Some nurses make you sick!!! - page 7

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   qpelf
    I remember as a new grad, uhhhhhh....okay, I'll date myself here, 19 1/2 years ago and went to work in a long term care facility. They threw me on the skilled floor and I hated it with a passion for that very reason. I knew nothing about the feeding tubes and had NO orientation. You're just supposed to know these things. And maybe you should have asked someone else about the feeding or if you were there by yourself, called either the day nurse that would have hung that feeding or your DON to see what proper procedure was. There should have been a policy and procedure manual on your floor also that would have told you about feedings. Look and see. Just remember this, if it doesn't add up....which the left over 400cc didn't.....then something was already wrong before you took over and finding out the reason before just jumping in and restarting the feeding would have been prudent. But as was said, this person has 6mo. experience and haven't we all screwed up????????? I agree on the bacteria thing. Feedings are only to be out for so long. But put this behind you and realize that it is a learning experience. Our first duty is to do no harm and if the patient is okay then that write up from the day shift nurse will come back to bite her/him in the backside someday. There are nurses out there that ascribe to the "How many people can I write up in my career?" philosophy.
  2. by   morte
    Quote from qpelf
    I remember as a new grad, uhhhhhh....okay, I'll date myself here, 19 1/2 years ago and went to work in a long term care facility. They threw me on the skilled floor and I hated it with a passion for that very reason. I knew nothing about the feeding tubes and had NO orientation. You're just supposed to know these things. And maybe you should have asked someone else about the feeding or if you were there by yourself, called either the day nurse that would have hung that feeding or your DON to see what proper procedure was. There should have been a policy and procedure manual on your floor also that would have told you about feedings. Look and see. Just remember this, if it doesn't add up....which the left over 400cc didn't.....then something was already wrong before you took over and finding out the reason before just jumping in and restarting the feeding would have been prudent. But as was said, this person has 6mo. experience and haven't we all screwed up????????? I agree on the bacteria thing. Feedings are only to be out for so long. But put this behind you and realize that it is a learning experience. Our first duty is to do no harm and if the patient is okay then that write up from the day shift nurse will come back to bite her/him in the backside someday. There are nurses out there that ascribe to the "How many people can I write up in my career?" philosophy.
    if you had read all the postings, you would realized that there may have been nothing wrong with that 400 ml hanging........
  3. by   bradleau
    some nurses are insecure in their job and can not handle the work load. A suggestion? Why not have a new set up in the room ready to go! Be it a new bottle or complete change. Also turn up to full volumn all pumps. It has been a while since I worked at a LTC facility, but I was the only nurse for over 40 + patients. CNT's were the help, but only so much one can do.
  4. by   RaElrA
    Quote from Hellllllo Nurse
    I agree.
    Did you check to see if the feeding tube was clogged? The pumps don't always beep when this happens.
    Did you check for proper tube placement? These things can dislodge and migrate.
    Did you aspirate gastric contents to see how much residual was left?


    If too much is left, you may need to call the doc. The next bolus may need to be held. The rate may need to be reduced, or pt may need a new med order to promote gastric motility, or whatever else the doc wants.

    Also, feeding hanging around that long can quickly grow bacteria. I would not have infused it.

    I understand you are upset about being reported, but please evaluate your own actions or lack thereof.
    Thank you so much for that helpful message. As a student nurse who will be experiencing this next semester, this message will stick in mind and potentially save me in a similar situation. Yes, I've read this, but given facing it for the first time, would I have remembered it? I will now. Thanks again!
  5. by   qpelf
    Quote from morte
    if you had read all the postings, you would realized that there may have been nothing wrong with that 400 ml hanging........

    Forgive me for trying to encourage this girl. I think that if you had read all of my email, all I said was that she should have investigated it to see if something was wrong. Don't attack me. You are exactly the type nurse that she's talking about. I have over 19 years experience, and I realize that there might have been issues making the feeding run behind somehow, but that should have been told to her in report then!!!!!!!!! It didn't add up to the MAR so something should have been questioned. Now with that said, I will gladly bow out of this discussion.
  6. by   morte
    Quote from qpelf
    Forgive me for trying to encourage this girl. I think that if you had read all of my email, all I said was that she should have investigated it to see if something was wrong. Don't attack me. You are exactly the type nurse that she's talking about. I have over 19 years experience, and I realize that there might have been issues making the feeding run behind somehow, but that should have been told to her in report then!!!!!!!!! It didn't add up to the MAR so something should have been questioned. Now with that said, I will gladly bow out of this discussion.
    lololololololololol....NOO, i am not......been on the receiving end of it though......my point to you was only that in LTC they often use feedings with 48 hour hang times....this is apparently an intermittent feed...and the fact that there was some hanging did not, on its face,
    indicate a problem of any kind......and as "dear abby" used to say, i dont give advice on the unasked question.....rough quote......lol, cant get over the idea that i am one of THOSE nurses!!!!!!!
  7. by   dotherightthing
    I agree with the mention of "continuity of care". There are 3 shifts for a reason, care goes on. I have a problem with nurses who think that everything should be perfect by the time the next shift starts. Sure, don't dump on the next shift, but **** happens. Resolve as much as possible but if you have 5 patients, getting them ready for the next shift is going to start, for instance, before 3p. By 3p, patients have had BMs, thrown up, IVs infiltrate, etc. Just because you clean up what you can between 2p and 3p doesn't mean the patient stopped living for an hour. You prioritize and continue working. And she didn't mention what she checked or changed at 2a, this is a post, not charting. Give her a break and some help. She is a newer nurse.
  8. by   labvampire
    I myself am 40 and have been practicing for 4 months. I work in an ER and also a Nursing home. The nursing home trained me for two days and then cut me loose with a wing of four halls to take care of by myself. I am an LPN. 112 people to pass meds to, 4 CNA's to manage. Thank the lord my CNA's rock. They have helped me so much with the patients. I was able to handle this, stressed at first, but it has become alot easier. I had 8 yrs hospital experience behind me before I was a nurse. I feel for those who have never worked in healthcare because alot of nurses are ruthless. They eat their young. You have to have a hard skin to be in this profession and don't be afraid to ask questions. Always ask if you are unsure, if that person doesn't help find one that will!!!
  9. by   husker_rn
    I too work in geriatrics and all too often newbies are thrown to the floor with no one else to ask questions of. It can be very difficult to handle 55 residents { that's what I have responsibilty of } 2 vents, 3 tube feeders and then throw in falls and prns and such. I agree that the situation should have been differently handled but I also know that if you are new and overwhelmed with no help, brain overload can happen. And sometimes in the beginning you don't know what you don't know. Thank God I had wonderful mentors in the beginning....
  10. by   frenchfroggyAPRN
    Quote from NursingAgainstdaOdds
    :yeahthat:
    Ditto
  11. by   lamazeteacher
    ".........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 resident gets 600 ml every 12 hours"


