Help! Feeling frustrated & overwhelmed!

[Shyred]

To start off with, I'm an LPN in a PCH. Lately at work I'm beginning to feel ridiculed & frustrated! I had recently changed a foley catheter for gastric feeding (this is how the resident was sent back from acute care d/t problems with the peg), because it was blocked. The doctor had ordered that the nurses at the PCH were able to change the catheter when need be. Some of the nurses were reluctant to do this procedure and thought that the doctor should do this, or we should send the resident to acute care. Our Co-ordinator assured us that we are capable of this procedure. So when it happened on my shift that it needed to be changed, I went ahead with it. I was excited about doing something new. The actual procedure only took about 15 min and went very well. I knew I had it inserted correctly by evidence of stomach content coming back into the catheter following insertion. I inflated the balloon. Placement, flow, and feed rate have all been running very smoothly. However, after the fact I feel like I am being ridiculed by some of the other nursing staff for doing this. For ex: "I should have measured the length of the exterior catheter" (where it enters site to end where it connects to feed). And that I "should have charted how much fluid I used to inflate balloon". The reason they said this is because they are concerned the resident may pull on the catheter and then we wouldn't know if it's out of placement. I'll admit that I should have charted the fluid volume of the balloon, but my view is that if the resident pulls on the catheter, then it will be obvious d/t internal trauma...evidence of blood around site, total removal, resistance with flushing, and discomfort experienced by the resident. Measuring the length of the exterior part of the catheter to me seems redundant. Perhaps I am being too sensitive, but these remarks are making me feel like they think I'm inadequate. I feel I did a good job and did confirm with the doctor who had no concerns. This is just one example of current issues I am experiencing. I dread giving report now to the next shift because it seems everytime there is some sort of "controversary". I'm feeling overwhelmed and frustrated. Anyone have some suggestions?

[Midwest4me]

Confront the staff who are making belittling remarks but do it with others present(preferrably a supervisor) and get the issues out on the table so they can be discussed.

[nursej22, MSN, RN]

Oh for heaven's sakes, some people are never happy. I think you have done some critical thinking about this and I agree with you on most points. Do they measure the length of a foley when it's inserted into a bladder? I Doubt it. I think the volume of the balloon is documented by convention so that when is deflated you know its empty before withdrawing the catheter. Perhaps your critics could write a policy backed up with references.

I am sorry you are being criticized for showing some initiative. I would just look 'em in the eye and thank them for their input.

[netglow, ASN, RN]

Sounds like they are the ones confused. Measure the cath? Sounds like they were thinking NG. I would ignore them. Always seems like those that back away from new experiences end up having all the criticisms once someone else goes ahead and takes initiative!

Good for you, now you can add another skill to your set!

[nyteshade, BSN]

What you did sounds ok to me. I've had to put in foleys in place of PEGs when the patient rips them out. I've never measured the external length. I just chart whatever FR it is, and cc in balloon. Our only other policy is to notify the GI doc of what we did so he can come in later.

[Shyred]

Thank you all for your valuable replies!! They have definitely helped me to think clearer about this and not quite so frustrated. I think my next step should be to talk to my supervisor about having an official policy developed...then there shouldn't be any confusion with the procedure-hopefully.

[pennyaline]

What you did sounds ok to me. I've had to put in foleys in place of PEGs when the patient rips them out. I've never measured the external length. I just chart whatever FR it is, and cc in balloon. Our only other policy is to notify the GI doc of what we did so he can come in later.

Yup, we used to place foleys blind for G-tubes all the time, before the trend shifted to PEGs placed with imaging. I never had a problem or complication after inserting a foley for tube feedings, but I've heard of cases where the placement failed (the catheter missed the opening in the stomach wall and lay between the stomach and abdominal wall) and peritonitis resulted. We documented the size of the catheter and amount of fluid used to inflate the balloon, and noted the presence or absence of difficulty/resistance to placement, just like inserting one into the bladder. We never worried about external length because these aren't NG tubes.

