I was wondering if you ladies and gentleman could help me with something that I personally feel I am struggling with! It is my 4th month as a nurse and I am learning tons of new things daily but certain things are not clicking quick enough!
I tried looking up certain books/sites but nothing seems to be clear as to what is needed.
I keep sending patients down for tests/procedures without normal saline running or sometimes with it running and I always get called from whatever unit they got sent down to with a "why did you do this and that?" I am grateful they called to yell at me otherwise I would never know of my mistakes.
It makes me feel incompetent every single time! I always make sure they have a saline lock but never know which tests require a solution to be running without a specific order?
For example: I had a patient going down to the O.R and I knew to send him/her down with a saline lock so I started one but then I had another patient going for a bronchoscopy and the transporter gave me hell for not having ns already running! ("I was wasting his time", then the charge nurse gave me the look of death). I feel like I am sinking in the smallest areas.
How am I suppose to just know this information, in the manual for procedures it doesn't mention preparation related to IV solutions required.
What tests/procedures require a standard ns running tkvo?
I constantly think about this now and when I ask questions no one seems to be giving me clear directions, I just want to be good at what I do and I feel like this is causing me unnecessary stress. Literally unnecessary.
Keep a little pocket notebook with all these things you have learned. How dare they pick on a new nurse with 4 months on the floor! Really! It's very "eat their young". Remember this when you are no longer the new kid on the block! Please be kind to new nurses people. You were once new, too. How soon they forget!
NS for the purpose of maintaining an IV does not require an MD order since it is not used as a medical treatment. An order for a peripheral IV includes the standards of care for that IV; just as an MD doesn't need to specify that you use aseptic technique or that you dress it properly, they don't need to write specific orders for an IV to be flushed after a med is given. You should however have some sort of policy or at least a reference to a practice source that defines these sort of things, particularly since leaving it undefined can lead to Nurses going beyond IV maintenance and into IVF infusions that do potentially have a medical effect, such as 50cc an hour.
There are studies that look into this and most show that 10cc/hr is sufficient to keep a peripheral IV open, and there are also studies that show saline locking with q 8hr flushes will keep an IV just as patent as one with a TKO rate running. We use 15ml/hr as the minimum rate unless it is a blood thinner (If you only have NTG running at 5ml/hr, then you would add NS at 10ml/hr to total 15ml/hr).
Most of all, some sort of standing policy or single reference helps deal with the situation you find yourself in where everyone believes something different and therefore they all believe everyone else is wrong, when really most of them are probably more wrong than correct, so don't feel bad.
Specializes in Management, Emergency, Psych, Med Surg.
What you do to prepare each patient for any procedure depends on the procedure, patient condition and hospital policy. You need to ask radiology or the manager for specific guidelines on this issue. I would hope that your hospital would have a policy regarding the requirements for diagnostic testing. As a general rule, patients who are having any type of exam that will require a dye injection should have an IV as high up the arm as you can get it. As for having normal saline running in advance, this will be specific to diagnosis, type of exam, and the lab values for the patient. It is inappropriate for anyone from another department to speak to you in an unprofessional manner. You should take that person aside and speak to them. Let them know that you are willing to help and do what is necessary to care for the patient and facilitate the exam, but you expect that they will relay this information to you in a polite manner. And as a word of caution, don't just take someone's word for what is "policy".
OldNurseEducator
290 Posts
Keep a little pocket notebook with all these things you have learned. How dare they pick on a new nurse with 4 months on the floor! Really! It's very "eat their young". Remember this when you are no longer the new kid on the block! Please be kind to new nurses people. You were once new, too. How soon they forget!
Good luck and be patient with yourself!