Some nurses make you sick!!! - page 4

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... Read More

  1. by   Dolce
    If it were my patient I would have thrown out the 400 ml left and checked the residual and then hung the next feeding as ordered if the residual was okay. Then, I would have passed on in report to the oncoming nurse the rate of infusion and how much time it had left. I have had situations before where an off-going nurse has given me a poor or incomplete report and I have been "surprised" by a number of not-mentioned details when I go in to complete my own assessment. I'm not upset about the patient condition so much as I am upset about the fact that key details were omitted from the report. We often forget things to say in report, this is why we should jot down notes for ourselves on our brain sheets. Although your actions may have been perfectly reasonable, you need to realize that the passing off of a patient in report is a big deal. This is a great opportunity for you to learn many things. I would suggest being careful in report that you give all the necessary details. You say that you were upset that the nurse spoke with the DNS instead of you first, but you had already gone home when she discovered the feeding. What was she supposed to do?

    I would suggest making hourly rounds on your patients and taking good notes on your brain sheet for report--both of these steps may prevent what just happened from happening again. The other thing I would suggest is that after giving report to the oncoming nurse you should ask her, "Am I forgetting anything?" That lets her know that you are open to feedback and questions.

    The first year in nursing is the absolute hardest...try to learn all that you can during this time!
  2. by   gt4everpn
    Quote from scubadaddy66
    where does it say in the posting that they didn't do an assessment?
    at 19, learning life and career at the same time can be very overwhelming. where are the other nurses who are working with her? how come they didn't make sure things were done correctly?
    also, nursing is continutity of care, not shift care!

    team work is a big part of nursing. i see alot of people with the attitude that "thats not my patient" or "i'm a nurse, not a housekeeper"

    what ever happened to common curtesy to help one another?

    thank you everyone for your responses but the issure i was tryng to raise isnt about the feeding itself, it is about the nurse who heard the feeding beep and then called the supervisor to report me. this isnt really about me being a new grad, anyone makes a mistake, the machine beeped on her shift indicating the bottle was empty and she reported me as not starting the feeding when my shift was already over! i've never had a problem with starting feeds, it just so happened that it was empty and instead of coming to me she instead just called the supervisor to report me, if a feed finishes on your shift, how can you blame the previous shift for not starting it over, it wasnt finished yet!! and better yet put another nurse in trouble!
  3. by   gt4everpn
    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. [/quote]


    i will take this piece of advice, thanks!! working at night with 40 residents and like 8 feedings its easy to forget , thanks!!
  4. by   gt4everpn
    Quote from michelle126
    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.

    thankyou michelle, thats all i was trying to say!!
  5. by   gt4everpn
    Quote from insurance rn
    i also cannot get past the fact that the op infused the 400 cc's that she found when she went to hang the new tube feeding.
    but, my bigger concern is that the op stated the patient receives 600 cc's of tube feeding q 12 hours, that @ 2 am when she went to hang the new tube feeding is when she discovered that not all of the previous feeding had infused. why was this not discovered until 2 am? i may not be seeing the whole picture here, but it appears that the evenng shift missed this as did the op until 2 am. does the oncoming shift do pateint rounds with the previosu shift?

    the feed starts at 2 am in the morning, it was m.d orders!
  6. by   gt4everpn
    Quote from widi96
    Okay, original poster said 600ml q 12hrs - so the bag had not been up over 24 hours - only 12. So those that have complained about the length of the time it hung, it could have been perfectly within her guidelines. I know at the hospital I work at, bags are not to hang over 24hrs, so she would've been within our guidelines. I can completely understand the original poster. As new nurses we are always under the scrutiny of everyone and trying our hardest to do everything correctly. It sounds like this other nurse was just being a pain. Yes, the OP should have stated about the tube feeding in report, but if the nurse who received the patient had a problem - she could've called and asked the night nurse. If the night nurse's explanation was unsatisfactory, then she could've called the nursing supervisor. I'll tell you what, I learn a whole lot better from my fellow nurses pointing out things to improve my practice (It's called Constructive Criticism) vs being called by the nursing supervisor to tell me I'd screwed up with
    something.
    thank you widi 96! you said it better than me!!
  7. by   NursingAgainstdaOdds
    Quote from gt4everpn
    thank you everyone for your responses but the issure i was tryng to raise isnt about the feeding itself, it is about the nurse who heard the feeding beep and then called the supervisor to report me. this isnt really about me being a new grad, anyone makes a mistake, the machine beeped on her shift indicating the bottle was empty and she reported me as not starting the feeding when my shift was already over! i've never had a problem with starting feeds, it just so happened that it was empty and instead of coming to me she instead just called the supervisor to report me, if a feed finishes on your shift, how can you blame the previous shift for not starting it over, it wasnt finished yet!! and better yet put another nurse in trouble!
    i find it distressing that you're still focused on the "what happened to me" aspect, rather than the "what i learned" aspect. your thread became about you as a new grad because your original post indicates you need some counseling on this issue, and from the information you relayed it's possible you're just missing some knowledge that will help you in the future. from what you've written, it seems you're so focused on being right about how you were treated that you're unable to also learn from the experience.
  8. by   gt4everpn
    Quote from NursingAgainstdaOdds
    I find it distressing that you're still focused on the "what happened to me" aspect, rather than the "what I learned" aspect. Your thread became about you as a new grad because your original post indicates you need some counseling on this issue, and from the information you relayed it's possible you're just missing some knowledge that will help you in the future. From what you've written, it seems you're so focused on being right about how you were treated that you're unable to also learn from the experience.

