Case Study
Liz is a newly hired RN. Lois, a senior RN who has many years of experience, is giving Liz orientation and additional training on the medical unit to which she is assigned. Although Liz has graduated from a baccalaureate program, she knows there a number of procedures with which she needs to become more proficient. Lois is providing instructions on these procedures and closely watches every move Liz makes. One day Liz is 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 physician has ordered diazepam (Valium) IV push as needed to decrease anxiety. Liz and Lois agree that the patient is displaying acute anxiety and she requires medication. Lois instructs Liz to “push the diazepam IV” through a port in the IV tube near the insertion site of the needle in the patient’s hand. Liz remembers from one of her clinical sessions in the ICU that the only IV solution that should be 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 Liz questions the procedure that Lois has suggested, Lois 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.”
• How should Liz respond to Lois’s demand that the medication be given with the current solution?
• Why does Liz believe the medication should not be given with D5W? What are the possible consequences?
• Does Lois display any “difficult behaviors”? What type of difficult person might she be?
• What are the important communication techniques that Liz could use in responding to Lois?
• What are the key ethical principles involved if Liz gives the medication as instructed?
• What are some possible legal consequences in this situation?