It drives me nuts when....

Specialties Private Duty

Published

Finish that sentence. Could be clinical, could be every day annoyances.

I'll start. It drives me nuts when nurses pull the rings to open the binder/chart. It breaks them and then the rings stay partially open so paperwork falls out. That's why the little tabs to open them exist. With our binders, its one tab to pull to open them. Its more work pull the rings anyway! I guess it goes back to basics...if you have to force it, you're probably doing it wrong. Kind of like the nurses that force the gt extension until it doesn't lock because they force it to turn past the point it should.

Specializes in Complex pedi to LTC/SA & now a manager.

Nurses take incomplete orders and expect others to verify. Same nurse never transcribes orders to the MAR (oh all my cases someone else always does it...)

Tylenol q 4-8h PRN pain (um dose? Route? Formulation? Rectal Tylenol and PO/GT/JT Tylenol are not the same dosing)

Incomplete documentation seemed in pain (really how so? What did you do about it? Did it work?)

Nurses seeking parental favor to get hours. Even asking if another (senior) nurse is getting fired so she can have the hours. Telling the parent they are taking my shift (I'm a senior nurse) the next day when parent texts me in a panic asking if it's true as they were expecting me. I just responded my schedule has _____. Don't ask me if other nurses are in trouble or getting pulled off the case so you can have more hours. I will just refer you to the case supervisor. ( hint don't **** off the siblings' babysitters as they are good friends with the parents and will tell them everything you said and did. And mom is not afraid to call the office and report what the sitters observed.)

Don't tell nurses you will fight them for hours. I have more experience and can do other cases, take my hours and you will quickly find out why the senior nurses are in the parents' favor. ;)

Gossip with the mom. Go ahead. Especially if you do more than listen. Know mom talks about you too.

Don't pre pour meds for me. Worse no labels on the mystery syringes & solutions. This happened. Mom let me know with a sly grin that you wanted to be helpful. I cannot legally use unlabeled unknown medications or solutions. Helpful is setting up for the next day and stocking supplies. Not wasting medications.

What's worse is when the nurse indicates that s/he wants your hours/job and then the client gives it to them on a golden platter and the agency does absolutely nothing about it. Of course, the client has already told you how the other nurse complies with every fraudulent action that you refused to do, and is oh, so, very, very, this that or the other. The exact opposite of what the client complains about them during any other conversation. Talk about two-faced. You get a headache from keeping up with the client's lies and complaining. And what happens when you tell the unemployment department all of this? The agency gives them some kind of lie to insure that you can not draw unemployment.

Another one: the staffing coordinator, clinical nursing supervisor, or the Director of Patient Care Services calls the client when they know that you are on duty, and engages in a sensitive, perhaps derogatory, conversation while you are present, without bothering to either call you first, or asking to speak to you, to discuss the matter. (You can hear or figure out the topic from the client's end of the conversation). This solidifies in your mind, your perception, that it is your nursing administration, not just the client, that has no respect whatsoever for you.

Specializes in nurseline,med surg, PD.

That is very disturbing and unprofessional.

Specializes in Pediatric Private Duty; Camp Nursing.

Question... what exactly is a "senior" nurse? Is that a term used by the agency, or do you mean you just have more seniority within the company or with the client? Or are you merely referring to age? :roflmao:

Specializes in Complex pedi to LTC/SA & now a manager.
Question... what exactly is a "senior" nurse? Is that a term used by the agency, or do you mean you just have more seniority within the company or with the client? Or are you merely referring to age? :roflmao:

Semi-official term used by agency to describe nurses who have been on a case for over a year, receive priority in scheduling hours for the case, and are qualified to orient and precept (preceptors are training new to peds or new to PDN nurses for a minimum of three 8hr shifts vs orienting--just giving case overview & facilitating a meet & greet). Our office uses the term senior for qualified in multiple cases , highly skilled and competent to precept and orient. Most senior nurses are qualified for the "transition team" (open a new case with clinical supervisor, assist developing plan of care, and work the case for a few weeks training/orienting/precepting nurses to work on the case). Not all nurses primary on a case are senior nurses.

Specializes in Complex pedi to LTC/SA & now a manager.

New one. Fill in on a case or two every time there is a prescription issue. Pet peeve #1 nurses who don't realize that you must prime new inhalers (they start with "124 puffs" you must discharge the first 4 before administering as the priming puffs have insufficient drug). Don't look at dose counters for MDIs and the few nasal sprays. There are zero doses left. Rx should have been filled days ago. But there is sufficient propelling to make a "puff". There is just no drug being given. Try explaining that to the parent when asked, that the other nurses have been giving the child essentially a placebo.

If you don't know look it up, call the pharmacy, call the clinical supervisor. Don't under dose a patient because you don't check!

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Backwards layering of the "chux" disposable blue pads.

I work with adult-sized patients, and one chux is not enough coverage, so we put two down with them overlapping. Typically the distal pad will get soiled, while the proximal pad is kind of a 50/50 toss-up whether it will escape the deluge. Therefore, it makes sense to me to always put the proximal pad down first, with the distal pad overlapping on top of it. This way if the deluge is minor, only the distal pad will be soiled and the clean proximal pad can be reused.

But some people put the distal pad down first, with the proximal pad over the top. This pretty much guarantees that both pads will be soiled, even if the spillage is relatively minor. Supplies can be hard enough to come by, why are we wasting one that is relatively easy to manage appropriately????

Smegma.

Foreskin management is not rocket science, people, honest it's not!!! When changing a diaper, you're already right there with a wipe in your hand, would it kill you to peel-and-wipe so that those who work after you don't have to deal with smegma from your shift(s)? I work three 12s on this job, and after the first diaper change of the first day, I never see smegma again, because I simply peel-and-wipe when I'm there wiping everything else.

Diaper Rash / Wound Care

Working three 12s in a row, it's gratifying to see diaper rash going away or a wound healing when you leave on that third day... you know that it's because of you and your nursing care/interventions that the patient's skin is improving. Then you are gone for four days and return to find that everything is right back to where it was one full week previous (or even worse off!), as if you'd never been there the previous week at all. Peeling back that diaper for the first time of the week is like Forrest Gump's box of chocolates... you never know what you're gonna get!

Specializes in Geriatric.

When CNAs tell the patient what was said about them in report and who said it.

I wish I could say I made that up.

Specializes in Complex pedi to LTC/SA & now a manager.
When CNAs tell the patient what was said about them in report and who said it.

I wish I could say I made that up.

We rarely have CNAs in private duty. There may be an occasional CHHA. Often we don't have overlap if working 12 or 16 hours so report is given directly to the parent or family caregiver resuming care of the patient. As there isn't often a large team of nurses on a particular case, this really isn't an issue in PDN. I'm sure you're not making this up but I'm betting you work in a facility not private duty nursing (this thread is in the PDN forum)

Specializes in Pediatric Private Duty; Camp Nursing.

When the day HHA comes in to work with a upper respiratory infection after she had been told never to come in w any sort of respiratory illness d/t client's compromised ability to cough up secretions.

... when my boss schedules me 5 nights a week and then when I call to tell them I can't do that they say "I do it every week all year".... you work day shift!!!

... when a nurse doesn't initial the mar or maintenance sheet EVER, supplies aren't cheap people.. I don't need to be changing a vent circuit when it was just changed only because you didn't initial that it was done already.

... when a nurse asks for you to switch a shift with them because it's their birthday, but won't reciprocate.

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