    oh I learned something alright! I learned that some nurses are quick to report you! what else was there in it for me to learn??? I know about feedings, what else do you think I should've learned??? honestly?? Maybe I should have went straight to the what the problem was, putting aside the issues with the the feeding and what time it was and when it was hung, etc.. etc..., what I am asking is was it right for the day nurse, who came in complaining about the workload on the floor (I forgot to mention that!) to call the supervisor who called me at home to tell me the feed isnt started, when clearly it ended on the day nurses shift!!( should I have waited around for the whenever the feed ended to restart it??) Tell me what you think!!
  9. by   FireStarterRN
    Quote from NursingAgainstdaOdds
    I find it distressing that you're still focused on the "what happened to me" aspect, rather than the "what I learned" aspect. Your thread became about you as a new grad because your original post indicates you need some counseling on this issue, and from the information you relayed it's possible you're just missing some knowledge that will help you in the future. From what you've written, it seems you're so focused on being right about how you were treated that you're unable to also learn from the experience.
    [S]She's only 19[/S]
  10. by   CoffeeRTC
    In any LTC setting you can have a number of patients on tube feedings....I would never be able to figure out how much feeding is left in everyones bag. Coming on my shift, I always go down the hall and do a check on all my pts....checking their feedings and IVFS and I will eyeball any tubes such as foleys, wound vacs etc. I will also do this going off of the shift too. If a fluid is gonna run out soon after the next shift is to start, but not soon enough to hang a new one, I willl always leave an extra bag or can of feeding in the room. I was taught this courtesy in school, but in LTC it really is against the rules. Very rarely do I see this courtesy shared with other staff members. To be honest....If I, as a supervisor, had to counsel or talk to my employee...this is what I would review and I'm sure a new grad would be receptive to this advice or counseling.

    Maybe I'm so riled up about this issue because of the way we we are treating each other. I think it is about common curtesy (sp)
  11. by   Nrs_angie
    Quote from gt4everpn
    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 will take this piece of advice, thanks!! working at night with 40 residents and like 8 feedings its easy to forget , thanks!![/quote]


    hi there, that was me who posted that little piece of advice.
    i think everyone who posted on here is assuming the bottle hung longer than 24 hours because... well to start we don't really know what brand of feed it was and how it is packaged... so lets say it was one of those 1200 ml prefilled bottles... that would have been hung at 2 am on the previous night... and thrown away at 2am on your shift... lets say it was one of those clear baggies that you fill up with cans of liquid feed.... fresh bag and tubing is hung at 2am on the previous night... it runs low so dayshift fills it with more cans... by 2am on your shift a new, fresh bag and tubing should have been started... see what i am saying... no matter what type/brand of feed it was... if it is started at 2am on your shift, then you always start with a new bag/bottle and tubing every 24 hours... to prevent bacterial growth... and the feed goes bad after so long... but why was there 400 remaining... we really don't know... some things we could assume are:

    1. during another shift, a cna turned the pump off when it was beeping, and no cna's shouldn't be turning on/off pumps but we all know that sometimes they do.
    2. during another shift, someone added too much feed to the bag.
    3. the line was occluded because the patient was sitting on it... no one heard the pump alarm.
    4. perhaps the patient was not tolerating the feed on another shift, so it was placed on hold according to orders if residual is greater than x amount. perhaps it was then restarted at a slower rate to see how the patient would tolerate it.

    these are just some reasons why we can assume there was 400 still hanging.

    i am not saying you are wrong. i am not saying the day shift nurse is wrong. i am not saying anyone here is wrong. but you didn't give a lot of information in the op. so this is just my best guess at what went wrong.

    the day shift nurse who's probably been there a long, long time, with all the same patients every day.... know's who gets feed tubes.... and she knew that this one should be running until 2pm ( every 12 hours ) before she would need to hang a new bottle. but mornings can be extremely hectic in a ltc facility... so for her to stop what she's doing and have to hang a tube feed... is probably what upset her enough to call the sup. no matter what shift you work, or how long you have been nursing, it always, always, always sucks when other shifts leave you extra work that they didnt do.

    again i will go back to what i said earlier... in the future... always, always, always tell the oncoming nurse how much is left up in a bag... whether it be an iv bag or a tube feed bag... so that way she can plan to go in that room with everything she needs!

    i hope i made better sense this time... and i sincerely hope that this helps you to learn. not too long ago, i was a new grad too... so i know how it feels!
    Last edit by Nrs_angie on Nov 16, '07
  12. by   NursingAgainstdaOdds
    Quote from jlsRN
    [s]She's only 19[/s]
    No doubt. Suppose me and my logic should go elsewhere...
  13. by   EmmaG
    Quote from gt4everpn
    thank you everyone for your responses but the issure i was tryng to raise isnt about the feeding itself, it is about the nurse who heard the feeding beep and then called the supervisor to report me. this isnt really about me being a new grad, anyone makes a mistake, the machine beeped on her shift indicating the bottle was empty and she reported me as not starting the feeding when my shift was already over! i've never had a problem with starting feeds, it just so happened that it was empty and instead of coming to me she instead just called the supervisor to report me, if a feed finishes on your shift, how can you blame the previous shift for not starting it over, it wasnt finished yet!! and better yet put another nurse in trouble!
    now you've really confused me.

    you said 600 cc q 12 hours. to me, that means it isn't running continuously, but over a set period of time twice a day. so if that is the case, why would she start it over at the beginning of her shift? and how could she have come to you when you were already gone? did she think you hadn't given the feed at all? or was she concerned you hadn't given the full amount? by the way, what rate is it ordered to run? over how many hours?

    seriously, this isn't making any sense to me.

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