I'll start by saying I'm UK based, as I've noticed most here are US based.
I've been working in my Crit Care area for nearly 6months. We have consistent issues with getting medical cover, and, due to training changes, a lot of the junior doctors we have don't know how to place Art or Central lines (kind of important, ya'know!). So I've become used to treating blind for a few hours until an art-line is in place, lots of real close monitoring and quick responding.
What I'm not used to is a patient waiting 16hrs to get an NG inserted after one came out overnight. I get that overnight on a Saturday, an NG that just finished a feed isn't a high priority. I understand that, even though the night doctor promised he would do it, he passed it onto the day team. I even understand that they said they would wait until the patient had been reviewed on ward round.
What I don't understand is why that patient missed 3 medication rounds and the start of an increasing feed regime because the doctor was busy.
The main reason this annoys me is that I can insert NGs. The Trust I worked at before didn't require a doctor to sign off, and if the pH of the aspirate was suitable and there were no adverse symptoms with a small amount of water, this could be used.
I agree, that's not best practise, and a chest X-ray is much better, but surely I should be able to site the gosh-darn thing, so all the doctor has to do is (remotely, if necessary) order and review the chest X-ray .
Who sites NGs where you work? What training do you require if you site them? And how is the NG confirmed as correctly sited?
I'd like to see if my first Trust was a one off, or if I would be justified in requesting the training from my ward educator.
Coude catheters require a proper insertion technique... That may be why. It's a certain demographic and a specific direction they need placed in. Our patient care techs can do any catheter-- except coudes.
I feel you.. we have some junior doctors who are hesitant to perform NGs. there was an incident,GCS of 13-14 they tried to insert NGs that was night shift. He tried many times then suddenly the patient went to bradycardia and that night she arrested. since then nobody wants to insert NGs at night they always pass to day shift doctors.
Only slightly off topic, but speaking to your frustration about seeing a patient wait and wait for needed care, knowing you are well qualified to do it but cannot.
So I am trained and experienced in providing miscarriage management, sometimes including medication to help the body release the pregnancy (if i has passed but not let go), or by aspirating the contents of the uterus. And while I can provide medical abortions, I cannot provide uterine aspiration if there is fetal cardiac activity. This is because my state, among most others, specifically bars "non physicians" from performing surgical abortions. What makes me competent to do a 1st tri MVA for a missed AB or a failed MIFE, but I can't be trusted with the 8 week aspiration abortion? And if I am not competent in first trimester uterine evacuation, I can't possibly be competent in things like perineal suturing, c/s first assist, or even a simple IUD insert (also riskier and more technical than a surg AB)
And back on topic, kinda. When I worked in Massachusetts our MAs could give injections for us. Down here in CT, they cannot. We do have an LPN on staff too but she carries her own schedule so jumps in to help when she can, otherwise the endless depos and rocephin and bicillin and vaccines have to be given by me and the other clinician. Weird how regulations like that are so variable. I could see more patients if my CAs (clinic assistants, as we call them) could administer for me. They do great drawing blood, all they'd need is some didactic slideshow thing, a little quizzy, then get your skills proven in the floor.
bgxyrnf, MSN, RN
1,208 Posts
Which takes all of perhaps 5 minutes to cover.
I doubt that's it.