Disrespect of LTC nurses by acute care (even though BMs neglected in hospitals)

[FireStarterRN, BSN, RN]

Kind here continuation of my BM thread, where I brought up that fact that I think BMs are being sorely neglected in the acute care setting.

I had a patient yesterday who was slated to be transfered for a week or two at a nursing home. He was a CHFer, with a 23% ejection fraction and pretty bad left ventricular failure, in addition to venous insufficiency, diabetis, etc and so forth. His massive abdomin wasn't helping matters, and to top it off, naturally his bowel function had been ignored during his hospital stay. No one had bothered to request or start a bowel protocol sheet for him and he admitted when I brought up the subject that he probably needed some help.

I mentioned to the other nurse that I was going to get his bowels going. I said to her that I thought we sometimes didn't pay enough attention to bowels. She kind of laughed it off, saying in essense that we had more important things to do, like making sure they are still breathing. I said that in LTC they really are on top of keeping the bowels going. I told her that I thought it would be nice to make sure the patient had a BM before sending him to the nursing home. She made some snotty remark about the inferiority of nursing home nurses, so I dropped the subject.

I mentioned in report what I had done thus far (patient still needed a BM) and how it would be nice to maybe give a fleets to help get things going before the nursing home transfer. Once again I got this elitist attitude regarding LTC nurses, and I got the feeling like they didn't want to deal with anything so mundane as getting this poor fellow's bowels going.

I think the different disciplines of nursing should be more collaberative and supportive of one another, and of the greater good of the patient's well being.

[nrsang97, BSN, RN]

I know it sounds silly but we really need to make sure they have a BM. Some do not go every day so I think every other day is alright. Our unit NP and Intensivest are big into when was the last BM. Everyone is on sennakot with dulcolax if no BM x2 days (I think or if not 2 then 3.) So many of our patients end up with c-diff colitis due to IV antibiotics and do not need bowel protocol anymore and we are trying to stop continuous liquid stool and end up with fecal pouches or flexi seal. Some still do need the protocol, so we have a order hold if more than 2 BM's in a day. Which I follow because we don't need laxative induced diarrhea, but some just keep giving it. So I always make sure on out report sheets that I say pt has had more than 2 BM in 24 hours so please hold laxatives today.

I do remember that the rehab unit for the previous hospital I worked at had a bowel flow sheet. They had to chart color, consistincy, and amount, for each BM. Many nurses hated it.

If none documented I always ask the pt if able. Sometimes they aren't documented and that is also a problem, especially when you have a vented and sedated pt on a fentanyl drip. Bowel protocol is so important for those on opiates since we all know how that slows the GI tract.

I do agree that at times I think this is crazy, but in fact it is necessary.

I don't necessarily think that it is a disrespect for LTC nurses because they have improtant jobs to do also. They also see this person every day for months and years, we only have them for short times in hospitals. I have to say I have tons of respect for LTC nurses because it is a area I just cannot see myself working. I did 3 months as a nurse aide in a LTC and hated it. The short staffing and crazy famlies. I think those famlies are crazier than famlies in the hospital.

I also think we tend to see a BM as last priority in something to do for the day. We have xyz to get done to that tends to get put on the back burner if you will.

[Tweety, BSN, RN]

Granted, the ABC's are important, but nurses are taught to take a systemic approach as well. If the ABCs are taking care of and the patient is being discharged, their other systems like bowels are important.

I don't like elitist attitudes in nursing at all.

[Ms Kylee]

God Bless the LTC nurses... they do a job I know I couldn't.

Maybe I am anal (no pun intended), but if a patient tells me no BM for 2 shifts, I investigate and see if they had one on my off shifts. If they haven't, I let the patient's nurse know that they haven't had a BM.

[plumrn, BSN, RN]

I agree with you. LTC nurses do tend to get attitude from some in the healthcare field, and I don't understand it. They have such an overwhelming job with few resources to support them. We have pts that are very hard to care for, but were at the nursing home a few hours ago with 70 other pts for that nurse to care for with maybe an aide or 2 to help.

Bowel problems can quickly become serious for the pt with respiratory or cardiac problems. Once they are compromised, it is very difficult to do anything to 'get them going again', when they can't breathe just lying still with the HOB up. The bowel assessment including the question 'last bm?', is there for a reason, and we should follow up on it as needed.

[SuesquatchRN, BSN, RN]

When I was fired from med/surg my NM told me I was better suited to LTC, where I don't need to use the critical thinking skills I lack.

Yeah, I've seen attitude. Particularly since everyone in med/surg was one of mine with an acute exacerbation of a condition with which I was familiar. The med/surg nurses all seemed, to me, to be a bunch of Nervous Nelliws who agonized over administering every stinking metoprolol, which was why nothing got done. JMO.

[MoopleRN]

I totally agree; keeping track of BMs including their frequency, consistency, color, amount is an important part of our assessments/documentation whether it's the nurse or the CNA doing the documentation. Listening for BS/assessing the abdomen is a basic part of a head-to-toe. It's also an opportunity to assess their hydration status/diet. If a patient tells me they are constipated since they've been in the hospital, I'm going to check their input/meds/activity level, maybe get an order for a lax/softener.

When I give report to the oncoming shift, I ALWAYS pass along a BM from a previous shift that was passed along to me.

Poo is impootant!

[lovingtheunloved, ASN, RN]

I haven't gotten much attitude about being a LTC nurse...usually other nurses have positive things to say. The few negative comments I have gotten have been more amusing than offensive, because the people making them truly have no idea what LTC is like. There is so much variety in nursing, and every area should be respected. Because maybe you can't do LTC. I sure as heck couldn't do PEDS or ER. God made us all different to get everything done. My words of wisdom, for what they're worth.

[leslie :-D]

Poo is impootant!

i guess it is important.

otherwise, they wouldn't tell us to eat so much of it.

leslie

[NurseCherlove]

Bowel problems can quickly become serious for the pt with respiratory or cardiac problems.

And vice versa as well...I really don't like the thought of my poor lil CHFer having to strain at trying to have a bowel movement - too much valuable energy being consumed (which can also affect the lungers) and can potentially induce a vagal response. Actually, all hospital patients need to conserve energy - they're sick!

Speaking as a nurse whose experience mostly lies in med-surg, I have to say I really hate that lack of attention to BMs. It doesn't even make any sense at all if you think about it, as such a large percentage of patients are old and/or having pain issues - both of which need meticulous attention to bowel regimens!

I did a short stent in hospice and that is a standard piece of information when giving report.

Not only that, impactions can be rather serious problems for patients, so we should be trying to work towards preventing them. Constipation can also make people feel nauseated - just what a hospital patient needs - so now their appetite begins to slack off and well...ok I'll shut up now.

Well, no not yet. I found it crazy that I had to raise so much hell just to get the techs to document I&Os on a consistent basis on the last unit I worked on. Ah well...renal failure smenal failure - I don't really need to know if we're heading that way. Sorry...I digress.

[Tait, MSN, RN]

I always wanted to start a sticker board in each room and name it something "inconspicuous". Then sticker it for each shift when they have a BM.

./shrug I think its important too :)

[oldiebutgoodie, RN]

I am a wound and ostomy nurse, and recently had a patient who had hard stool throughout her entire bowel, which, of course, then perforated, and now she has a colostomy.

So, keep on keepin' an eye on those BMs!

Thanks!

Oldiebutgoodie