Victoria19

I like your vote. It is very general but it contains a lot of truth. Maybe I do have knowledge deficit. I am alway open to learning new things. Thus, I am spending time discussing things that otherwise might not be a good idea to discuss at workplace. I agree this clearly was not STAT order. So we are on the same page. I agree there is not specific time written in stone. But it is written in stone that this medication is high risk. (please do not read into my metaphor). However, to be completely honest. 100%. How long would you like the nurse to take to stop the heparin order on your loved one?? ( Likely elderly) How long would you be OK with the nurse stopping IVF? Maybe, that is the time frame we should aim for as Registered Nurses Professionals? What do you think? Thank you for sharing and example to model what is on your mind. My knowledge about heparin drip involves working 7 years in ICU/CCU/CTICU settings. So I believe I have a grasp on how heparin is ordered and when it needs to be stopped. As far as therapeutic levels go, we usually "bridge" the patient to Coumadin. Meaning first give PO. Wait for few hours then stop the drip. If the drip is stopped without prior order of Comandin with instructions to stop the drip after few hours then it is due to the fact the patient is scheduled for the procedure and they need the time to thicken the blood so they do not bleed to death during the procedure. I am reacting because the original nurse OP was concerned enough to post this question. I am reacting because there are many, many nurses that despite of best intentions and working without bathroom and food go home and worry if they have caused harm. Because there are many nurses that suffer quietly or not even realize they do and that leads to burn out. Then nurses leaving profession or at least bedside and reaching out for substances. I know this is far from the example of the heparin but not that far. What kind of bedside nursing do you do by the way? I am sorry if I missed that in your posts. Thank you for doing research about the time frame recommended for med administration. Also, thank you for suggesting more clear expectations to protect the nurses. Sadly, it is a common thing in 2 states I have practiced as an RN: "If in doubt, blame the nurse..." I agree Susie2310 with every word you have said. If I have time I do learn of the meds the patient is on and find out what the goal is for some of them. Like heparin or number of Vancomicin doses in the renal patient. Also, wait for the results of the digoxin level before giving 6m dose. I will entertain that idea, but that rationale would demand then, that every heparin order be written as a STAT or NOW, and there would be a very proven tool/protocol/process for notifying floor nurses of such orders. Since it's a very sensitive matter. JKL33 it is not every heparin order that is STAT. It is the judgment of the nurse and receiving detailed report to know that the heparin might need to be stopped soon for possible procedure in AM or starting oral theraphy. is it part of your hand off report? Thanks Sour Lemon. Feels like it is only one thing that you have said to me so far. I will take it. I do have quite a bit of patience. It was not always like that though. JLK33, there could be another alert that high alert medication is requiring of discontinuation. That is one solution. If you gave it to your organization how long would it take them to implement it?? Would they ever do that?. I personally think that solution is knowing your patients, getting detailed report and understanding what is going on with your patients and how what were are doing to them at the hospital is affecting them. I ask a lot of questions during the report and IfI do not get answer and know it is important to know I will search the chart of ask quick question of the MD. "Hey, this patient is supposed to have toe amputated tomorrow. Do we stop his heparin drip at any point?" So, awarness begins when you are taking a report. It is hard in the first years of nursing. Very hard. But questioning like OP did and thinking about this like we do helps for the future. Nurses check their orders accordingly to the hospital , unit policy. They will be held to that standard in the court. Check your hospital policy. Besides policy there is common sense. But to be legally protected on med -surg it is every 2 hours for example. In ICU every hour.

