In a nursing rut here...need a pick me up

CathyLew · Apr 17, 2010

The way I see it, good Conscientious nurses have nightmares about mistakes.. even minor ones. Crappy nurses can cause harm, have errors and sleep like a baby. So that puts you in a good category to start with.

Second, about the meal tray. I have a dozen times passed a tray to a patient that was NPO, had a change in status and been put on a liquid, ground, whatever type of meal. In each case it was a breakdown in the system, or a breakdown in communication.

-- the patient was ordered a reg meal, reg consistency, sent up from the Kitchen.... Dr comes in at 7:30am and orders a test..- the NPO order doesn't of course get to the kitchen, the tray is here, and passed. Bam! they can't do the test/procedure, etc...since the patient has eaten.

Or..... the patient strokes in the night.... The staff does everything except stop the breakfast tray.... so the person who has not had report on the patient, sees the tray, passes it..... lack of communication.

Or a vaigue order of assist with feeding.... what does that mean? cut up meat? Open milk carton? needs a straw? Some people put in an order of needs assist with feeding, when they mean aspiration precautions.

so back to you "causing the patient to aspirate" were you force feeding the patient? giving fluids with a large bore syringe? or was it a breakdown in communication---which should always be seen as a learning teaching tool.

PAERRN20 · Apr 17, 2010

No I was not force feeding the patient. We were holding the patient in th ER, the MD wrote for a regular meal tray, and I gave it to the patient. The floor nurse said I let him aspirate because I didn't do a swallow study. The patient did swallow pills fine for me, so no issues there, I just didn't formally document it. Hence, the floor nurse accusing me of causing the patient to aspirate.

CathyLew · Apr 17, 2010

see..... I would think if the MD thought there were swallowing issues.... he would order a swallow eval. and if the pt took pills fine...why would you have seen an issue? and in our hospital a Swallow eval costs $$$ for the pt. we only do it on an MD order.

unless the diagnosis was dysfacia, CVA or aspiration.... we would not jump the MD diet order and cancel it, order a swallow eval. unless you see the signs. Anyone can aspirate. If you don't see a condition preceeding it.... I don't see where you are in the wrong.

netglow, ASN, RN · Apr 17, 2010

You do have documentation of oral meds given.

leslie :-D · Apr 17, 2010

I have been pretty hard on myself lately and just have been having an all around hard time. I posted the other day about an event that happened at work, and I have been blaming myself for it, and even having nightmares about losing my license over it. I know I am a good nurse but this has just thrown my confidence into a downward spiral. (BTW what happened is I gave a patient a meal tray and the floor nurse said I cause the patient to aspirate). I am even thinking of changing careers because I am tried of worrying about losing my license or injurying a paitent. Any other nurses ever have these thoughts? I just needed to get this off my chest.

omg, i can't believe you're still upset about that idiotic floor nurse!!

why the heck would you note on any swallowing difficulties, if there wasn't any admission dx reflecting this, or if there weren't any noted difficulties???

as i stated in your other thread, you acted on YOUR assessment...

and if i remember correctly, you observed him to be pocketing food?

how long have you been a nurse?

you really need to learn how to grow a thicker skin, and i mean this respectfully.

otherwise, there will always be someone who tries to chew you up and spit you out.

for all you know, the pt aspirated on the floor and the nurse is trying to put it on you.

nurse defensively at all times.

and on the rare occasion, it's ok to nurse offensively as well.

stay strong...even if it's one shift or one hour at a time.

leslie

PAERRN20 · Apr 17, 2010

I've been a nurse for over 2 years and I do need to grow a thicker skin. It's a work in progress and thank you for your comforting words everyone.

leslie :-D · Apr 18, 2010

I've been a nurse for over 2 years and I do need to grow a thicker skin. It's a work in progress and thank you for your comforting words everyone.

come here ANY time, and we'll pull you back up.

you seem like good people.:)

leslie