the policies of various hospitals but some are very happy to do little and get a lot of money.

I will not let them classify me as a bad nurse when I did what was good for the patient but some petty part timer only saw a policy in front of her and nothing of the patient puking thick green bile and distressed. Mostly the full time want to be seen doing the good stuff of nursing while we sit back and look pretty or stupid so thats another take on the pettiness.

I'm suprised that you are finding work as an Agency Nurse at all at present , the trust i work for has not used agency nurses at all for several years - using only flexible hours from it;s own staff and NHS Pand rarely uses Agency ODPs

The person in charge of the unit has seen me do IV meds for over a year and not once was there a mention of a policy. PCA, EPIDURALS, A-LINES, OPIOD INJECTIONS in 4 different recovery areas and not once was i deemed an agency nurse incapable of looking after the patients before. So why would they want to make an issue just because someone thinks its right to brand me with a label. I just followed through what was right for the patient and will stick to that. And will always do unless I am told otherwise from the start.

the fact is that you have ignored policy , and are publicly stating that you will ignore policy, i would be sending adverse feedback to to the ward manager / NHS P /agency of any member of staff who was not in the direct team who behaved in that manner.

Even with the policy does a direct order from an anaesthetist not count to some degree even though I told him i was not allowed to give it and he said give it on his behalf as he was stuck in OR. I prepared the drug in front of him and he followed as soon as he settled the patient.

I have the experience and competency to perform my duties

Doctors in the UK do not give 'orders' , they prescribe/ give directions to administer and the accountability for fulfilling that direction lays with the practitioner who administers the drug.

[gdc67]

Most hospitals have different policies regarding agency staff and sometimes hospitals under tha same trust have separate policies for the agency nurse. Most of the ODP's state they dont give IV's so I am just going by what is said.

As stated before some hospitals do NOT want agency nurses to give IV medication whether they have an IV certificate or not and will not allow them to do the trusts own proficiency training either. The two sister hospitals under the same trust have different policies as well when it comes to iv opiates for example. What you do in the one hospital is negated in the other.

The majority of recovery, scrub and ODP are agency where i am placed and the staff refuse to do NHSP as they are tired and the payment, which is sometimes late is not good enough.

Yet again as stated in the past, for a year and a half I was allowed to give IV medication to patients under different circumstances in the trust and no one informed me otherwise. No policy was mentioned. Every single manager in four diferent recovery areas witnessed that fact.

The point I am trying to make is that despite the policy suddenly rearing its head, and acting on nurse mode by thinking about a vomiting distressed patient, I refuse to be victimised when the hospital should have made it clear from the start about the policy. Okay, the doctor prescribed and told me to give it and I took the responsibility for my actions as I always do, policy or not and yet again when i got to the recovery room my patient was my priority and not the policy while with my part time co worker was behind a screen with an intubated patient.

Yet even after the policy was mentioned and before my a=incident, there were distressed patients of sorts and we were allowed to give IV medication, in front of the manager who never said a word and when no one was available and the doctors could not leave theatre. Why make a point of it now when a petty and spiteful part timer complains when the full time staff were witness to the agency nurses giving IV care.

I have worked at several hospitals, where there is a NO agency IV policy and you were told on the day you started and they never wavered despite the circumstances and all agency adhered to it. Me including. For the hospital to have sloppy policy management and then make a villian out of me is one I am not prepared to accept.