Some nurses make you sick!!!

[gt4everpn]

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!

[CoffeeRTC, BSN, RN]

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)

[Nrs_angie, BSN, RN]

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!!

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!

[NursingAgainstdaOdds]

She's only 19

No doubt. Suppose me and my logic should go elsewhere...

[EmmaG, RN]

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.

[EmmaG, RN]

Well, I see the OP edited the initial post for clarity. It helped a little, I guess, but I'm sorry no one had quoted the original because I could swear she said she started what was already hanging then added another 200. I do remember it saying the feeding might have been beeping empty between 5 and 7 while she finished up her shift.

In any case...

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!

ok..

It would appear it's running at 60 cc/hr.

400 cc started at 2 am should have lasted until almost 9am.

And yet:

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??

I don't blame that nurse for calling the supervisor to question you about the feeding...

[Hellllllo Nurse, BSN, RN]

She did say she saw there was 400cc in the bag when she initially checked, and she restarted it.

[EmmaG, RN]

She did say she saw there was 400cc in the bag when she initially checked, and she restarted it.

Yeah I know, but I could swear in the post before it was edited she said that she'd added another 200. I know for sure she said she may have missed the pump beeping empty between 5-7 as she was finishing up her shift; I know because that caught my eye that the pump would have been beeping for two+ hours.

In either case, if the feedings were running over 10 hours (going by the previous one being 2pm to 12mn), it should not have been empty at 7 am.

[Hellllllo Nurse, BSN, RN]

Aside form how much feeding was left in the bag, etc. This post expresses what disturbs me the most about this situation:

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.

[EmmaG, RN]

Aside form how much feeding was left in the bag, etc. This post expresses what disturbs me the most about this situation:

I agree. My point is, if I'd followed her, I'd have called to get this clarified too.

I would love to know what the order actually says, though.

[Hellllllo Nurse, BSN, RN]

Me, too.

[Nrs_angie, BSN, RN]

Yeah I know, but I could swear in the post before it was edited she said that she'd added another 200. I know for sure she said she may have missed the pump beeping empty between 5-7 as she was finishing up her shift; I know because that caught my eye that the pump would have been beeping for two+ hours.

In either case, if the feedings were running over 10 hours (going by the previous one being 2pm to 12mn), it should not have been empty at 7 am.

I remember what the OP said... she mentioned that she restarted the 400... and she was going to go back and set the pump again to add for another 200... but she also mentioned that she may have forgotten to go do that with it being the end of her shift and being busy with 40 patients... her main squabble was that the day shift nurse called and reported her rather than talking to her personally...

according to one of her recent posts... it ran out at midnight...

her shift started at 11PM...

if the order is 600 mL q 12 hours... that tells me that it is a continuous feed...

so I am still not understanding why a Diabetic doesn't have the feed going from midnight til 2AM... what happened in those 2 hours...

AM I MISSING SOMETHING HERE?? ANYONE HAVE ANY IDEAS?

[EmmaG, RN]

I remember what the OP said... she mentioned that she restarted the 400... and she was going to go back and set the pump again to add for another 200... but she also mentioned that she may have forgotten to go do that with it being the end of her shift and being busy with 40 patients... her main squabble was that the day shift nurse called and reported her rather than talking to her personally...

according to one of her recent posts... it ran out at midnight...

her shift started at 11PM...

if the order is 600 mL q 12 hours... that tells me that it is a continuous feed...

so I am still not understanding why a Diabetic doesn't have the feed going from midnight til 2AM... what happened in those 2 hours...

AM I MISSING SOMETHING HERE?? ANYONE HAVE ANY IDEAS?

Confusing, isn't it. I was looking at it as an intermittent feed, since it said q 12 hours. That's why I've asked a few times over how many hours was this supposed to run. The 10-hour thing was what I gleaned from her post, assuming the prior feed started at 2pm.

I'm used to most continuous feeds being ordered as ___ cc per hour. Never worked LTC, though, so the way it's ordered there might be different.