0.9%NormalSarah

Oh dear this is all very terrible! I second Emergent's suggestion to take this to a regulatory body. I have a friend that worked in hospice for a long time and she told me they have to be super careful about referrals and how it looks, I'm surprised they have been getting away with this. Also that poor woman, her husband quite possibly had a different reason for the falls.

My facility does this and has been doing so for more than a couple years. It's just the first draw the first time the patient comes to the hospital. Also they're really annoying about it, they have to have a phleb draw it or in ICU we are allowed to draw, but a phleb has to be standing there watching you. Not sure why when we draw all of our other labs, but whatever.

Yes, a second chance. ONE human error, or a couple...how many times would you like one person to say that in a given shift? 8 times? 10 times? That is in the ballpark of the number of times RV bypassed a common safety check that is hammered into us at the nursing school level. How many chances should one get?

Holy crap, what a cluster. 1. Night RN couldn't get a lab draw in 12 hours and didn't bother to attempt to titrate the drip? Big problem, and was not caused by you. 2. Lab was a little crazy on this one, they could totally have sent you back that bag and asked you to place that sticker on the tube, as long as there were correct patient identifiers and it's the right tube, they should have worked with you on that one, especially given this was a hard stick patient who was getting uncomfortable with so many lab draws. Hard sticks are not your fault either. You tried your best to get that lab done. 3. As a charge RN, if someone asks for a change in assignment, I try to do so. We have to have tough assignments sometimes, and this one sounds like a tough one! But we also need to try and spread that love a little so people don't burn out. They could have at least broken up the group of people jumping out of bed. And yeah, orientees do nothing to help with productivity. And that's not really the way we should be thinking about them, they need a nurse that isn't so crazy busy so they can have time to learn the unit and systems. As far as the drip is concerned, write an incident report. That can help your administration identify places to improve, like with lab processes and early line placement in patients like her. You can be part of the solution by bringing the situation up in the professionally accepted way.

Nice article! Coffee is definitely my friend. I've tried to quit caffeine a few times in my life including when I was in basic military training where we had to quit, but I've always gone back. I'd say it's just my main vice, but I try not to overdo it with the additives.

Ahhh the reasons I love night shift ❤️. We still get a lot of this turbulence, but at least it's tempered a little bit with less visitors and less staff walking around. I would feel so bad after a busy day because I'd be in the middle of something important running my bottom off and there would appear a social worker or maybe dietitian or even a chaplain who would stop me to ask how the patient is doing etc. I was always so short with them. I felt like a real you-know-what and I just couldn't help it. And then every different medical team stopping me in the morning to ask how the patient is, giving updates to 8 different people....do you people talk to each other?! Now my biggest peeve is when I'm giving report to the morning RN and a resident or even attending comes over to interrupt. DO NOT interrupt report! And then I'm the big bad nurse who has to be firm and request they wait until end of report for their questions while losing my train of thought. ? But yes all these other issues like constant alarms, tracking down meds and supplies, answering phones when the secretary/ tech is busy, etc, make for an unnecessarily difficult job at times. Great article, Nurse Beth!

No. I have overridden vecuronium so far 3 times in my career and it was urgent and necessary every time to prevent a patient from breathing in a very dangerous pattern so as to compromise his or her own airway. The patients already had advanced airways and it still scared the crap out of me. I pulled it, triple checked what I was doing, and administered, which helped save my patients' lives. Just because you haven't found yourself in dire need of a medication like this in a pinch doesn't mean it doesn't happen and that we should remove this responsibility from prudent nurses. Also most of the time RSI kits with paralytics in them are kept in the fridge and must be overridden. And before anyone goes on about needing to sedate the patient first, they were all heavily sedated. Their lungs were just so far gone and noncompliant with the vent that they couldn't even function without the use of paralytic. A code is not the only emergency a patient may face. There are other reasons to override medication needed urgently. See my above comment.

I'm sure that goes over great when you need an urgent Med in a pinch. I don't think the solution is to remove responsibility from prudent nurses and make the system more difficult. The solution is to bring nurses in line with prudent practice. What do you think happened back when medications were simply stocked in a room and nurses had to choose and remove them carefully? It has been stated many times here that relying on technology to do all our thinking is making for more dangerous practice.

Because you don't want to be challenged on your line of thinking or statements? See below. My point was that someone who can't follow a simple routine we all do many times every shift, ON TOP OF making multiple bypasses of known safety features while believing themselves to be handling a high alert medication, which they claim they understood how to administer, they perhaps can't be trusted to handle something else life-changing like an insurance claim. And I stand by my opinion that you were insinuating she can do some other nursing work. No matter how you spin that, it belittles the other work. Wasn't trying to put words in your mouth, but perhaps say what I thought you were saying in a more crude manner to get my point across. I struck a nerve.

With this line of thinking, you might be okay with her screwing up someone's important insurance claim or work comp case etc. Just because a nurse isn't giving medications that could instantly kill someone doesn't mean that they can be trusted to do a good job. Those jobs are so important, too, and I think it might come across as insulting to the nurses that do those jobs. Oh yeah she's not allowed to give meds, she can just do the mindless work of claims....doesn't sound very nice that way.

I find that ridiculous. Any good training program in the ICU teaches about procedural sedation and we do it fairly frequently on the unit. I'd be very surprised if one didn't know they need to monitor for procedural sedation. But anyway, it was a small dose for anxiety as others have stated. But as an ICU nurse, I'd be concerned about giving any amount at least to watch for a few minutes.

I'm seeing where your opinion of new grad nurses is coming from. Not all of us went to programs that so poorly prepared us. I'm sure there was plenty lacking in my program, but medication administration was very heavy because they had to know we would be safe on one of the skills nurses perform many times every shift. I think it's possible that your experience is clouding your judgement in this case.

You keep saying "a nurse that has only been practicing for 2 years.” Well I worked in a procedural area at a little over 2 years where it was the same: no Med scanner, so we used a paper MAR. I still pulled correct meds, administered them appropriately and safely, and accurately recorded and carefully monitored the patients. It's a little insulting to suggest a nurse working for 2 years couldn't do that. And yes, I learned my rights of Med admin in nursing school. It's not a systems error.

What? A 2 year nurse should definitely be able to practice safety with medication admin. In fact I'm pretty sure we had to be able to do that before getting out of nursing school. Like others have said, a policy wouldn't have helped if there were one. You just can't teach the type of awareness that should come with certain nursing skills like giving IV meds. You either are on high alert and understand the consequences of making a mistake, or you're not and the other shoe will drop some day. Unfortunately for her, it killed a patient. It's sad and all of us will make mistakes, but there are checks that should mitigate such a tragedy and she just didn't follow prudent nursing procedure.

Yes the social media "influencer" thing is so annoying! I got totally off social media this past year just because it was so bad for my mental health to see all these people suddenly become medical experts and the politicization of our career. I was never on Tik Tok, but on IG the nurse influencers are also there and it's all over my feed because I said I'm a nurse in my own bio. And the amount of those horrible videos posted where the nurse stages a crying moment or some emotional breakdown in front of the camera because they lost a patient: ? I'm betting those are the same ones that are backing up RV so much. No awareness.