    the way i read it, each night at 2 am a 1000ml bottlet goes up, and 600ml should infuse by 2 pm, at a 50ml/hour rate. the remaining 400ml in the bottlet at 2pm would infuse until 10 pm, at that rate. then another ?1000ml bottlet goes up then, and by 2am, 200 ml goes in, leaving 800ml in the bottlet. so, if the feeding rate increased, the patient got an extra 400 ml. by 2 am. since the patient is diabetic, the medications for that disease would have to be adjusted, as the patient ingested too many calories during the evening. the night supervisor should have been called at 2 am, glucose testing should have been done, and depending on that facility's infection control guidelines, a new 1000ml bottlet wouldn't need to go up until go up until that one was finished, having the rate adjusted until the patient's glucose level returned to an acceptable level.
    the night supervisor should have called the ordering doctor, reported the faster rate during the evening, told him/her what diabetic meds had been given at bedtime, and asked what adjustment to make, giving the glucose test results.
    i think the gt tubing change policies would not be the same as iv tubing, which does have 48 hour changes.
    it would have been helpful if we knew what the i&o sheet indicated, and what was written by the evening nurse when she checked the infusion; and gt site for inflammation (at least every 4 hours).
    in home health, after gt feedings (usually boluses are ordered), gt extension tubing is detached from the gt, and that and the bag is washed, rinsed, and put to dry on a towel bar, and used over and over. remember we're dealing with the stomach here..........it's not a sterile organ. i imagine the patients in ltc had gts, and those stay in until the doctor decides to change it - usually once/month, unless it pops out (whereupon someone - hopefully an r.n. immediately pushes it back in). of course, if it's just been surgically placed, that's another thing......
    didn't the nurse say she put up a new container at 2 a.m., 5 hours before the end of her shift? there must have been something very wrong with the infusion pump (he/she did say that a bell went off when the bottlet ran out), to make the feeding go in so much faster. (800ml in about 5 hours, which was more than 4 x that ordered!) if the oncoming nurse hadn't been into blame, and focused more on his/her patients' wellbeing, corrective action would have happened.
    the emphasis/priority here, is the extra caloric intake for a diabetic who would certainly have to be given extra insulin to cover the added calories; the tubing change is incidental.
    by the way, the nurse who originally wrote in, on 11-15-07, had to have been an lpn, as her/his age is given as 19 years and she was a year away from her training. so she graduated high school at 17, immediately took the 1 year lpn course, graduating at 18 years of age. considering her level of training and little experience, the night supervisor should not have left her alone all night with so many patients and feeds, especially having a diabetic on infused feedings! r.n.s are responsible for the lpns. culpability here is squarely on the supervisors and administrative shoulders there, for improper staffing/supervision, and the evening nurse (however trained and experienced he/she was) for not realizing that the diabetic patient's infusion was too rapid). did anyone check loc, dryness of skin, etc.? geez!
  12. by   kansasnurse51
    Give her a break! Most of us dont even remember being 19 let alone a new nurse. My suggestion is get a different job where you have someone working with you to support and intern you. You would probably get more experience and support as a new nurse in a hospital, and if you prefer working with the elderly, try a skilled nursing unit or acute care. And I hate to say it, but I think some of these coments show that there are a lot of nurses out there that would report their fellow nurse in a heartbeat rather then give advice and encouragement! Keep working at it hon and you will be a great nurse someday!
  13. by   cooblu
    after thinking about this, i have to give "the venting nurse" the benefit of the doubt for 400 cc whatever...but to the point of this issue is going to the supervisor for this small matter of a beeping/empty feeder is malicious. true enough finding empty iv bags, feeders.etc is a pia, but who has the time to go whine. i work nights and i find many mistakes and questionable issues but i fix them if i can and go on. But, i am no florence nightengale - should some nurse following try to gain points or just mean and bring matters like this up. i will make every effort to find their errors and it usually won't take very long as we all make mistakes. who enjoies being called at home by the supervisor?

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