Some nurses make you sick!!!

Nurses General Nursing

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hello everyone!! so here is my vent!!!:angryfire, i work at this lovely ltc , anyway i just got off working 11-7 shift, the supervisor calls me as i am goin home and tells me that the day nurse called her and complained about a resident whos feeding is beeping and the bottle is empty, this resident gets 600 ml every 12 hours and the feeding is supposed to start at 2am, so at 2 a.m i go to start the feeding but there is 400ml in the bottle from the previous feeding,which finished at 12mn the feed is diabetic resource which comes in a 1000ml bottlet! this unit has 40 residents about 8 feedings, so while i'm doing other tasks i wait for the feedings to beep so i knowmy next moves, the day nurse comes in and starts complaining about how heavy the floor is and the feedings. i give report and leave i am expecting that the feed is still running!seeing that i started it at 2am and my shift ends at 7am, anyway she calls the supervisor on me and the supervisor calls me on my cell phone, couldnt the day nurse have spoken to me first?? if the feed ends 15 min after my shift ends am i still liable?? why did she have to call the supervisor to report me vs. starting a new feed and giving the 200ml balance that would complete the 600!

Indeed, every day is a learning experience. I think the OPs first mistake was focusing on how this situation would effect their standing at work, rather than focusing on what could have been learned from the situation. The knee-jerk response was "Oh, SOME NURSES!!!" and not "Perhaps I am missing some knowledge here". Certainly a new grad should not be written-up for every mistake they make, but the actions described by the OP indicate an unsafe knowledge deficit which warrants some counseling and further education.

Hit the nail right on the head.

Specializes in Med-Surg, Tele, Vascular, Plastics.

Hi there,

Since most of my experience has been with Vascular and Plastic Surgery patients... I could be wrong about this. But my first instinct would tell me that if the bottle was up for 24 hours it should have been tossed, regardless of what was remaining. I definately know that enteral tubing is tossed in 24 hours... so shouldnt the bag be tossed as well?? Again, ive only seen a handful of tube feedings and I was dayshift or second shift. We mostly started the tube feeds on night shift. My second instict tells me that if the order was for 600 ml every 12 hours, then I assume it was running at 50 ml/hr which is a very common rate... usually they run 15 to start, and work up to as fast as 80, depending on how it is tolerated ect. If these assumptions are correct, then the 400 ml would have lasted until 10 am. Your shift would have been over by 7 am. So I really don't understand why she called to report you??? Am I missing something here??? If someone out there sees something that I am not getting, please correct me...

In future, I think the best thing is to let the oncoming nurse know that the feed is still running and always tell her how much is up (remaining amount) the last time you checked it. This way she knows when to plan to hang a new bag/bottle. Offer to check it before you go... she may just say, "thats ok, I'll check it, go home and get some sleep!". Atleast this way she is aware of it.

I think that since this was the first time a mistake was made, the other nurse should have confronted this nurse instead of going to the supervisor on her. And the supervisor should have stepped up and explained to the other nurse that this is a new nurse and that she needed to be counseled.
True, but:

I'm not making any excuses by I dont think it was right for the day nurse to report me, even if she told the supervisor to just remind me to be more careful, or even if she spoke to me first directly!!
To be honest, the OP wasn't very clear about what exactly the complaint was all about. And Lord knows, we all forget stuff, no matter what our experience, so I can understand her frustration. As far as the feeding, it's up to the nurse to know proper policy and procedure or know where to look it up, regardless of how new they are.
Hi there,

Since most of my experience has been with Vascular and Plastic Surgery patients... I could be wrong about this. But my first instinct would tell me that if the bottle was up for 24 hours it should have been tossed, regardless of what was remaining. I definately know that enteral tubing is tossed in 24 hours... so shouldnt the bag be tossed as well??

Policy everywhere I've worked is that all feeding tubing, bags, etc., are tossed at 24 hours. Feeding that is in a sterile liter pre-filled container is good for 24 hours while infusing, but if disconnected and just hanging there? A new one must be set up, and especially if it is going to run past that 24 hour mark. And those where you add to the feed, never add more than can be infused over 4 hours.
Specializes in Med-Surg, Tele, Vascular, Plastics.
Policy everywhere I've worked is that all feeding tubing, bags, etc., are tossed at 24 hours. Feeding that is in a sterile liter pre-filled container is good for 24 hours while infusing, but if disconnected and just hanging there? A new one must be set up, and especially if it is going to run past that 24 hour mark. And those where you add to the feed, never add more than can be infused over 4 hours.

Hello and thank you Ms. Goldstein,

But what do you mean by those where you add to the feed? Can you clarify? Do you mean increase the rate? increase the dose?

Thanks

Hello and thank you Ms. Goldstein,

But what do you mean by those where you add to the feed? Can you clarify? Do you mean increase the rate? increase the dose?

Thanks

I mean from cans that you add to a bottle or bag, rather than the pre-filled bottles you spike directly. (am I making sense lol)

Lots of things wrong here, but does that really warrant a call to the employee? Couldn't all of this have been brought up the next day when she/ he worked? I think I would have waited and spoke to the nurse when she came on the next shift and reviewed the policy of tube feedings.

I can't tell you how many times I came on a shift to an empty tube feed, a beeping pump etc. Yeah...it isn't very nice, but if it happens all the time, you bet I might say something.

Specializes in SNF.

I agree. She doesn't state that she didn't do these assessments. Also, in LTC we have these 2000mL bottles of nourishment for our G-tubes. Thats exactly what I thought of when she said their was 400mL left. We use up the previous b4 spiking a new bottle.

Let's give the poor girl a break.....I don't know how many times I've gone home and thought of all the things I should have done. We learn from our mistakes.

Teresa

Specializes in Med-Surg, Tele, Vascular, Plastics.
I mean from cans that you add to a bottle or bag, rather than the pre-filled bottles you spike directly. (am I making sense lol)

Gotchya now!

hehe, duh I feel dumb...

Actually though, I have never heard that you should not add more than will infuse in 4 hours... Why is that?

Specializes in Pediatrics, Med-Surg, Cardiology.

Personally, if I came into the room and found 400ml in the bag I would have just thrown it away. Next, I would have just started my own new fresh feeding in a fresh bag. These feedings are to be changed every four hours to every shift at least. I frequently did feeding tube care as a student nurse. I am a new RN and I definately would do the same thing as I did a SN, with the addition of checking residual, placement, etc. If I was a patient, I would sure not want to lay in the bed with a peg tube feeding that is infusing bacteria, even if my bowel is not sterile.

Specializes in Telephone triage, hospice, LTC, CCU, ,.

I hope you will take this the way I mean it. This will not be the last time another nurse complains about you :uhoh21:. It is a fact of nursing life, for various reason, many that have less to do with you and more to do with other nurse, or the working situation, we pick at each other. Hang in there, learn from this and do your best.:welcome:

Gotchya now!

hehe, duh I feel dumb...

Actually though, I have never heard that you should not add more than will infuse in 4 hours... Why is that?

I'm sorry... I know I'm not making much sense here lol. Our policies (and info from the companies we purchased from) stated the formulas were only 'good' at room temp for up to 4 hours. So we'd not put more in a bag or bottle than would infuse over 4 hours.
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