J-tube. RN/LVN

Nurses Relations

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Hi all,

I am an Lead LVN in a facility and I am the one who has to train all new nurses. RN and LVN alike. I have a new grad RN and we have some disagreements on a few things. I could definitely be wrong so I wanted to clarify.

For J-tube I had informed her that we do not check placement, aspirate, or put air in the j-tube. She said she checks placement by putting air.

For bradycardia, would a pacemaker be beneficial? She has informed me that they are only for people who's hearts stop beating.

I try my best to help anyone new and let them know to ask me any questions if they are unsure, and help them do things accordingly to protocol if I see it is being done incorrectly, sometimes I feel that because I am an LVN they refuse to listen to what I have to say. I have been with this company for over 5 years as a lead.

I understand in the medical field, we are constantly learning new things or new ways of doing things. I just want to be sure I'm training the nurses correctly, if I am incorrect I would want to make sure things are being done the right way. Thanks in advance for any advice.

Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.

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Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.
Yes you check residual. Make sure their digesting the contents. Just a small pullback.

To me it feels like you have some resentment towards training new nurses. Are you assuming some new grads are judging you by your title? It's probably not the case. Being new is scary and intimidating. You appreciate the experienced nurses no matter what their degree. Make sure your not reading into things too much. It's not about proving who's right and who's wrong, it's about safety. Pull up the policies and procedures for her.

In my eyes the best nurses are the ones with work experience, the title is just that. Think of all the lives you have changed and are changing by sharing your knowlege. It can be frustrating I'm sure, lol, but know that you wouldn't be teaching them if you werent a expert.

Resentment is the last thing I would have come to in regards to her post and wording. What exactly makes you draw that conclusion? To me, OP is seeking clarification to ensure the teaching and guidance she is providing to new nurses is correct. She said more than once she could be wrong on her end and wants to make sure everyone is on the same page and the practice being taught is the standard of care.

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Other posters are correct. You don't check residuals with J-tubes. When I did skills training, I always double-checked my facility's policies on all tasks so that I would be confident enough to answer other nurses' questions during the training.

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I understand in the medical field, we are constantly learning new things or new ways of doing things. I just want to be sure I'm training the nurses correctly, if I am incorrect I would want to make sure things are being done the right way. Thanks in advance for any advice.

Please train (orient) your new staff to your facility Policies and Procedures. That would cut down on much discussion about "how to do things". Nurses who deviate from the accepted procedures end up causing patient issues by wanting to do things "their way'. This takes all ( most) discussion out of your hands and into the hands of the writers of such policies and procedures.

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Specializes in Emergency, Telemetry, Transplant.
For bradycardia, would a pacemaker be beneficial? She has informed me that they are only for people who's hearts stop beating.

Perhaps she was thinking of an AICD? Even then, they only help with shockable rhythms (V tach, V fib)--the would not be effective for asystole or PEA.

As for a pacer, one could be beneficial for bradycardia. I.e, is the pt. symptomatic? What is the cause of the bradycardia?

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Specializes in Dialysis.
From the Cleveland Clinic: "It is NOT necessary to check residuals on postpyloric feeding tubes (nasoduodenal, nasojejunal, or jejunostomy tubes)."

It may not be necessary to do this, but if the facility policy requires it, then do so. But I would show someone this and let them know. I've never checked residual on a j-tube

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

I just want to say that the new grad RN is lucky to have a preceptor like you, OP. And I appreciate that you came here to check yourself and get opinions en masse.

I very quickly found out that if I asked my preceptor questions about why we did things a certain way she got mad as hell really fast. So I stopped that really quick. But it would have been very helpful to me had she explained and been patient instead of assuming I was a jerk.

We should clone you.

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Specializes in Primary Care, LTC, Private Duty.
It may not be necessary to do this, but if the facility policy requires it, then do so. But I would show someone this and let them know. I've never checked residual on a j-tube

Where did anyone state that it's facility policy to actually check J-Tube residual? I was just posting, from a verifiable source, information to substantiate the OP's statement that it wasn't required to check residual on a J-Tube when Bettytom11 was posting that you DO check it (which is incorrect).

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Specializes in Dialysis.
Where did anyone state that it's facility policy to actually check J-Tube residual? I was just posting, from a verifiable source, information to substantiate the OP's statement that it wasn't required to check residual on a J-Tube when Bettytom11 was posting that you DO check it (which is incorrect).

If she is orienting someone, I would hope she's going by facility policy. If that is indeed the policy to check, perhaps it needs updated. If not, she needs to update the way she orients a nurse to the facility. She could use that as a source if needed when pointing it out to p&p makers

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Thank you everyone for your input. It's all been very helpful.

Resident has g-tube with gastric drainage bag connected which is measured q shift. I train by all policies and procedures just to clarify. She had also read all the p&p.

I am very grateful for all the input and appreciate the kind words.

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Perhaps she was thinking of an AICD? Even then, they only help with shockable rhythms (V tach, V fib)--the would not be effective for asystole or PEA.

As for a pacer, one could be beneficial for bradycardia. I.e, is the pt. symptomatic? What is the cause of the bradycardia?

pt is nonverbal with profound intellectual disability and has gone to see a cardiologist who stated to "ignore slow pulses" what he actually wrote in his progress notes. Has had episodes of HR in the 30's, lethargy, and not easily aroused from being asleep when hr is low. Cause is unknown. I just wanted to know if there was more that I can do to advocate for the pt. EKG was normal

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