Almost lost it last night

[catlvr]

I changed two PEG tube dressings last night, 5/5/12 (ordered for daily clean site and change on tubes with continuous feedings). Found my dressings from 4/30/12. Called the sup in to witness, and was told that I could only do what I can do to sleep well at night. As I see it, there was an opportuity to for a bunch of nurses to change those dressings since the tube was accessed every shift, but apparently nobody thought that they should do it for the good of the pt, since the nurse who signed off on having done it apparently didn't. Natty looking dressings, as you might imagine.

I want to work for CapeCodMermaid, since I suspect that she would not tolerate this type of behavior.

[JZ_RN]

Sorry this happened to you. sad for the patient too.

When I find old dressings, I always note in the chart that the date on the last dressing was "such and such date." And describe its appearance. Management doesn't like it when I make the other nurses look bad and contradict their TAR but.... They don't do it again after it's documented forever.

If you signed off doing it, do it, otherwise, make a note "Did not have time to complete, asked oncoming shift to complete such and such treatment"

[morte, LPN, LVN]

...and not all tube sites need drsgs, get rid of the orders for those that don't.

[CapeCodMermaid, RN]

Catlvr--you're right. All the nurses who should have changed the dressing would be counseled and if they had signed off in the treatment book that they had done something they hadn't done, they might even get suspended.Morte--you're right. Not all g-tubes need a dressing and certainly none of them need to be taped down on all sides.

[catlvr]

I guess that it was the final straw for me at this place. I agree that not all gtubes need dressings, but when I suggested that we d/c some of the dressings that clearly were not being done, I was told to let it go - don't make waves. And why do qid blood sugar checks on someone who is stable, and not receiving sliding scale coverage anyway? (I can certainly understand for brittle diabetics who need better control; but sticking a ltc patient four times a day and doing nothing but recording the info for years on end? That's not fair to them.) My view is that this place doesn't have a lot of interest having proactive nurses who want to improve the residents' lives in whatever ways they can; nor do they have much interest in doing quality control checks. Lots of time to sit at the nurses' station and watch youtube videos, though, and I guess that I'd fit right in if that's how I wanted to spend my work day.