is "beating around the bush" common in nursing?

Published

I know I'm still a student and all, but after going through some clinical rotations and working in a hospital I've noticed nurses oftentimes do a lot of things...wrong. For example, I was always taught in school to push morphine for 4-5 minutes. I've had patients ask me, "why are you taking such a long time pushing that?" and I explain why and they tell me, "oh, all of the other nurses just push it in real quick. I'll make sure they push it in slow next time!" The same thing happened in OB...my patient just gave birth and had an order for phenergan and morphine, both IVP. My instructor was not in the room but we are allowed to administer meds with another nurse's supervision. After calculating the dose and drawing up the meds, she asked how long I would push them for. I said 4-5 minutes. She said just over a minute.

Same with Lasix...again, I was told 4-5 minutes because pushing really fast can cause their BP to bottom out. At work I was in the room with the nurse giving our patient IVP Lasix...and she just pushed it all in really quickly! :eek: Of course I didn't know the exact dose and maybe the length of time spent pushing meds varies depending on the size of the dose, but it looked like there was a lot of Lasix in that syringe.

I've seen nurses break sterile field...leaving meds at the bedside and walking out of the room for clients who do not want to take them...

Does this happen a lot where you work?

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Nurses pushing drugs quickly? Well....I can't tell a lie...where I work, that does occur....we are still obligated to the standards of care, but I can't pretend this doesn't occur.

This is why no new grad works there. It is very difficult to reconcile real world with theory--without compromising too much. Drugs should not be pushed fast. However, no one I know sticks to the recommended time.

As for leaving the meds at bedside, no way. THAT'S a big, big no-no and I won't do that.

And for breaking sterile field, I work in a surgical area...absolutely NOT allowed.

Up Vote Up Vote ×
Sorry you have had some disappointments. Should a med be pushed faster than recommended? Probably not. And according to guidelines definitely not. Does it happen often? You bet. Should a sterile field be broken? Definitely not. Does it happen? I bet more than we realize. Are nurses human? Busy sometimes? Trying to manage patients with different accuities and take care of them the best they can? Most of the time. My advice is to learn what kind of nurse you want to be and do the best job you know you can. I bet in a few years you won't be pushing a 1ml vial of morphine over 4-5 minutes, but maybe not quite as fast as 2 seconds. (and by the way, I have been made fun of by the crises team for pushing morphine over 1 minute in a central line, and pushing atropine on a totally alert patient with hr in the 50's over a minute.) Just live and learn and don't judge to harshly or quickly until you walk a mile......(but that doesn't mean to EVER endanger you patients!) Hope this helps (haven't slept yet)

Great advice.

In the real world of nursing, if you tried to do everything the way you are taught in school, you would not have time to do critical things for your pts that must be done. You would quickly become overwhelmed, and probably end up quitting or getting fired.

Nursing school teaches us how to do things in a perfect world.

The world where things can always be done the way we are taught does not exist.

Nursing is a balancing act- you have to prioritize and pick your battles.

Up Vote Up Vote ×
FWIW I've heard more than one green nurse acting as if their knowledge is superior, that experienced nurses who are not doing things "the way we were taught in school" are lazy or sloppy and offering up their opinions about things like their uneducated thoughts that we over medicate our psych patients.

I certainly agree that one won't win points by accusing experienced colleagues of being sloppy or the like. And some folks just are plain obnoxious & inappropriately critical no matter what.

On the other hand, sometimes nursing educators (depending on who's teaching) set up this common conflict. Some instructors never explore why some questionable actions might actually be okay. Instructors may even have none-too-subtley given the impression that only lazy, sloppy, unsafe nurses would ever stray from following protocol - that compromise is NEVER okay. At least that's the impression I got from many CI's. From the commonality of students and newbies questioning experienced nurses, it would seem that many nursing students get this impression as well.

The overmedication of psych patients is a great example. I know we had it pounded into our heads that overmedication of patients was a rampant problem out there, and that we as the new vanguard armed with the latest information had a great responsibility to protect our patients from overmedication even if it meant upsetting the status quo. Any good nurse worth their salt would be grateful to learn from any source, even an inexperienced newbie. And that we would be irresponsible if we didn't question and share our information.

