Shy Wegiel March 7, 2014 Weekly Self Reflection: Legal/Ethical Issues: This week while at clinical, I had a number

of different concerns related to possible legal and ethical issues. My patient was on a NS IV infusion. In the morning, I noticed that patient IV site on his right forearm was infiltrated and had signs of phlebitis. I reported my finding to the nurse who said that she would check on it. She didnt come to check the patients IV until the site started hurting. I noticed that in her documentation she had noted that the site was free of both infiltration and phlebitis. The site was discontinued and the infusion was switched to an IV site on the patients left hand. The nurse did not document the IV sites discontinuation and continue to document the IVF infusion as if it were still infusing at the original IV site. The nurse also had the IVF infusing at a different rate than the doctor had ordered. I brought this to her attention on more than one occasion but she said that she used her nursing judgment and decided that the patient only needed on a TKO rate. This was confusing because she should have contacted the doctor, informed him of him of her recommendation, and then changed the rate. I ran into problems with this when trying to document my patients IV intake. I didnt want to document the wrong infusion rate and be responsible for an IV rate which that is against the doctors orders. My patient previously had an order for a Morphine PCA pump infusing a bolus dose of 2mg every 15 mins as needed. The order was discontinued prior to the start of our shift. I voiced this concern to my nurse who looked up the information in the computer. Although, she acknowledged the discontinuation of the order she wanted to keep the patient on the PCA

because PT was coming soon. This was confusing because she was once again going against doctors orders. She couldve contacted the doctor to extend the order or possibly receive an oral analgesic. If something were to go wrong, such as the patient experiencing dehydration or respiratory sedation. The nurse could potentially get into legal trouble because there is no doctor order related to the change in IVF rate or the continued use of the PCA pump. I was also confused about how she would document the patients use of the PCA because there is no order or place in the MAR for her to document how much morphine he had received during her shift. As a student nurse, I was highly concerned about these issues and notified my primary nurse. I did not document the IVF rate but did continue to monitor my patient for any signs of respiratory depression or dehydration.