how come we as nurses are taught and do things differently?

Nurses General Nursing

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I just had to ask because it seems no 2 nurses were taught the same way or do things such as skills the same way. For instance,I was taught the nursing theory using the Sister Callista Roy . But there is a sticky about Jean watson,who I have never heard of until I read that sticky. Even among nurses trained in the Usa it differs. As an example,there was this elderly woman receiving a gtube feeding who's bed was elevated 15 degrees.I asked her why she wasn't elevated at 45 degrees and she stated"we don't have an order to". Now,I thought it was common knowledge for nurses to know that with tube feeds the hob is to be elevated at all times to at least 45 degrees. Or (another example) when a pt. on a tube feed vomited and had 55ml residual and I was going to hold it for an hour. Along comes the supervisor who states "you have to turn it back on,we can't hold it that long. Fifteen minutes is good"

I also have a thread on here about documenting "asleep vs"resting with eyes closed". I learned some new things out of that thread and also the fact,that well,we are taught differently even when you take into account the different years and state boards we all graduated and were licensed in. Add the foreign trained nurses and it really gets confusing. Sorry,I'm just curious and its a slow night shift. (Ok,I'm admitting I'm using the blackberry and texting while at the nurses station)

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We are all trained differently. The things that will unite us are the BON practice acts and the institutional standards and policies. No matter where you're from or what book you were taught in, we have to follow these two.

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Specializes in ER.

I agree with you, 45 degrees, and hold tube feeding for a vomiting patient. I would do both without an order unless the doc specifically stated otherwise.

I would not start a tube feed for at least an hour after a patient vomited, even if instructed to do so by a supervisor. She can- and sign for it- but I'm not that gullible anymore.

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It is the same reason every doctor likes to do things differently. We are all different. We have all read differenet research and we all teach differently, so we all will learn differently. Also, there are different institutional policies based on whatever experience and research is being followed.

For instance, with the tube feeds: I learned in school to hold them for 1 hour if the feeds were more than 50 ml. Well, I was told by the nutritionist that as long as it is under 150 ml of residual, you can continue the feeds. She had a study to prove it and everything and ws backed by many other physicians. I figure that as long as you are following evidence-based practice, you will be fine.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

PRUDENT NURSING.

Order or not, what would a prudent nurse do?

That's the FINAL question.......when faced by a lawyer.....

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Be careful because sometimes nurses do things to save time. So follow your policies, BON and what the above poster stated.

If a supervisor tells you to do something that violates policy or makes you uncomfortable, then stick up for yourself. "My supervisor told me" doesn't really hold up in court. ;) I know it does take awhile to get comfortable with what you know in order to stand up for yourself.

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PRUDENT NURSING.

Order or not, what would a prudent nurse do?

That's the FINAL question.......when faced by a lawyer.....

Yep.

BTW...we elevate 30 degrees or more for TFers.. More than that can increase shear/ friction etc.

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But how come if I post something and I get 6 different replies? For example,I would post a question about suctioning a trach and get 6 different replies. It actually does intefere with my teaching too. I might teach something the way I was taught and along comes another nurse who teaches them differently.

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Specializes in Med/Surg.
But how come if I post something and I get 6 different replies? For example,I would post a question about suctioning a trach and get 6 different replies. It actually does intefere with my teaching too. I might teach something the way I was taught and along comes another nurse who teaches them differently.

My question to you is, what is YOUR source for your information? You cited "common knowledge" for the HOB to be up 45 degrees for a patient receiving a tube feeding. I have never heard 45 degrees, in all my years of patient care (which, between CNA and RN years, is 14). Our HOB elevation "standard" for tube feeding is 30 degrees. Our P&P has "standing" orders for tube feedings, and that is one of them, as a matter of fact. For other things r/t tube feedings, the dietician will write specifics based on how long to hold based on what amount of residual, etc, so there isn't a whole lot left up to interpretation, most of the time. Some of it is common sense, though, and IMO, the nurse leaving the HOB up only 15 degrees since she "didn't have an order" to have it up any higher wasn't using any. As far as residuals go, if there are no orders to hold based on what it is, you have to look at how fast it's going, that is going to make a difference when determining how well the patient is tolerating it. If the residual on a 4 hour check is 50ml, say....not a big deal if it's going at 150ml an hour, but it IS a big deal if it's going at 20ml/hr. You have to look at the big picture. Long story short, it's not just what nurses are "taught to do," it's how nurses critically think, and that's not something that can necessarily BE taught, that's something that you can either do, or not do, for the most part.

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But how come if I post something and I get 6 different replies? For example,I would post a question about suctioning a trach and get 6 different replies. It actually does intefere with my teaching too. I might teach something the way I was taught and along comes another nurse who teaches them differently.

Are you looking at your facility policy? If you are going to train someone, I would pull up that policy, have them read it and train them based on that. Policy can differ even between facilities in the same city.

BTW I was also trained that 30 degrees was the standard for TFing patients. Never had heard the 45 degrees.

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I actually have it in an old textbook of mine about 45 degrees.

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Specializes in Med/Surg.
I actually have it in an old textbook of mine about 45 degrees.

How old? I am curious what textbook.

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