Jump to content

First job and I am in total shock!

Posted

I graduated from LVN school this past August and just started my first a few weeks ago. The place I am working runs 8 hour shifts and I work mostly graveyards (after 4 days of "orientation"). On that shift I am the only LVN overseeing about 40 residents with 3 CNA's helping. Some of the stuff I am seeing is just blowing my mind! After passing meds there is no way to chart on all the residents and finish all the paperwork we as nurses were taught to do. All we have time to do is pretty much run through the charts and go off of what the last nurse checked. Last night a resident was complaining that her catheter was leaking so I ran to find out where they kept all of the supplies (because we were never shown). I asked one of the nurses that had been there for years for advice and she was more than willing to help out. We gathered all the supplies and went into the room, the resident had a horrible yeast infection and was unbelievably chaffed. Sure enough urine was leaking out around the catheter. She pulled the catheter out and didnt even lubricate or use sterile technique to SHOVE the new cath in. When it went in she had a huge return of blood and the nurse said well I dont know what that is but Im sure it's normal. A few hours later she was leaking around the cath again and she just did the same thing, pulled it out and shoved a new one in (without lube or sterile technique). Im just curious to see if this is what it's like at most nursing homes?

DSkelton711

Specializes in OB/GYN/Neonatal/Office/Geriatric. Has 25+ years experience.

Ouch, that made me cringe just reading that. I don't care how long anyone has had a catheter, I would never insert one without lubrication or sterile technique. And I'm pretty sure blood is not normal. I don't have much experience with long-term catheters so I will leave any advice about that to someone who knows what to tell you. But I just had to comment about that nurse's technique--or lack thereof.

No!

That is not how it is in all nursing homes... and I hope not even most.

Sounds like you just landed yourself in a doozy.

Since when is it ever "normal" to have blood in the urine?

I'm sorry you're there and having to deal with that.

I have seen that before nursing doing things that are not right..the main thing is for u to do things the right way , yes it may take more time but it would protect ur license. If its to much find another job because u hate for ur name meaning ur license on things and u can be sued..

OUCH! That makes me squeeze my knees together.

I mean this in the nicest way, but why didn't you speak up?

As a nurse, it's your responsibility to advocate for your patients. You didn't have to be rude about it, but you could've said, "Here, let me set the sterile field for you before you start," or after witnessing the first disaster INSISTED on placing the second one using the proper techniques.

People remaining quiet and doing nothing is exactly the reason things like this continue.

No that is so not normal. No not every nursing home is like that. For the residents safety you need to tell someone. On s second note, I was always taught that nurses are the patients biggest advocate and sometime the only advocate. You need to stick up for your patients. There are many ways to get your point across in a tactful respectful way. When that fails, you go over their head but you need to look at for your patients safety and well being.

Ouch. Not normal. The blood that you got from return was-in my experience--due to a traumatic insertion. You can see this on males who have prostate issues if you don't use a crudet catheter--and sometimes when you do--but on a female--rough unlubricated insertion, the cath was either shoved too far in on insertion, therefore scraped against the bladder wall, scraped the ureter on the way in, or there is some sort of growth/tumor process can be reasons. Also if the cath is leaking it is either not in all the way, (and you are inflating a ballon in the incorrect place) or for some the 10cc saline to blow up the balloon in not enough to hold the cath in place without leaking. However, with all that being said--an active yeast issue, skin breakdown and unsterile catheter insertion and repeated changing of the catheter to involve trauma---you are setting yourself up for a septic shock of this patient. I do not know if you are charge on this shift, who this other nurse was, whatever....but no one should be cathing patients who don't know how to correctly and aseptically. And at this point with a cath not working correctly, I would ask to have it pulled--if the reasoning was just to save someone's skin--obviously if it is leaking, it is not doing what the purpose of insertion is. If it is for urine retention, I would suggest a urology consult--the yeast needs treatment, and unfortunetely, you also may be looking at antibiotics as propholaxis due to this mess. BUT I would ask to do a u/a c&s to be sure that whatever antibiotic that you need to give is the correct one, or it may r/o a UTI or bladder infection so that would not be needed. Get to know how to cath yourself. If you are responsible for a patient, then you need to see to it that things are done correctly as to not cause the patient harm. Now that you know this other nurse is not one to follow protocol, I would no longer ask for her guidance. Additionally, follow up on this patient as to what needs to be done for the patient's comfort and safety. I would even go so far as to do cath care and peri care myself for a while, as to see this infectious process to resolution.

JoyfulNurseLPN

Specializes in Utilization Review / Geriatrics. Has 10 years experience.

I graduated from LVN school this past August and just started my first a few weeks ago. The place I am working runs 8 hour shifts and I work mostly graveyards (after 4 days of "orientation"). On that shift I am the only LVN overseeing about 40 residents with 3 CNA's helping. Some of the stuff I am seeing is just blowing my mind! After passing meds there is no way to chart on all the residents and finish all the paperwork we as nurses were taught to do. All we have time to do is pretty much run through the charts and go off of what the last nurse checked. Last night a resident was complaining that her catheter was leaking so I ran to find out where they kept all of the supplies (because we were never shown). I asked one of the nurses that had been there for years for advice and she was more than willing to help out. We gathered all the supplies and went into the room, the resident had a horrible yeast infection and was unbelievably chaffed. Sure enough urine was leaking out around the catheter. She pulled the catheter out and didnt even lubricate or use sterile technique to SHOVE the new cath in. When it went in she had a huge return of blood and the nurse said well I dont know what that is but Im sure it's normal. A few hours later she was leaking around the cath again and she just did the same thing, pulled it out and shoved a new one in (without lube or sterile technique). Im just curious to see if this is what it's like at most nursing homes?