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.
The overmedication of psych patients is a great example. I know we had it pounded into our heads that overmedication of patients was a rampant problem out there, and that we as the new vanguard armed with the latest information had a great responsibility to protect our patients from overmedication even if it meant upsetting the status quo. Any good nurse worth their salt would be grateful to learn from any source, even an inexperienced newbie. And that we would be irresponsible if we didn't question and share our information.

I was in total agreement with you until this last paragraph. Although I am interested in considering and researching any new information that is available, from whatever source, please keep in mind that it would be highly unlikely that any new student no matter what they are "armed with" has the magic bullet to offer my patients. I am always willing to brainstorm or explain my rationales if approached in a genuine manner but I'm weary of some of the know-it-alls that I have precepted. FWIW I think you will find that many CIs are not necessarily a wealth of up to date information.

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.
We were warned. We were counseled to not challenge the RN, but to bring up any concerns with our clinical instructor on the floor with us. We'd then have a conversation (instructor and student) about what we saw, possible reasons for it, context of what else was happening, concerns about what could result, etc.

This is how it should work. If you are fortunate enough to have wrap up sessions with your group after the day that is often when the real learning takes place via reflection.

Up Vote Up Vote ×
This is how it should work. If you are fortunate enough to have wrap up sessions with your group after the day that is often when the real learning takes place via reflection.

We have those too....but if I see something that I think could have fast implications, I generally don't want to wait to clinical seminar. Often, my instructor would ask me (or whomever it happened with) to share the highlights during seminar though.

Up Vote Up Vote ×
I can see both sides of this debate but a side note about Lasix. You push it slowly because it is OTOTOXIC-(ears). A patient can end up with permanent deafness from one dose pushed too fast! Hospitals have thier own policy for IVP lasix but I never push more than 20mg/min. If the patient c/o ringing in thier ears-STOP and evaluate exactly how badly your patient needs IVP Lasix. Is there another alternative you could ask the doc for?

just a side note -if your doc is ordering ivp lasix, my guess is the patient needs that lasix PRETTY BADLY. lets not slam iv pushes unless it's adenosine. really i know we are all in a rush. but what is more important at that moment than in IVP med? this is one situation i don't 'rush'. just my :twocents:

Up Vote Up Vote ×
I was in total agreement with you until this last paragraph. Although I am interested in considering and researching any new information that is available, from whatever source, please keep in mind that it would be highly unlikely that any new student no matter what they are "armed with" has the magic bullet to offer my patients. I am always willing to brainstorm or explain my rationales if approached in a genuine manner but I'm weary of some of the know-it-alls that I have precepted. FWIW I think you will find that many CIs are not necessarily a wealth of up to date information.

Just to clarify, I wasn't saying that I personally thought that newbies should be on a crusade to educate their more experienced peers. I was saying that that was what several instructors seemed to be encouraging us to do.

I did have two clinical instructors that were much better at a facilitating a really worthwhile wrap-up that addressed real-world concerns and not just textbook-perfect expectations. I appreciated them at the time, and appreciated them even more after finishing school.

Up Vote Up Vote ×
Specializes in Emergency, Occupational, Primary.

Every field has its providers that cut corners to the patient's detriment. You have to find your own way to deal with this. In my opinion, your clinicals and/or exam are not the time to be debating stylistic differences. Unless your examiner or preceptor are asking you do to something that will surely harm the patient, I'd just roll with it.

Having said that, your examples of morphine and Lasix over 4-5 minutes seems excessive. A minute or two, sure, but a patient in fulminating CHF is not likely to afford waiting 4-5 minutes for their meds.

Up Vote Up Vote ×
Specializes in Emergency Dept. Trauma. Pediatrics.

So staying online with the differences in school and in the hospital (I don't start hospital clincials until Jan)

Are many nurses doing this new practice of doing injections at 10seconds per mL and waiting 10 seconds after before withdrawing needles???

I have never had it done, I think the Z tracking I have, but not the injection into the Ventral Gluteal and between my injections and 4 kids getting injections, it has never lasted more then a couple seconds max.

Our instructors say this is very new evidence based practice so I am just curious if it's being adapted a lot of not.

Up Vote Up Vote ×
+ Join the Discussion