I am not sure what you meant by it. Please clarify. Also your last paragraph. So you think insurance companies are to blame for nurse not picking up the heparin order? Please elaborate how so? Also, the process of orders is to blame. Give me an example of the process that is to blame. macawake. I am sorry if I offended you by addressing you dear. It is also a form of being warm showing endearment to someone you are trying to have positive opening of the conversation with. I also personally feel all the nurses are DEAR. For doing what they are doing. Clearly I am wrong about you if this offends you. Interesting that you are bringing up the sociopath in your next paragraph.... Hmm.... Makes me wonder. ... Nurse was made aware by written order. Interesting macawake that your husband is a pilot so you can really compare first hand. I am sure you know the pilots have limitations and are constantly monitored to assure they are at their best to fly the plane. Nurses work night shift. Take care of kids at home, while "napping" then come to take care of patients in ICU. Mistakes are bound to happen. Nurses take care of sick people but do not have health insurance on their own. If I hospitals would keep us more accountable we would start keeping them more accountable. So shhh, do not ask do not tell.... Please do a detail research if you are disproving JH numbers. Share with us better knowledge that they are sharing. I think you nailed it here. Do you know how much hospital CEO makes? Nurses are giving, sweet people pleases does play a big role. I agree is hard to follow. I am getting a hand of it. Perhaps we can make some suggestions to this website to make it easier to follow and post. If we could answer each individual person instead of having quote and copy paste. It would be so smooth. Yet we are going through some interesting, valid concerns for nursing filed plus working out some personal feelings. Truly enjoyable discussion.

JKL 33. In my organization the STAT means 20 min to acknowledge the order and 1 hour to carry it out. What is it is yours? JKL 33 I do think way beyond the headline of the original post "Is this med error/bad". Because this nurse that posted it is a prime example of someone who wants to, understands to do the right think for the patient but can not. Like many of us. So I see it as a bigger problem. Because it is not just her making those mistakes as evidenced by another post of "Sour Lemon". Things often get "overlooked". Those things lead to death. With all that replied. Thank you for your comments I enjoy healthy discussion and learning from each other. Why do the nurses stil keep being interupted even though we know the rule?

According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.Feb 22, 2018 Medical errors third-leading cause of death in AmericaSome 393 people were killed in civil aviation accidents in the United States in 2018, up 13 percent from the 347 killed the previous year, according to preliminary data from the U.S. National Transportation Safety Board (NTSB).Nov 15, 2019 2018 Data Show Increase in U.S. Aviation Fatalities - Flight ... https://flightsafety.org › 2018-data-show-increase-in-u-s-aviation-fatalities We should not be OK with this. "Overlooked" most things. Would you want your mom or dad to be on the busy unit where most things get "overlooked"? People that come to the hospital trust us with their life. Is this really the best we can do for them? If the airplane mechanic told you he did not have time to check the breaks on the airplane you are about to take because you were too busy would you get on the plane? I am attaching statistics to all nurses, this is how our number look like, this is the people we sign up to take care of. Is this really the best we can do?

Mirinone. How long should the patient be in the step down unit after starting the drip? What is your option?

Given it is heparin I am very cautious about this kind of medication so it is more serious than less risky medication. It is great that you are thinking about it. It means you care. You will make mistakes as you will go along but nursing is challenging and we are overworked. So just like in emergency prioritize and make sure you do not not miss important things. Meaning things that can kill your patient quick. Here, bleeding during the scheduled procedure. ABC- airway, breathing and circulation. Once you have these secured you will sleep at night. So once you drill in yourself to take care of those important things like their life and safety and hospital allows you for proper staffing and support then you do everything else. Charting after time left taking care of the patients needs. Thats just me.

Thank you for your straightforward reply. It was very, very helpful. Next time I will make sure my contract is more clear and read by the attorney.

I was hired to work as an NP after 3 years of hard work, studying and clinicals. I have resined from my RN job to work 9-5 schedule. Finally. I have passed a $100 per hour opportunity to work on COVID assignment to take $58.00 job as NP since I committed to it months before. After 2 weeks when office was slowing down I was indirectly asked to go work in the hospital. Nobody explain in what kind of role. I was send to classroom to be trained to work as a floor RN with Covid Patients at no different pay rate? Is that legal to do?