Wow, there are all sorts of major problems here. First off, any catheter inserted not using sterile technique is a major risk factor for a nosocomial infection. SHOVING it in is also another big no no, that can cause major trauma to the urethral walls. Secondly, the blood return is usually a sign of trauma or infection and needs to be reported to an RN supervisor immediately. I would also take a temperature of the patient, note any dysuria or pain during voiding. I ASSURE you a large return flow of blood from a catheterized patient who has not had any recent genitourinary surgical procedures is highly suspicious of something brewing and not normal. Finally I would document thoroughly everything you observed with the patient and report it to your superior. This is substandard care and could cause immediate harm to the patient.

Finally, no, this is not what it's like at most nursing homes.

I hope everything works out!

BeentheredonethatRN

Has 20 PLUS years experience.

You haven't seen anything yet -just wait till you start your second job lol.All this sterile technique ,interventions, tell Supervisor, trauma , etc. = joke . I once work in a joint that had nine floor with two wings each. Each wing had 67-72 pts. Guess what ? One nurse per wing and throw in a few CNAs . 60 plus to one nurse ? It was one of the best jobs I had -know why ? I caught on quick that this nursing home just wanted a nurse to be on the floor. Come on ! There was just too much going on to pass meds ,etc. . Better yet - they just were just grateful you showed up and the pay was good. I was so young and would show up late and hung over lol . Now ,I work in a Super Mega Magnet Hospital ranked really high in the state ,but you know what it's about the same -just alittle different. This hospital just knows how to hide it better.

MedChica

Specializes in Psych, LTC/SNF, Rehab, Corrections.

I graduated from LVN school this past August and just started my first a few weeks ago. The place I am working runs 8 hour shifts and I work mostly graveyards (after 4 days of "orientation"). On that shift I am the only LVN overseeing about 40 residents with 3 CNA's helping. Some of the stuff I am seeing is just blowing my mind! After passing meds there is no way to chart on all the residents and finish all the paperwork we as nurses were taught to do. All we have time to do is pretty much run through the charts and go off of what the last nurse checked. Last night a resident was complaining that her catheter was leaking so I ran to find out where they kept all of the supplies (because we were never shown). I asked one of the nurses that had been there for years for advice and she was more than willing to help out. We gathered all the supplies and went into the room, the resident had a horrible yeast infection and was unbelievably chaffed. Sure enough urine was leaking out around the catheter. She pulled the catheter out and didnt even lubricate or use sterile technique to SHOVE the new cath in. When it went in she had a huge return of blood and the nurse said well I dont know what that is but Im sure it's normal. A few hours later she was leaking around the cath again and she just did the same thing, pulled it out and shoved a new one in (without lube or sterile technique). Im just curious to see if this is what it's like at most nursing homes?

I'm new myself (

Did you report it to the oncoming shift or put it in a 24/hr report book...for every shift that follows to be aware, contact her provider and monitor the condition?

The bleed? I had something like this with one of our transient residents, a delusional, seizing alchoholic (DTs). He kept snatching it out and ended up bleeding because of it.

Maybe that's it?

The leaking around the cath and the return upon reinsertion would rattle me. Makes me think that something is blocked and scabbed up there....and the nurse who keeps 'shoving' the cath in with no lube or sense of procedure is causing more and more damage. I don't think it's a bad scabbing. At least the resident can void and it doesn't hurt her TO void.

Maybe the scabbing is crusting over the opening of the cath?

Who is to say? That's why I'd contact my RN and her provider.

In the meantime? You could've got a fresh set of vitals on her (r/o infection), let her groin and vagina 'air out' by undoing the brief but padding the bed + keep that area cleansed with the cream on her afterwards (soothes and heals chafed skin...but you must stay on top of the pericare), initiate the process to DC the cath(suspected cause of problem) among other things, removed the cath, etc....

That's all that I can think of at the moment.

No, it's not like that at my facility and you can't fault all nursing home facilities just because a single nurse at yours (perhaps more) is completely inept. That doesn't make sense.

Charting issues?

If you don't know the pt's then it's difficult to chart effectively on them. I've caught mistakes in the lookback assessments from other nurses. A nurse will check off that the pt is incont and fully dependent on staff. That's not entirely true. That resident CAN void in the commode... with help.

I know this because I took of the woman as an aide and I've taken her to the commode many a time. So, if there's a question? Utilize your resources. Ask you aides. You're a team, you know.

If I want to know how much this person ate? I ask the nurse aide.

If i want to know if there are any bruises on that person? I ask the nurse aide.

This is not to say that you rely on them entirely.

I'm just saying that the nurse aides tend to know the residents better than the nurses....b/c the nurses don't have to time to be hands on with them.

Unless they're a re/admit or it's their day for skin assessments...the nurse probably hasn't looked at their body. The aide has because they've been showering and toileting them all day.

I chart the MARs while doing my treatments/med pass. The med pass that nurses perform isn't the major one (unless you're med nurse). The med aides handle the scheduled meds unless they're peg tube.