Doesn't It Make You Want To Scream, Part 3

Sam J. · Feb 5, 2014

Really? You've worked here how long and don't know the bowel protocol?!?! You didn't bother to check the bowel report on the computer??? You said you wait till the residents (most of whom have dementia) complain of a stomach ache before you give them MOM?!?!? Can you dress yourself? Can you feed yourself? Are you really that stupid or is it just that you don't care? Please let me know.
end of rant

Makes you wonder how many of your nurses might be walking around with their own guts full of stool for 3, 5, 8 days, thinking that's normal?

withasmilelpn · Feb 5, 2014

Stupid or just ignorant? New nurse or nurse that is unaware how awful constipation feels? Never had a patient with an obstruction? Unaware how to run the bowel report?

Given this situation I'd initially be frustrated, but then ask some questions.Who normally runs the report? In our facility the report is run by 11-7 daily and 7-3 initiates our bowel protocol. Because it is a daily expected task, breakdowns can occur if say a new nurse on 11-7 forgets, or 11-7 has a nightmare shift and simply doesnt get to it. So ask do your nurses all know how to run the report? Or are they reliant on a few knowledgeable people? It may be a computer training issue.

Look at your policy as well. Is is clear when to start your protocol, what to give and when? Are all your nurses aware of the policy? Also, look at your documentation and follow through.

Education on constipation might help as well. Just a reminder, your nurses are juggling a million things, some which may not seem as important as others just given their experience. Whenever I train new staff, I speak of personal experience to drill home why what we do policy wise. I feel like emphasizing the why of things rather than focusing on the tasks/steps expected educates staff better and nurses are therefore more likely to remember to do them. For example, speaking of my personal experience taking care of obstructive patients dealing with nausea/vomiting and their pain makes an impression of the importance. Inservices on narcotics/ monitoring bowels closely may be helpful as well, and on normal bowel habits as well. Nurses often forget that loose stools can also indicate a partial obstruction, or may not be made aware of loose stools by CNAs that indicate a problem is developing.

Finally, once problems are identified, it takes constant follow through by management afterwards before policies really stick. It may be annoying having to follow through daily, but it can take a month or more for tasks to become routine. They'll catch on you mean business, and will pay closer attention. Thereafter, I recommend random checks for compliance with your policy.

CapeCodMermaid, RN · Feb 5, 2014

They've all had hours on inservices on the protocol and the computer problem. The problem is they don't think.

withasmilelpn · Feb 5, 2014

Not thinking is definitely a problem. Your employee though didn't check the report and didn't know the protocol. So are the inservices effective? Who gives them? Are they interesting and informative or are employees zoning out? I would still recommend a specific shift like 11-7 run the report and day shift start the protocol. Then either you or a supervisor round in the morning to see that it's being done and in the afternoon to see that it was followed up on. Doing this will tell your staff you mean business, that this can't fall through the cracks. I know you have many important things to do, but sometimes just keeping on top of them annoys them enough that they take it seriously.

My biggest pet peeve with being a floor nurse is having so many tasks to do I go from task to task without having time to really think about my patients and the bigger picture. I'm experienced, I know what to look for, and what is expected. I make time, but it's really difficult at times. That can be harder for nurses that aren't as experienced. Best of luck!

chevyv, BSN, RN · Feb 5, 2014

I recently found new employment and assessment goes something like this: they are up and moving so pulses are obviously present, they are talking so lungs are clear, they ate supper so bowels are fine....... seriously. These were nurses that have been around for a very long time.

CapeCodMermaid, RN · Feb 5, 2014

Not thinking is definitely a problem. Your employee though didn't check the report and didn't know the protocol. So are the inservices effective? Who gives them? Are they interesting and informative or are employees zoning out? I would still recommend a specific shift like 11-7 run the report and day shift start the protocol. Then either you or a supervisor round in the morning to see that it's being done and in the afternoon to see that it was followed up on. Doing this will tell your staff you mean business, that this can't fall through the cracks. I know you have many important things to do, but sometimes just keeping on top of them annoys them enough that they take it seriously.
My biggest pet peeve with being a floor nurse is having so many tasks to do I go from task to task without having time to really think about my patients and the bigger picture. I'm experienced, I know what to look for, and what is expected. I make time, but it's really difficult at times. That can be harder for nurses that aren't as experienced. Best of luck!

Please don't make excuses for them. I was a staff nurse...BMs are pretty basic. If they can't even do that what else aren't they doing?

withasmilelpn · Feb 6, 2014

Not making excuses, of course they should be monitoring BMs appropriately. And of course this is a place to vent your frustration, so wondering whether someone is stupid, or just doesn't care is appropriate as a way to vent. However; if you really think they are stupid/and/or just don't care the most obvious solution is to write them up until you have enough documentation to fire them. You have an obligation to get rid of them - your patients deserve the best of care. But if they have redeeming qualities, are good nurses in other ways, and there is a way you might fix this, why not do it? Wondering what else they aren't doing is sort of defeatist and negative, in my opinion.

I know you were a staff nurse, Cape Cod, and I've long respected your posts and opinions. I'm quite sure you are a marvelous DON. You have a very hard job. This is just my perspective and again best of luck!

ktwlpn, LPN · Feb 10, 2014

But how do you solve the basic problem? You educate over and over and still staff nurses"forget" or "don't know" to follow through with basic policy and protocol. Do you seriously have to instruct your supervisors and unit managers to audit this very basic nursing care every single shift? I'm beginning to think so. We have a supervisor for every shift-by the time they deal with staffing they don't have many hours left in their shift.I have seen some pretty egregious things at our facility in the past few weeks, by both LPN's,RN's-full time and PRN. . We have greatly improved our orientation process and we have outlines everywhere regarding the most frequently used p and p. The info is readily available BUT you can't teach common sense. They have it or they don't .AND family members are eager to call a lawyer...We have had nurses suspended and fired in record numbers in the past year-one would think the rest of us would get real but it is not happening.