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Should I report this nurse?

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?

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.

emtb2rn, BSN, RN, EMT-B

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.

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:

Pheebz777, BSN, RN

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?

MaxAttack

Specializes in 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.

amoLucia

Specializes in 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?

Rose_Queen, BSN, MSN, RN

Specializes in OR, education.

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.

Nurse Leigh

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.

sugarwahine10

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!

Edited by sugarwahine10

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.

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.

Wile E Coyote, ASN, RN

Specializes in Critical care.

I say to report the situation, not "the nurse". As noted, the delay was not only limited to one individual/event. It would have been appropriate to type and cross this pt BEFORE surgery ( I noted that you wrote you typed and crossed on your returning shift), the order to transfuse should have been given sooner, the transfusion should have been started sooner, etc.

Yes- report the nurse, and the charge nurse- an incident report does nothing. An entire shift going by without a critical order being carried out is too much.

Exactly. You can run blood through any gauge. Research studies have showed this. This is one of those nursing urban legends that people keep wanting to cling to. Hang the freaking blood!

AutumnApple

Specializes in M/S, Pulmonary, Travel, Homecare, Psych..

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?

This.

Report the incident, not the nurse. There is a difference.

Many things lead to the problem, non of which are 'personal'. IV team not responding, protocol/policies on what gouge the facility wants used being unclear and disagreement on whether the IV in place was functional or not (again, unclear policies).

These are things Risk Management wants to hear about and will address.

While the other nurse's behavior smacks of avoiding the task of hanging the blood, you should at no point in time let this subjective information affect your ability to report the objective facts. Starting a blood feud (no pun intended) will most likely lead to the parts you do need to report being overlooked.

OMG...INCIDENT REPORT ASAP. This is just weird and mind boggling.It sounds to me that the nurse just plain didn't want to give the blood, forgot about it and made some flimsy excuse about why ....on and on the possibilities...but why in the world can't an IV be started by any old bedside nurse....even a house supervisor?? HUhh??

I don't know that it is your place exactly to write up this individual; but the incident report will definitely start a housewide improvement effort. And of course, you notified the MD right away? I think I read that in there somewhere? I'm sure the MD will speak to nursing management about this. If I were the MD I would certainly be wondering what the heck is going on with nursing that my blood didn't get hung.

There has actually been more than one time within my history that an MD himself started an PIV at the bedside for us in the middle of the night when not even the "best" from ED and ICU were able to start one. Besides,even if the IV was marginally working, there are these cool things called tape and arm boards.....etc etc : )

This is blowing my mind....the things I have heard nurses being written up for lately re: nothing more than their posture or something as ridiculous....and this nurse AND the charge nurse thought it perfectly ok not to hang this blood????? HUhh??????

Of course it should be reported. It could cause the patient harm. But may I ask why no one on the floor attempted to start an IV? Isn't that a nursing skill? In the ER we start thousands a week it seems...why didn't anyone ask them to help out? I'm not trying to be catty I'm just confused as to why no one thought of that or tried themselves? Is it against the rules for the ER to come start IV's or does no one on the floor you work feel comfortable doing it? Was he a hard stick?

Hello!

First of all I am sorry you got wrapped up in that because it was not only unfair to you, the nurse taking over, but MASSIVELY unfair to the patient. So I read that you are not allowed to start IVs in your facility? Is that true? I have never, ever heard of anything so crazy. IVs can be intimidated but after you do a few you realize it is not so bad after all. Plus, it can be a life saving intervention at times. What if this was more serious and no one who was checked off to do IVs could get there? Can you explain to me why this rule is in place? I do believe that while you can cause lasting harm doing an IV improperly, it is VERY rare and I have yet to see it happen just from an IV start. Granted I have seen medications infiltrate and cause a lot of damage. So did they give you a reason as to why they are so strict on this policy?

Also, as far as the question goes, I hate when people report other nurses. All too often it seems as though one nurse is trying to tattle on another for personal reasons. HOWEVER; in this case I think that it is necessary because it could of cause a lot of harm not to mention it seems like true laziness on the other nurses part. Not only that, but the charge nurse was involved. Sad. Especially when the IV that the patient had worked just fine, as you mentioned. This would be a situation that I would report the nurse. Plus, it may come back around and you don't want to be in trouble because you "passed the buck" too.

I work in the ER and I know ER nurses and floor nurses seem to have some unspoken rivalry. I can understand why but it is sad, after all we are all nurses and deal with the same tough situations. But I am not here to get into that argument. I have worked in the ER for almost 10 years but I will never forget my year on the med/surg/oncology floor on night shift. I was once afraid to do IVs myself because we never had to! Even mediports were typically accessed before the patient arrived to the floor. But one thing I did not do was ignore an important order due to IV problems. If you are not allowed to place the IV because of rules then I would have norified the supervisor immediately. If you ARE allowed to do IVs, it would have been a great time to practice because that is the only way you will get better.

Also, in my hospital, the floor calls the ER occasionally (actually probably a little more than just occasionally) to come help start a difficult IV. Most of the time, if we are asked nicely and it is not too busy in the ER, we are HAPPY to help out. I know I am at least. I just hate it when I go up to the floor to start the IV and everyone is sitting around and no one bothers to help me find the equipment or even say a simple thank you. Most of the time that does not happen and people are very thankful. Plus, it helps relationships between departments!

Having worked a short time on the floor I respect you. I have no idea how you do it. I was terrible at it! You nurses have a tough job especially when it comes to calling doctors. Most of the time I found I had no chance to form any type of relationship with the hospital docs and they would get so angry if they were bothered by anything. I do not have that problem in the ER. In fact, we are friends with most of the docs and we have a lot more autonomy because of it and that makes the job easier. So I give you all kudos for the hard and thankless work you do!!

Sorry to make my answer so long. In short, I would report this, because this is actually not just a petty oversight. This can cause blatant harm to the patient and imagine how you would feel if it were your family member! Hope this helps.

Please, let me know what happened! I hope it went well for you!

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