They didn't teach me this in nursing school and I could have killed someone!

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What things "didn't" you learn in nursing school or during orientation that could have resulted in a patient being harmed? I knew a person who said that she was never taught that certain (any?) IV medications cannot be given during a TPN feeding in the same PICC line. She had a situation where she was going to push a med using a free lumen on the same double lumen PICC line while TPN was running, and was stopped at the last second by another nurse who just happened to come into the room. I cannot remember the med, but she was told that it would have likely caused an embolism had she proceeded. This caused me to ponder what other sort of "common knowledge" that is sometimes missed in school and on orientation, but that could result in real client harm. What would your "top three" things be that fall into this category?

Specializes in ER.
Yes, you learned them because you are probably a bright, attentive nursing student with exceptional focus and attention to detail. I'm looking for things that will help the "mentally challenged" like myself who struggle to remember to put the cap back on the toothpaste and to not leave the electric burners on the stove on when they leave the house (okay perhaps I am beyond help, but others who are more borderline might not be).

Not true...I am a hands on learner...and I am strong in a clinical setting but when it came to nursing school, which I went to 10 years ago when I was young and unattentive and had ADD...I was only a C student...I think this job in and of itself is a learning experience and most of what we do is on the job training...like someone else said...Nursing school is only there to instill the basic nursing principles for which you are to build on as you gain experience...They can't teach you everything...its like getting a driver's license...you learn how to drive a car, the basics, you learn how to follow certain traffic signals and signs, you may even learn how to drive in some hazardous conditions...but just because you have a driver's license doesn't mean you know everything there is to driving a car, or how to drive safely in every situation...it comes from just doing it, and sometimes, even making a mistake along the way...learn from others experience...maybe one of the biggest mistakes of new nurses is coming out of school is thinking they know it all....when in fact they have only skimmed the surface of what this field has to offer, and you learn quickly that no situation, no patient, no illness is the same...

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I agree that as an RN it is her responsibilty to look up the capatabilty for any med before giving it. It has always been policy at the various facilities where I have worked to infuse TPN/lipids through a dedicated line..........meaning nothing else can be given through that line (but not The site if it is multi leumen)

What things "didn't" you learn in nursing school or during orientation that could have resulted in a patient being harmed? I knew a person who said that she was never taught that certain (any?) IV medications cannot be given during a TPN feeding in the same PICC line. She had a situation where she was going to push a med using a free lumen on the same double lumen PICC line while TPN was running, and was stopped at the last second by another nurse who just happened to come into the room. I cannot remember the med, but she was told that it would have likely caused an embolism had she proceeded. This caused me to ponder what other sort of "common knowledge" that is sometimes missed in school and on orientation, but that could result in real client harm. What would your "top three" things be that fall into this category?
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Specializes in Oncology/Haemetology/HIV.
Okay, here's a couple more example's (I think) of the sorts of issues that could be easily missed or overlooked by newer nurses:

1. Never giving K via IV push (maybe I shouldn't say never since maybe you would to counteract some sort of acute hypokalemic situation that I cannot imagine right now).

2. Remembering to use an airtight seal for a chest tube that comes lose (such as petrolium jelly), but using a vent bandage (three sides sealed with one side loose) for a penetrating, open pneumothorax type injury.

3. Confusing mls, with units on insulin injections (I think I read a post here or somewhere where that occured).

Virtually all of these issues were covered in my ADN nursing program. #1 and #3 were covered very thoroughly in Pharmacology, before I was even accepted into the Nursing program. #3 was covered in Nursing 5 (ICU, trauma care semester). And all of them were addressed on the NCLEX, but then my NCLEX was the written, two day, hundreds of questions trial (12 years ago), and then the 4-12 week wait for results/license.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Yet, back to Roland's question:

Quite bluntly, properly done, Nursing eduction teaches one principles. And if one applies those principles through out their Nursing career, I don't think that there are many "blunders" that one could stumble into making. Therefore nursing fundamentals is one's "Nursing for Dummies" as you put it. It was taught there.

This is why you are finding few answers to your question.

As far as the Beta blocker issue. Most MDs include in their orders the appropriate parameters for either BP or Heart rate, or parameters for both under meds. And most nurses attempt to know why the drug is being used, more for rate control, cardiac OP issues, or BP. If the nurse in question, didn't know the purpose for the med and withheld it erroneously with a low BP, that nurse disregarded a Nursing and pharmacology fundamental principle. And if the nurse withheld the med on the basis of the low BP, and did not notify the MD of the excessively elevated heart rate after researching the issue the chart, the nurse has again breached a fundamental/basic nursing principle.

Now at times nurses let their egos or their fears get in the way...they don't feel like calling the MD, they don't want to question the MD, they are afraid of getting yelled at, they think that they have "the answer" to the situation, they are too busy to look in the chart or the the pharmacy book. And that gets them into trouble. But that is still not an issue with a lack in their education. Unless, you consider it the duty of Nursing school to teach people to have initiative, self respect and guts.

It is somewhat like religion. If you obey the principles that underly all of the rules, you will do the right thing..even if it is not easy or pleasant at times. But too many people let their egos, desires, and personal issues get in the way of "doing the right thing"...and they get in trouble.

bottom line post. EXCELLENT and well-stated.

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KCL should never, ever, ever be given IV push. Only in a drip, and maximum is 20 meq per hour in an ICU. Maximum on a med-surg floor without cardiac monitoring is 10 meq per hour. And both of these are always diluted to about 100 ml.

