They want us to give drip meds on med/surg

[bindikwan]

Hello fellow nurses,

I need your input! I work for a large hospital system in Texas. Recently management rolled out a class that is mandatory for all nurses. It's called "Advancing Acute Care Nursing" and this class entails is teaching how to titrate drip medications that are typically reserved for IMU/ICU. Some of the medications include Diltiazem, Epinephrine, Lidocaine , Vasopressin etc.

Here is the issue, after this class we will be expected to start these medications on med/surg floors. Management is pushing for this because "we cannot delay patient care". Of course this comes with huge issues, which we have brought up to management. Is our patient to nurse ratio going to change if we are expected to do this? These drugs require much closer monitoring so are we expected to do this with 5-6 patients as it is currently? Management has given us no clear answer about this and has made statements such as, "well you're nurses, you can't hang a medication when it's ordered?" And specifically regarding the concern with the amount of patients we take now and how are we supposed to do this with patient's who need much closer monitoring while on these drips, management has told us that, "Other hospitals are also doing this". This doesn't make me feel any better but I want to know if this is indeed true. Is this a new thing at your hospital on the med/surg floors? I would love to hear back specifically from med/surg nurses in Texas.

In talking to my nurse friends from other states they have all said no, it's not a thing. Thanks in advance guys! Appreciate you!

[Stella.didnt.doit, BSN, RN]

While I dont envy you, I understand what working in TX is like. My only reassurance would be the focus could be to address a sick patient and have no bed available. For instance. Sepsis is time critical a delay of just 6 hours has a huge impact on mortality. I would chill if this is just a stop gap to address this issue. I have had instances of frustration trying to make others understand. take the vitals every 15, titrate accourding to orders they will either stabilze in next couple hours or the crash and burn will bring help.

[rockchickrn, ADN]

In my opinion just trying to push more onto already overloaded med-surgery nurses. Why I left med-surg nursing.

[Kooky Korky, BSN, RN]

On 4/18/2019 at 8:42 PM, JKL33 said:

Can't comment much on the issue at hand except to say that there is nothing you can say that is going to change their minds about this.

Classic:

- Pretend it's about safety ("care delay")

- But don't actually plan to staff for safety

When opposition voiced:

- Insult everyone, then

- "Everyone else is doing it"

??‍♀️

I mean, this is written down in a book somewhere that lots of people seem to have read.

You'll have to make a choice, accept it or don't. They don't care which you choose.

They do care. They will require that you do it or will fire you for not, give you bad evaluations. Evil at its best.

What will you do?

[Kooky Korky, BSN, RN]

On 4/21/2019 at 2:27 PM, marienm, RN, CCRN said:

I work in ICU, but in my hospital a rapid-response nurse would stay with a patient when starting many of those gtts. (These are also our code-team nurses.)

I'm not trying to nitpick, because I think your concerns about monitoring/titratimg are very valid, but the gtts you list are very different. At my hospital, we don't titrate vasopressin at all. We do check vitals frequently (and maybe stop the gtt if VS are improving) , but otherwise we just change the bag when it's empty. Diltiazem is sometimes titrated by providers outside of the ICU (but definitely needs frequent vital signs while actively titrating). Epi is a third-line pressor in many cases, so unless it was started during a code I would never expect it to be started in med-surg. See what I mean? It sounds like the gtts they're proposing don't even make sense.

On the other hand, if a pt needs an epi gtt, you'd better not wait to start it! But I say that with the luxury of knowing that the RR nurse would be with the pt until the pt was transferred.

What happens if the RR or Code nurses are needed stat elsewhere?

[Nunya, BSN]

What I would do is get the "rules'' from the ICU about staffing, VS etc and then tell mgmt that you feel you should follow those rules on med-surg. So if a patient on one of these drips is a 1:2 then that's what should be followed on the floor.

[ArmyRntoMD, BSN, RN]

Sounds unsafe to me. I wouldn’t want to work there.