I have had a really busy day today and as part of my job I am the nurse practitioner for surgical outlyers. We don't get them often but today we had a few on medical wards.
One of these patients was a bowel obstruction, distended, vomiting and poorly. He was going to be treated conservativly with IVI and NG tube. I got to the ward and the staff nurse informed me that his NG had come out, she was in the process of bleeping the doctor to put it back and there were no nurses on the ward who could put NG tubes in.
Now when I did my training we were taught to insert ryles tubes, is this no longer the case. I find it worrying that the doctors that she bleeped are house officers and haven't put NG tubes in (our surgical nurses do it) and there weren't any nurses that could do it. I did it which is fine but I wonder what happens tomorrow on my day off.
I worry that as nurse pracs we are doing these things but not allowing the ward nurses or new docs to learn because we always do them.
Not sure what the solution is, if I were a patient I would want the most experience person doing things like that for me but we all have to learn sometimes. I do try to teach when I do these things but the nurses on the ward today weren't interested, as far as they were concerned they hadn't done a course to put NG tubes in so they wouldn't do them (OUr trust doesn't rund a course by the way)
Not sure what my point is, I know I am rambling a bit, but I do wonder (and maybe Ayla can answer this) is nurse education lacking in clinical skills, is this the sort of thing we should be learning in nursing school and encourage our students to be doing and do we really need a study day to be able to put a naso gastric tube in? (or catherise for that matter) or is this something that should be covered in nursing school.
Specializes in Nursing Home ,Dementia Care,Neurology..
I trained in the 70's,long before P2K and we were members of the team as soon as we set foot on a ward.You learned from the bottom up,the infernal intricacies of sluice machines ,the doing of a whole ward of observations,cleaning as well.Once you had taken a whole 30 bed Nightingale ward's worth of temperature's pulses and resps you fast became competent!One lesson I do remember was ,we were taught to pass N/G tubes and feed.Now in the ward where I learned this they quite happily taught you to use a plunger with the feed!!Knowing no better I did this on my next ward only to be soundly told off for it quite rightly!When it is pointed out to you the damage you can cause doing this it seems so obvious but,as a student,you learned from the best and the worst sometimes!
By the time we were second years we often took charge of wards ,especially at night ,but we were confident in doing it because that was what the training developed in you.Receiving night in a busy surgical ward was hectic and exciting as you tried to clerk in patients ,find doctors and generally cope with what ever was thrown at you.By third year we knew more than the junior doctors mostly.They often asked us for advice in the ward.
We had a blue book all the way through training which was signed off when you did a procedure.Our main aim was to get this book totally signed off.If we heard that a certain procedure was to be done then we were there ,asking to help ,observe etc so that we could sign it off.
Fast forward to the 90's when I had my Gall Bladder removed.The students were there,yes but there did not seem to be any motivation to observe like we had.One of them said that he could sit in a bay all day and no one would tell him to do anything.I asked him why he didn't come and watch my drains being removed but he said he didn't know about it.We went out of our way to find out these things!
I 've just got back from a holiday in America, visiting a friend who I trained with. She has a much more extended practical skills list than i'll ever be able to achive, yet whilst i've stayed in the UK I've clocked up a lot of uni and in house courses, mentorship venepuncture facilitator etc.
Some of my 'skills' are not things I ever wanted to learn, or a role I previously associated with nursing, but unfortunately they have become' necessary for my job'... i never wanted to host MDT meetings to persuade spocial services to find a package of care that wasted three hours of my shift, i never once wanted to be part security guard lokcing away property that has to be signed in by two RN and then escorted down to security, ( roughly a half an hour job)
We now have six forms to complete one in triplicate if a patient dies, i often wish i could be left to do my job, without the paper work and '' new roles'' I'm sure I'd be ble to learn new clinical skills... I've fine with defibs, or looking after patients with tracheostomy or chest tube or pacing wires, tpn or ng feeds, takes me a little time to remeber how to work the machine, but i've never inserted one, or had the opportunity to learn, heck since i qualified i think i've catheterised about five patients!!!