[Shyred]

Yup, we used to place foleys blind for G-tubes all the time, before the trend shifted to PEGs placed with imaging. I never had a problem or complication after inserting a foley for tube feedings, but I've heard of cases where the placement failed (the catheter missed the opening in the stomach wall and lay between the stomach and abdominal wall) and peritonitis resulted. We documented the size of the catheter and amount of fluid used to inflate the balloon, and noted the presence or absence of difficulty/resistance to placement, just like inserting one into the bladder. We never worried about external length because these aren't NG tubes.

Oh wow, this is good to know. Just wondering...as long as there is stomach content that comes back into the new foley after insertion and no resistance with flushing, would that indicate proper placement or not necessarily?

[pennyaline]

Oh wow, this is good to know. Just wondering...as long as there is stomach content that comes back into the new foley after insertion and no resistance with flushing, would that indicate proper placement or not necessarily?

I talked to one of the nurses who failed to insert the foley into the stomach. She got stomach content on aspiration, but the tube was misplaced all the same. The resident's doctor, who happened to have seen this several times, explained that even though the gastric wall is almost always adhesed to the abdominal wall after gastrotomy and feeding tube placement the adhesion can be separated by manipulation even in patients who have had g-tubes for years. When the adhesion breaks, the channel for insertion is no longer intact and the tube can go awry. The doctor also explained that small amounts of gastric content can leak from the stoma and lurk in space around the stomach, and that is what is being aspirated after tube misinsertion. The giveaway is always that a small amount of stomach content is aspirated even when a moderate to large amount could be expected.

[CapricaNurse]

I think one of the hardest things about nursing is the amount of stuff you have to let "just roll off your back". Seems like everyone thinks they have the right to take out their life frustrations on you. It doesn't matter if you are in the wrong or right, you are where the buck stops and the yelling-at begins. You are expected to somehow know everything there is to know about everything. You are expected to magically somehow make the manipulative patient (who is getting their jollies by expecting the queen bee treatmen)t become reasonable and appreciative of your care plan to get her more independent. And when she uses her highly polished manipulation skills to report you to management for not having been 'nice' enough, you are expected to nod appreciatively and thank everyone for their feedback. Fair is fair- I don't expect a pat on the back from the 'everybody has to wait on me' patient, even though I am sincerely trying to help her gain the ability to have more real control over her life by encouraging her to do things for herself. But I do expect at least some of my coworkers to understand the situation. We've all had patients like this. Instead I find that the coworker who told me she' totally understood' that the patient was just resisting positive change, and to 'not worry', turned right around and reported the patients comments to my boss. The only details my coworker left out where the nice things the patient said about me before and after getting mad for having been (gasp) encouraged to become more independent. This same coworker makes very - not- at- all - funny "jokes", all the time, about taking (stealing from work) controlled meds for herself. I don't laugh, but she keeps it up. She snoops on rooms where a spouse is staying over with a patient, using the facilities fall risk cameras, to 'see if they are doing anything'. Last week she came in having had so much 'coffee' that she was literally bouncing off the walls. But she is the one tapped for charge nurse, and I am the one sent to the bosses office to get chewed out for trying to help some one who I guess didn't want to be helped. I feel frustrated and overwhelmed. The CNA yells at me for not doing her job, saying: "but you were in that room a long time". I was in the room a long time, doing things I can't delegate to a CNA, but that doesn't mean I want to or can afford to add in doing her jobs too. The phlebotomy guy wants to yell at me because I got an order for a stat lab and asked for the draw, when it turns out he normally does other things for the 5 hour block of time my request landed in. Does he think I can tell my patients when to have their heart attacks? I choose this midwest hospital because it was supposed to be all about teamwork, but that's not happening. And yes, there are lots of great patients and great nurses here most of the time, just not so much now.

[aquino5043]

i feel you did the right thing. nurses can be so critical of each other sometimes. you could get an xray to check placement of the tube.

[PsychNurseWannaBe, BSN, RN]

I have never used a foley catheter to feed someone... I am baffled. I have had someones peg come out and I put in a foley to keep it patent, but was specifically told by the doctor not to inflate the balloon. Interesting. Is this common?