As an RN, you are providing care for a highly agitated patient

As an RN, you are providing care for a highly agitated patient who has been diagnosed with general anxiety disorder and is awaiting transfer to the mental health unit. The provider has ordered diazepam (Valium) IV push as needed to decrease anxiety. You and the senior RN agree that the patient is displaying acute anxiety and requires medication. The senior RN instructs you to “push the diazepam IV” through a port in the IV tube near the insertion site of the needle in the patient’s hand.

You remember from one of your clinical sessions in the ICU that the only IV solution used when pushing IV diazepam is normal saline, and it should be pushed through a large vein in the arm, not a small vein in the hand. The IV solution currently hanging on the patient is D5W. When you question the procedure that the senior RN has suggested, she says, “Look, this is how we do it here, missy. We are understaffed and do not have the time to switch the IV over to normal saline. When you push it in a port close enough to the IV site, it doesn’t matter what solution is hanging. If you want to work here, that is how you will do it.”

QUESTIONS

1. How should you respond to the senior RN demanding the medication be given with the current solution?
2. What are the possible consequences of administering the medication this way?
3. What difficult behaviors is the senior RN displaying?
4. Provide at least two strategies to communicate and work with the senior RN during this scenario.