And to go on the course to learn how to catheterise men... you need to have 'reasonable experience'... so thats one course i don't think i'll be going on!
stepping off my soap box now,
students are often eager to learn the 'essential skills' but perhaps retention of newly qualifed nurses is so low, because once you qualify the quality time for care just vanishes in a wave a paper work and phone calls?
...develop your relationship with the HEI and perhaps the link tutor or other lecturing staff will come and work with your students...
I seem to remember trying that when we had a student with VERY unsavoury personal habits :eek:. Despite being failed on that placement the student qualified and was last seen smirking in the corridoor as she walked past us.
not reading thourgh all this on dodgy dial up at present
ng tube insertion is someitng i only got the cahnce yo do twice whilst on a neuro ward so feel this is one skill inculded in pre-reg taiing i lack experince in. but i would have a go.
i am happy to try other skills female caths, any type of injection setting up s/c fuilds etc. my mate never had the oppurtingy to do any caths
Interestingly here in Canada students have what I can only describe as clinical nurse tutors come to the wards & work with them (hey guys who remembers those??? We had to prove we could do certain competencies like aseptic technique to our clinical tutors before we could pass our modules!)
Undergrad nurses (final year I believe, although I haven't worked it out quite yet) can work pretty much as our old EN's on the ward as paid bank staff - they give meds & take their own pts but can't do some things like hang TNA/TPN or change PCA meds.
I work a couple of hours north of you. We are finding that more and more of the "clinical instructors" that are coming from the universities have very little "real world" experience. It becomes difficult when as a LPN (your old EN) I have to "assist" in demonstrating the skills along with the university lecturer. I'm trained to insert NGs but regional policy only permits a RN to do it. So there I am an LPN "reminding" the lecturer on how to perform restricted skills. You know the lecturer is bad when they don't know how to shorten a Penrose drain.
As to employed nursing students. First years can work as NA and provide basic patient care. Second through fourth years can work as UNE's or ENS. They pretty much have the skill set of the LPN but have restricted patient loads (usually between 2 and 4 patients max). So you will find that many units perfer to get an LPN who has good skills and can manage a full patient load over a student who will pout if given 3 patients and causes the rest of the staff to work over safe patient limits. Any more than five patients on an evening shift will result in an incident report being filed and the unions being notified. Personally as an LPN, I resent having to take on 7 patients on an evening shift so that a UNE can have 2-3 patients.
Neither the LPN or UNE can spike the blood bag, both can witness and be the second signature required under law. TPN is a bit of a joke. On my unit, the LPNs witness the correct bag is being used, spike the bag and prime the lines and leave it ready for the RN to come along and attach to the IVAC. We can hang new bags if the bags run out. Farce or what?
I seem to remember trying that when we had a student with VERY unsavoury personal habits :eek:. Despite being failed on that placement the student qualified and was last seen smirking in the corridoor as she walked past us.
I had a house mate when I did my training, that had very poor personal hygiene, did a double shift, came home and slept in her uniform and went back and did another double the next day in the same uniform!!
When myself and other house mates raised concerns with the univeristy we were acused of bullying and had to prove our characters, the student in question passed her course, and now works in a department I avoid and would not let any of my family attened, I know she's been taken to task a few times, but the trust is tied because they are afraid of getting sued (but they do receive complaints about her cleanliness from patients).
'Failure to Fail', puts the responsibility on the ward staff and mentors, but without university support, the de-skilling and general spiral downwards seem set to continue!
When I told nurses here back in 1989 when I arrived in the US that I had never catheterized a male patient they thought I was joking. I told them we were not allowed to catheterize male pts and I could not give them a good enough answer to why not! I was terrified doing it the first time - I can`t believe how easy it is compared to female catheterization! Bloss
It seems crazy doesn't it? It is so easy to cath a male unless they have prostate problems. The PCT'S do male caths here you dont even have to be an RN.
