Frustrated

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I am frustrated at work. I have a co-worker that gives me the impression that she believes she knows everything, and is supperior to everyone else (I think she can even smell when a doctor is present). background info is she assists the wound nurse sometimes in the clinic. I have a patient that has a resolved by scar tissue stage III ischial tuberosity pressure wound. The patient has become weak through the long healing process. The patient has been working on transfers with PT (oh yea parapalegic) and the inadequate strength and shear has created one intact bullae and one that ruptured each 1cm diameter. I am not a wound nurse yet but I am currently in school for certification. I called and got an order to cover area with tegaderm, rational being it will keep a proper moist wound healing environment, provide protection/skin barrier and will be easy to visibly monitor. I applied dressing, had 2 days off and return to a patient with a 3 cm long 1.5 cm wide denuded area on the ischial PU scar. My frustrating co-worker had the order changed to butt paste. I was irritated because the patient has had a long road of healing and didn't need this set back. I called the doc explained the wound and asked what dressing he wanted. Once again I write an order for tegaderm. Over the next couple of days the wound made visible progress, smaller. The patient was then moved from my hall to make room for a new patient. The same day as the patients move my frustrating friend changed the order back to butt paste. I know I can be critical of Ms. Frustrating because there seems to be a personality conflict but come on. The second order for butt paste was written to be applied before patient is up in chair and leave wound OTA while in bed. That would just create a bigger wound from washing the butt paste off. I have seen Ms. Frustrating do similar things to other nurses. How do you deal with a person who needs to be so important? Or is it just me and I should shut up and just go to work.:uhoh3:

Specializes in Operating Room Nursing.

Why don't you try and work with this nurse and see what you can come up with together?

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Why can't you work WITH the other nurse? Did you ever ask her with an open mind why she felt the paste was the more appropriate treatment?

I am assuming since a doctor and other health professionals are monitoring her wound, if the other nurse was doing something harmful, it would be caught and corrected. So I'm getting this feeling like this is more about you being right than it is about the patient. Trust in the system and in your patient's doctor. Stop trying to outdo your co-workers.

If you find this is a personality conflict you cannot get past, the only thing I can suggest is to request a change in shifts or floors so you're not working with this nurse.

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Specializes in Emergency Nursing.

Only somewhat related to this thread, but I have a shirt that says "Those who think they know everything annoy those of us that do." OP you should look into getting one of these shirts.

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Specializes in soon cwocn.

Great advice everyone, but I think I've been misunderstood. I don't wish to run over any co-worker and I don't need to feel speciall at work., I have a hard time letting go when the patients wound took a step backward. Although I have let go at work, I did my part, I didn't just change the order because she came up with it, the wound had increased in size. Many of us on the same shift with this nurse have tried to work with her. She makes it difficult and its hard to explain without sounding like i'm bashing her (not that this doesn't occur in the breakroom occassionally from us all). The DON has commented that she has had to reminded her to work within her scope of practice and this is from a situation that didn't involve me. I don't want to be a "shining star hero" of a nurse so I will take the advice.

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Great advice everyone, but I think I've been misunderstood. I don't wish to run over any co-worker and I don't need to feel speciall at work., I have a hard time letting go when the patients wound took a step backward. Although I have let go at work, I did my part, I didn't just change the order because she came up with it, the wound had increased in size. Many of us on the same shift with this nurse have tried to work with her. She makes it difficult and its hard to explain without sounding like i'm bashing her (not that this doesn't occur in the breakroom occassionally from us all). The DON has commented that she has had to reminded her to work within her scope of practice and this is from a situation that didn't involve me. I don't want to be a "shining star hero" of a nurse so I will take the advice.

Have you tried speaking with her? Asking her the rationale behind using the butt paste?

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Specializes in soon cwocn.

Not yet, haven't worked with her for few days, but I will. The patient is no longer mine since he has had a room change.

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according to our facility's CWON tegaderm is not to be used as stated previously.

There are new coverings, such as the brand Mepilex, or a protective barrier such as Proshield, that are better for the wound and new tissue.

Now that pressure wounds acquired in house are not going to be paid for, the new big initiative is prevention.

