jackbeninja

This is just a smidge unrealistic. Not every situation permits for best practice. I agree with you, that's the way it "should" be, but nothing is so simple. Small gauge IVs will rarely draw back even immediately after insertion and will still flush just fine. Ive had the IV team place peripherals and confirm with ultrasonography and the IV still won't draw back. I find that much of nursing is a compromise between best practice in the textbooks and reality on the floor. What care environment do you work in?

While I have mixed feelings about scripting, using prompts can be beneficial in standardizing care. I have seen some nurses who have literally been called "nurse ratchet" by patients come around and become very talented and service oriented nurses after focusing on their bedside manner and focusing on use of key words during rounding. While I dont think every interaction needs to be scripted, I also seriously doubt we are seeing a lot of this nationwide. And as for how it "makes management look" that has little to do with it, its about scoring on HCAHPS. The hospitals that score badly and fall in certain percentiles actually lose money on medicare/medicaid payouts, and if they do exceptionally well then they get a bonus 2%. These scores mean real money for hospitals, and unless you work in a unit that is a high earner already, then try and get used to it because its here to stay.

There are several differences between these two diuretics which may influence why they are given. Lasix is slightly older, being patented in 1962, versus Bumex, which came out in 1970. Bumex is more potent than Lasix at a concentration of 40:1, such that 1mg IV Bumex is generally equivalent to 40mg IV Lasix. Given orally, Bumex is better absorbed than Lasix, and also food does not impact the absorption, which makes it a little more predictable, and can sometimes be preferred for that reason. If a patient is not responding to IV Lasix, sometimes they will switch to Bumex simply because it's an alternative. Some older studies have shown that Lasix can be more potent than Bumex, and I've heard anecdotally that Lasix is "harder" on the kidney, although I didn't see that reflect 100% in the literature. Check UpToDate.com if you have a prescription at your institution. Generally speaking, there are not HUGE differences between the two. A lot of it comes down to personal practice of the physician and the hospital convention.