Males are so easy. For the enlarged prostates get a lidocaine gel order, it numbs as it goes in and use a Coude tip. That will get you past most prostates.
Now, we won't discuss the little old lady who took 6 attempts before we hit gold.
Specializes in Spinal Cord injuries, Emergency+EMS.
like so many of the pointless rituals of UK nursing the treatment of maile catheterisation as an extnded role is one rlated to victorian views of what is is proper for well brought up young lady to do ...
there's not much crimea sand in Uk hospitals either but the pillows still take account of it
I am not so sure that I agree with you Zippy, I think that things are changing in the UK slowly yes but they are changing. Where I work we have quite a few nurses who do "advanced skills" routinely such as venepuncture and cannulation, catheterisation (male and female) DRE. In fact our catheterisation study day is not gender specific but teaches both. As a practicing UK nurse I find your comment about crimean sand personally quite insulting, there is a lots of excellent nursing practice in the UK and comments such as that devalues what nursing has achieved. There is so much negativity in the UK (and I understand why this is) but I truly believe that the majority of bedside nurses strive and achieve a high standard of evidence based practice.
I do think these skills should be taught and practiced as students but understand that there is not always the time on a busy ward to spend the time doing that.
Its interesting how much regional variation has cropped up, even with in the UK, some trust seem to have a taken extending nurses roles much further than others.
My last shift I was moved wards due to a bedding crisis, I ended up 'baby sitting' ( the bed managers words not mine) a twenty bedded ward, my self and an AN. My charge nurse apologised before sending me, I went there expecting the worst..... all the patients had transport booked or due for d/c next day back to care home. But it was fantastic, did 'proper' nursing (some one else had done all the planning) i was very tired but had a great day.
The Staff nurse who took over from me on nights, laughed at how little i knew though about some of the patients condition, or when my pronunciation was off. She'd trained a good while ago, and her general knowledge was much better than mine, where as my knowledge base is very specific to where I work, I didn't like to tell her that I'd had to google many of the conditions, because I'd never come across them before. If what she said was true, about nurses being trained to work any where and being able to do a basic role on any ward, then we need to go back to the old system, because every time we move i feel like a fish out of water, the last time i moved i went to ortho, and ordered an air matress for a patient with a fractured NOF!!!
Whisper
ps, found out about ot using the matress just after i'd inflated on an empty bed, so nobody was harmed, except my ego
:eek:
nightmare, RN
1 Article; 1,297 Posts
I trained in the 70's,long before P2K and we were members of the team as soon as we set foot on a ward.You learned from the bottom up,the infernal intricacies of sluice machines ,the doing of a whole ward of observations,cleaning as well.Once you had taken a whole 30 bed Nightingale ward's worth of temperature's pulses and resps you fast became competent!One lesson I do remember was ,we were taught to pass N/G tubes and feed.Now in the ward where I learned this they quite happily taught you to use a plunger with the feed!!Knowing no better I did this on my next ward only to be soundly told off for it quite rightly!When it is pointed out to you the damage you can cause doing this it seems so obvious but,as a student,you learned from the best and the worst sometimes!
By the time we were second years we often took charge of wards ,especially at night ,but we were confident in doing it because that was what the training developed in you.Receiving night in a busy surgical ward was hectic and exciting as you tried to clerk in patients ,find doctors and generally cope with what ever was thrown at you.By third year we knew more than the junior doctors mostly.They often asked us for advice in the ward.
We had a blue book all the way through training which was signed off when you did a procedure.Our main aim was to get this book totally signed off.If we heard that a certain procedure was to be done then we were there ,asking to help ,observe etc so that we could sign it off.
Fast forward to the 90's when I had my Gall Bladder removed.The students were there,yes but there did not seem to be any motivation to observe like we had.One of them said that he could sit in a bay all day and no one would tell him to do anything.I asked him why he didn't come and watch my drains being removed but he said he didn't know about it.We went out of our way to find out these things!