I'm guessing you're in a LTC facility as opposed to my critical care setting, but I would think that prevention and promoted healing would still be a high priority.

As for the "know it all" I would think that there could be an opportunity for staff education with evidence based materials.

Good luck.

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i would think that notes showing increase/decrease in wound size, would dictate what dsg is superior.

op, if you say the wound is larger w/the butt paste, do the notes reflect your observations?

clearly, whatever is documented, s/b the deciding factor, wouldn't you think?

leslie

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i would think that notes showing increase/decrease in wound size, would dictate what dsg is superior.

op, if you say the wound is larger w/the butt paste, do the notes reflect your observations?

clearly, whatever is documented, s/b the deciding factor, wouldn't you think?

leslie

only if careful documentation of what happens with dressing removals is present. If she came back to a dressing with butt paste that was bigger, was it the butt paste, or the pulling off of any inappropriate dressings that made the wound bigger, or continued lack of turning? Days later could be hard to determine.

Again, most facilities are picking up the call for evidence based care, and wound prevention/healing is very well studied.

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Specializes in soon cwocn.

Food for thought:

Main wound management principles are to control causative factors (shear), prevent infection, maintain appropriate level of moisture, protect wound and periwound.

Transparent film : function protection; indication partial thickness minimally draining or closed wounds; the adhesive is inactivated by moisture and will not adhere to a moist surface, such as the wound bed or periwound surface. The film dressing is semipermeable to gas, such as o2 and water vapor, allowing excessive amounts of moisture to escape when used over a wound. percautions contraindicated with infection, liquid skin barrier may be applied to periwound skin to prevent stripping.

Moisture barrier paste : provide thick barrier over vulnerable skin; indications protect from moisture, wound exudate, urine, or feces, perianal, peri-rectal, or periwound denudent. precautions may be difficult to remove which can cause more skin damage due to friction used to remove product.

The wound was not a facility aquired PU, patient is on a rehab wing of rural hospital r/t PU. Much education has been given to patient regarding prevention. I believe there is adequate documentation on this case, the state surveyors focused quite a bit on this patient with there recent visit and upper management seemed pleased with there visit.

Bryant, R.A. & Ovington,L.G. (2007). Principles of Wound Management. In Bryant, R.A. & Nix, D.P. (Eds). Acute & Chronic Wounds: Current Management Concepts. St. Louis Missouri: Mosby inc. pp. 391-414

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preprinted manufacturer's advice for use of their products is not evidence of appropriate wound care.

But since you asked for advice and then don't want the advice, you just want people to tell you you were right, I will sign off from this thread.

Again, good luck.

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Specializes in soon cwocn.
preprinted manufacturer's advice for use of their products is not evidence of appropriate wound care.

But since you asked for advice and then don't want the advice, you just want people to tell you you were right, I will sign off from this thread.

Again, good luck.

Information is from a WOCN accredited course text book, ment to add to the discussion. I'm not a physicain and don't pretend to be, like I have noticed other repliers. Personally I have enjoyed the feedback (hence my continued responses), I don't want anyone to tell me I'm correct with anything, I was venting, discussing, learning, and sharing. I haven't been a nurse long and I know I don't know everything, The above info is why I considered tegaderm, The patient needed protection. I haven't agreed with everyones post but I have learned that many people think I used the wrong dressing and that I want someone to say it's right. Thats not at all what I want. The dressing was approved by the pcp and the wound did make improvement for a few days.I don't know what happened on the days I wasn't there, I have seen good things come from butt paste and I have seen some raw butts from butt paste. This thread has made me question appropriate dressings and alternatives for this situation. So far I don't have the perfect answer other than to completely eliminate shear. Short of never allowing the patient out of bed I haven't come up with anything else. Amongst all the hostility this is a professional forum where profesionals discuss and debate. Advice is just that... ADVICE...it is not law and no one has to accept my advice. In the event that they don't except my advice I don't believe I'll stomp away from the thread like a child.

The main context of my original post is lost (thats ok) I was asking how others would handle dealing with the other nurse who is continually a struggle for many co-workers. in turn the post turned me into a self rightous know it all who needs validation. It's kinda like playing the phone game. I don't see any reason to get upset though. :redpinkhe

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