Should I report this nurse?

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Hi all,

To give you some background- patient X admitted for L leg AKA, post-op bleeding, dressing/wound vac to site. I am a night shift nurse 1900-0730 hrs.

At 0645, his hgb level was 6.1. I notified the covering MD and the day shift nurse about this. According to his orders, 1 unit of blood transfusion was ordered at 13:25.

When I come back for my shift later that night at 1900, the nurse tells me that the 1 unit of blood wasn't hung at all because his IV live wasn't working that great and it was a 20 gauge. She wanted to put a new IV using IV team 18 gauge, but no-one responded to her from the IV team all day. She also said she consulted with the charge nurse about what to do and they all mutually agreed there was nothing to be done because there was no IV team.

I assessed, IV line is working fine, patent, no leaking, etc. I also consulted with the Rapid Response RN about running blood through 20 gauge, and she agreed it could he hung.

I ended up doing the type and cross, and then hanging the 1 unit of blood, and got things a little organized.

Should I report this nurse for not bothering to care? Or to not take it seriously to try to hang the unit of blood? She could've at least called the Rapid Response nurse to help. He is actively bleeding, from 1325- 1900, his hgb may have gotten even lower.

What would you do?

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I would use my hospitals reporting system for near miss and actual events or report it to nurse manager. yes it should be reported, not for punishment but to determine how to make improvements so it doesn't happen again.

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Specializes in Emergency.

We run blood through 20's all the time. 22's work fine too. If it's a trauma or blown varices rapid infusion, then yeah, an 18 (or 2) is nice but not a law.

And I agree this should be an incident report.

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Does this nurse and the charge nurse know that they have could have called the RR Nurse to insert one since the IV Team wasn't calling back? That needs to be looked into as well. Why didn't they call back even to say they are super swamped and can't get there?

At my place (I guess yours too) I love how some support areas just don't call back/return pages and I don't think much is said to them or anything is ever done.

This is funny/not funny about using an RR Nurse or ED Nurse or EMT to place IVs: We were told that we could call down to the ER if 2 floor RN's attempted to get an IV 1x each and couldn't- this patient is now a "hard stick." We did this mostly on nightshift for 2-3 weeks then found out that was never supposed to be the case and bigwigs don't know where the authorization came from and my unit and a few others got written up by the ED. Moral of the story: Make sure you really can use the RR Nurse!!! :banghead:

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Specializes in ICU, CVICU, E.R..

Don't need to report the nurse per se, just report the incident. Is there a policy in your institution not to transfuse blood through a 20g?

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Specializes in Research & Critical Care.

The whole thing's a mess. Six hours before an order for PRBCs on a post-op bleed, then another few hours until it was actually hung. An entire shift with a critical hemoglobin and nothing was done because an IV wasn't working that great?

I'm all for non-punitive reporting, but that's not acceptable by any standard.

They run PRBCs into neonates using #26 IVs, I'm sure a #20 would be just fine.

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Specializes in retired LTC.

Agreeing with all the PPs. But I also see another issue.

Is there some reason why the nurses could not start a new IV themselves??? Like ONLY the IV team can start IVs???

Even in LTC, all our nurses (LPNs too) are permitted within their scopes of practice to start IVs (we don't have IV teams!). I find it hard to understand that within a hospital setting, there wasn't one other nurse with the education & experience to try for another vein.P

I'm usually not one to blow the whistle on nurses making error. But this episode bespeaks POOR professional judgment. All I can think of is that phrase when one starts thinking lawsuits & malpractice & BOB inquiries, like "what would any other prudent nurse do in this situation?"

And it always makes me wonder if those 2 nurses would consider such a situation as ACCEPTABLE for their own care of that of their families?

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Specializes in OR, Nursing Professional Development.
Is there some reason why the nurses could not start a new IV themselves??? Like ONLY the IV team can start IVs???

Actually, yes. In my facility, training is required before a nurse can start an IV, then there are requirements on how many must be started to maintain competency. So, there are limited staff who are trained and are allowed to start them: IV team, ER, ICU, peds, and preop. Any patient in any other department? Gotta wait for IV team. Or call a rapid response if the patient condition warrants it. A facility may always have policies that are more restrictive than what is allowed by scope of practice. Can a nurse start an IV without the training and not have issues with her license/the BON? Absolutely. Is she going to have issues with violating facility policy? Oh you better believe it.

That being said, there's a lot missing here. If the critical lab was reported at 0645, why was there not an order to hang blood until 1325? If the IV team wasn't responding, why wasn't that escalated to get a response? Why wasn't the patient transferred to a higher level of care?

An incident report is definitely warranted here.

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Specializes in Telemetry.
Actually, yes. In my facility, training is required before a nurse can start an IV, then there are requirements on how many must be started to maintain competency. So, there are limited staff who are trained and are allowed to start them: IV team, ER, ICU, peds, and preop. Any patient in any other department? Gotta wait for IV team. Or call a rapid response if the patient condition warrants it. A facility may always have policies that are more restrictive than what is allowed by scope of practice. Can a nurse start an IV without the training and not have issues with her license/the BON? Absolutely. Is she going to have issues with violating facility policy? Oh you better believe it.

That being said, there's a lot missing here. If the critical lab was reported at 0645, why was there not an order to hang blood until 1325? If the IV team wasn't responding, why wasn't that escalated to get a response? Why wasn't the patient transferred to a higher level of care?

An incident report is definitely warranted here.

Yep, in my former hospital floor nurses (med surg, tele, ortho, etc.) were not permitted to insert IVs. We had an IV team for that.

Agree about the order not coming through til afternoon. And did I understand correctly that *OP* also had to initiate type and cross? So the order just languished all afternoon with *nothing* done? Um. Yeah. Incident Report for sure. Sorry you fell into this mess, OP.

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Specializes in Telemetry; CTSICU; ER.

Yes I would definitely do an incident report, MAKE SURE YOU REPORT THIS TO THE DOCTOR that ordered it also that the nurse he gave the order to just never did and what the flimsy excuse was for not doing it, and a write-up to your unit director about that blood not being given for almost a full shift with a critical hemoglobin. I have ran blood through a 20g iv many times with no issues--it isn't like it was being pressure bagged in! Why not have asked for an order for a picc line stat or central line then if she was concerned about "the iv" (and not the patient's critically low hemoglobin apparently). On top of that she DOESN'T EVEN do or order a type & cross for the blood! That should have been done as soon as critical hemoglobin result was received or order for blood was given. That just sounds like pure laziness and she didn't want to run blood. Then leaves it for the next shift--unacceptable & ridiculous!

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I think it's weird nurses can not start IVs. Every person with RN behind their name can start one at my facility because of issues like this. All this policy does is delay care and make RN incompetent of a task that is fully within their scope.

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Specializes in BMT.

This old myth bugs me to the core. If you have a working iv, i dont care if it's a 24 or 16: hang the freaking blood. There are patients who you just can't get a 18 or 20 on, but they still need blood. I actually pulled up an old study recently that looked at the issue, and it stayed that as long as the iv was patent, it was fine. There was no "lysis" of the RBCs or any of that nonsense. It only stated to run the blood a little slower to maintain integrity of the line, which is a given. Yes, an incident report it warranted.

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