To give even a small amout IV push, would instantly kill your patient. There is never any acute situation that requires IV push, to do so will kill your patient.

Instant cardiac arrest that you will not be able to reverse.

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Specializes in Critical Care, ER.

Sorry but the example I am still wondering about is the beta blocker given to someone who is hypotensive and tachycardic. I have been thinking about this example for about 24 hrs now. I can really really really tell you that the only circumstance that you would give a beta blocker to someone who is hypotensive and tachycardic is, perhaps, in a pt who has a new onset sinus tach of cardiac origin. The problem is, however, that the vast majority of occurences of hypotension and tachycardia are due to any number of types of shock. If your pt is severely hypotensive because they are bleeding internally or severely fluid depleted for some other reason, a beta blocker is actually detrimental as it will compromise brain perfusion due to decreased MAPs. Furthermore, I can't really see how it would help in septic or other forms of shock either. So you see, that example you gave is not universally true. What if your wife's cardiac pt actually has another underlying shock pathology and she follows her "rule"... without thinking first? You may say, well I would know if my pt is bleeding because the H/H would be low however it takes 12 hrs for bleeding to show on a crit. Your wife may or may not have a CVP at her disposal to assess fluid status.

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This is such a strange thread and I wonder why someone who is not a nurse would ask all these questions at all, let alone starting a thread in a nurses forum with this title. JMHO.

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Specializes in Gerontological Nursing, Acute Rehab.
This is such a strange thread and I wonder why someone who is not a nurse would ask all these questions at all, let alone starting a thread in a nurses forum with this title. JMHO.

Funny.....I was just thinking the same thing.

I have no problem with anyone asking questions, but this kind of worries me. JMHO2.

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Specializes in ICU, step down, dialysis.

I agree...and it's not just this thread, there's alot of strange threads started by this OP on Allnurses.

This is such a strange thread and I wonder why someone who is not a nurse would ask all these questions at all, let alone starting a thread in a nurses forum with this title. JMHO.
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Specializes in Nursing assistant.

Honestly confused: I don't understand what the concern is about this post. I looked at the profile, and it said the poster was a nursing student. Could you explain?

A lot goes over my head!:)

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Specializes in surgical, ortho.

I sometimes precept nursing students on my floor. One thing I like to always teach them is a very simple thing that no one taught me. Whenever I draw up a medication into a syringe, even if it's only one IV med that I am giving, I like to tape the vial to the syringe. Then I know EXACTLY what I put in that syringe. I have seen many nurses draw up anywhere from 1 to 3 or more IV meds and have no idea which syringe has what med in it. Since this little trick was not taught me, I try to teach it to all my students. In my mind it is a simple matter of patient safety and medication error prevention.

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Specializes in Critical Care, ER.
oh boy levo neo tpn propofol ns antibx lab draws.cvp pressures(don't ask no swan) we are a small community hospital we cant do CVVH or IABP but we do allot of Quinton's. and push ALLOT of bicarb,It is usually one surgeon we have this issue with . we have brought him to ethics a bazillion times .These patients never make it and he cant let go he dances around the family questions and so on. It is always nursing trying to educate family and push "what would your dad have wanted?" If you came to our unit and asked Who is the grandstanding jerk(nice way to put it) Who will just keep adding lines and tubes and is IMPOSSIBLE they will all answer you with the same answer.It is difficult as times to work community we have Boston residents floating through and they do allot of stepping on the old time surgeons toes( we like it) We usually tell medical doctors when they write for a surgical consult to use Boston vs. our long standing old time jerk(again im being polite)But community is allot different then major hospitals you use what you have and improvise allot.

I was just in Boston (my dad is their) So I quizzed the nurses about their working conditions and if they like working for Boston, most unit nurses have a max of 2 patients The hospital has an iv team who will draw off cvp, residents do the ABGS ,cardiology techs do EKGS , and so on. In my hospital we are the IV team ,Lab , ekgs tech and the secretary,unit aide we have no monitor techs(I am not even sure I know What that is)I was amazed I have been thinking of a job change .you just get so comfortable where you are.But I would be worried about losing all my skills like phlebotomy and picc lines and such. We also make allot of decisions as we wait for the md to call back (we have no ICU doc. ) We remove all Piccs,Midlines, Alines,Swans,Cvps. We assist in floating swans and temp internal paces,we are the recovery room for the entire hospital on the weekends and night shift. We do all conscious sedation and we assist in all UGI, lower Gis ,Bronchs,TEE's WE are the code team. It gets hairy at times but I have learned allot over the years. I wont be really surprised as they consolidate if we also became the cath lab.But if you read thru my post we have no staff we have allot of travel nurses and international nurses . we had a manager that replaced a manager who was there for 22 years(fired when the new CEO came in)She basically was a union buster. We lost a total of 400 years nursing experience in a 6 month span.We were a great unit with a great staff at one time ,it is so sad. We have been unable to fill their places. And what we get for travel and international nurses isn't good enough, some are really good ,some are their to make money. They don't float ,they don't do charge , they don't know a thing about the community so, on. So some day I might make it to a unit like yours.It would be fun to learn continuous hd or balloon pumps. Or to be in either a sicu or micu . I don't know why or how I got off topic but I hope I answered your question

Gosh that sounds awful. I am so sorry. :crying2:

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