New vent, old topic

JustBeachyNurse, LPN · Jul 2, 2015

You mean like the "experienced" night nurse who volunteered for a day shift but never changed the trach ties because she hadn't since training & was afraid to do alone? (This case tie changes are done on days when client is awake) but never told anyone and put an indecipherable mark in the checklist. When the other nurses have to use peroxide to get the crud off the trach stoma & tube it was pretty clear you didn't do trach care. If you had said something we'd do it first thing instead of mid shift.

Or the nurse who couldn't figure out how to pause the continuous GT feed to give free water boluses? So just didn't do it, and signs of dehydration were showing by later in the day...

Or the wonder nurse who documents presence of a GT (wrong size, client has a GJT, G for venting and certain medications, J for feeds & other mess) and feeds through GT. then can't understand how client aspirated? (Only PPI & acid blockers via GT)

Or better the nurse who decided that the child with a progressive neuromuscular disorder just needed to cough and jammed an oral swab to initiate gag. Then had to call 911 for aspiration and ultimately necessitating an emergent tracheostomy years earlier than projected. Then acted innocent when the physician extracted a little pink sponge from the swollen airway that strongly resembles an oral swab. It seems the cough assist and CPT vest were too much trouble to learn how to use these relatively simple devices.

JustNursn · Jul 3, 2015

YES YES YES YES!!!!!

It's crazy!!!

The best is when they document the mistake in the communication book and it with 'LOL'!

Sostuckrn · Jul 3, 2015

You mean like the "experienced" night nurse who volunteered for a day shift but never changed the trach ties because she hadn't since training & was afraid to do alone? (This case tie changes are done on days when client is awake) but never told anyone and put an indecipherable mark in the checklist. When the other nurses have to use peroxide to get the crud off the trach stoma & tube it was pretty clear you didn't do trach care. If you had said something we'd do it first thing instead of mid shift.
Or the nurse who couldn't figure out how to pause the continuous GT feed to give free water boluses? So just didn't do it, and signs of dehydration were showing by later in the day...
Or the wonder nurse who documents presence of a GT (wrong size, client has a GJT, G for venting and certain medications, J for feeds & other mess) and feeds through GT. then can't understand how client aspirated? (Only PPI & acid blockers via GT)
Or better the nurse who decided that the child with a progressive neuromuscular disorder just needed to cough and jammed an oral swab to initiate gag. Then had to call 911 for aspiration and ultimately necessitating an emergent tracheostomy years earlier than projected. Then acted innocent when the physician extracted a little pink sponge from the swollen airway that strongly resembles an oral swab. It seems the cough assist and CPT vest were too much trouble to learn how to use these relatively simple devices.

ouch! I have seen many incompetent nurses in my day too. Some of those are really bad! ðŸ˜µ

Sostuckrn · Jul 3, 2015

I'm confused if you are not allowed to do these things or if you are wondering why no one can do them correctly.

I will never understand some of the people deemed safe in pdn. Even if you warn the agency nothing gets done.

JustNursn · Jul 3, 2015

I'm confused if you are not allowed to do these things or if you are wondering why no one can do them correctly.
I will never understand some of the people deemed safe in pdn. Even if you warn the agency nothing gets done.

For me it's why they aren't done correctly. My agency has a pretty decent training program. And if you don't know that's ok just ask for help/training...pretending you know when you don't is endangering the patient.

I agree the agency does nothing when they are made aware of these situations...even when it's the parents complaining.

caliotter3 · Jul 3, 2015

In my experience, the majority of the time I have found that things are not done due to the laziness and negligence of the nurse in question. Very rare for any of these people to even make the effort to come up with the "I wasn't trained to do this" excuse for not doing something. I learned a long time ago, to do what needs to be done on my shift and document what I did so that nothing can come back on me. If it turns out that the lazy nurse gets away with yet another instance of being lazy and pawns patient responsibility off on me, so be it. On occasion, if I find it necessary, I will report to the nursing supervisor, but I do not do it to get another nurse in trouble, rather, because I feel it is necessary to the situation at hand. I hate making all the written records of this; just more work on top of more work.

JustNursn · Jul 3, 2015

I don't report to the agency. People I work with inadvertently report themselves by writing their mistakes in the communication book or telling the parents directly (who then tell the agency).

caliotter3 · Jul 3, 2015

I don't report to the agency. People I work with inadvertently report themselves by writing their mistakes in the communication book or telling the parents directly (who then tell the agency).

Apparently your agency either does not treat the communication book as a legal document as most agencies do, or they neglected to inform the nurses that it is a legal document. "LOL" and like comments do not belong in the communication book.

Nibbles1 · Jul 5, 2015

I have on so many occasions, wondered why the agency would hire a nurse who clearly cannot perform simple tasks. I have seen nurses who didn't know how to start/stop a Kangaroo pump for feedings. I recently had to take a leave of absence about a month ago. When I got back 5 days later, the g tube had been broken 3 times, a nurse overdosed the client on Keppra, a nurse gave the meds where the water goes to inflate the balloon. Prior to that, I had a case where the weekend nurse didn't change the clients clothes since I had on Friday. Didn't brush her teeth, nothing. Don't even get me started on CPT. In May 2014, I was finally getting 3 days off I was called in to work the next day because the ignorant nurse pulled the CUFFED trach out of the stoma to make sure it was still inflated with water. The mom said it looked like a murder scene in the clients bedroom, blood was everywhere. Back to the case I have now, the nurse just 6 days ago, accidentally turned the oxygen on to 8 liters instead of turning it off. The parent heard the sound of the oxygen and the client was turning pink cheeked. She was hyper-oxygenated for 20 minutes. Geez! I could write a book about the errors I have seen, heard, or witnessed in PDN. I feel like the agencies don't care who they put in the home or if they even have proper training. Just like the nurse they hired that was brand new, never went to training, didn't know how to suction a trach etc. I posted on this forum about that. I was ready to quit this case if they were seriously going to put this nurse in the home. Sometimes I wished that PDN nursing was supervised a little more than what it is. End vent!

Nibbles1 · Jul 5, 2015

Apparently your agency either does not treat the communication book as a legal document as most agencies do, or they neglected to inform the nurses that it is a legal document. "LOL" and like comments do not belong in the communication book.

We have a communication book, me and the other night nurse started it because she and I were the only ones for 8 months. We didn't have a report off. I refuse to put my signature at the end of my quick note. I heard that if you sign your name to it, it becomes a legal document. If I am wrong, please correct me.

JustBeachyNurse, LPN · Jul 6, 2015

We have a communication book, me and the other night nurse started it because she and I were the only ones for 8 months. We didn't have a report off. I refuse to put my signature at the end of my quick note. I heard that if you sign your name to it, it becomes a legal document. If I am wrong, please correct me.

Writing it is a record regardless if you sign it. I never sign those. Just write objective facts no lol etc

There are nurses that feel they rule a case and leave "instructions" for everyone else...not a supervisor. Such as commenting on how others document not like anyone is perfect. 50% of the time her instructions don't match policy or reality