Nurse digs out necrotic tumor!

MassED, BSN, RN · Sep 21, 2013

Did you witness this? If not, it's hearsay and unprofessional to "report" anything that is not first hand knowledge. Also, what do you mean "dug out?" Was it debridement??

Christina12345 · Sep 21, 2013

She stuck her hands into the wound and pulled out the necrotic flesh- without an order. I didn't know it would be hearsay to report a concern. I don't know how to ignore the sudden hole in my patient- perhaps I could report that this patient suddenly had a change in his wound with no supporting documentation on what happrned?

RainMom · Sep 21, 2013

Not sure about reporting it, but you can't just ignore it altogether. It has to be included as part of your skin assessment documentation, your observation of what it looks like in real time without elaborating as to how it may have gotten to that state.

Must be a pretty shoddy facility to limit something like a washcloth.

jadelpn, LPN, EMT-B · Sep 22, 2013

If someone was training her, then she was being directed, no? Is part of your scope in wound care debridement? If there was already a wound, then it could be part of cleaning it out--it could be a number of things. So if there was an order for wound care, then there was an order. You then need to assess the wound. You need to map the wound. You need to measure the wound. And perhaps an order to pack the wound. Otherwise, you can only document what you assess, and the interventions that you did. You can not account for what another nurse may or may not have done. Especially if it was already reported to the DON who chose to do nothing--then you start a fresh assessment for your shift. You may need alternate wound orders though--but look and see what the current ones are.

Are the powers that be suggesting that you use one washcloth a day to do peri care on a patient and then re-use as needed? You have no other means to do peri care? A peri bottle and disposable wash cloths? If the DON is sweating the state coming down, then perhaps they need to account for alternate peri care needs. And could be something you could discuss perhaps.

LaRN · Sep 22, 2013

hopefully the nurse didn't use the patients last wash cloth when she dug that tumor out :no:

Christina12345 · Sep 22, 2013

I get that the place is a pit

And good for everyone else who works in better places- I do too- I'm just obligated to continue for this month for insurance reasons. I can leave and never come back. But for the 240+/- people who live their- they can not. Just to clarify: The nurse who "allegedly" performed the "manual debreedment" with out orders was not IN training but had a new nurse that she was training- so a bedside whitness is available if needed. This is NOT about getting a particular nurse in trouble. My question would.have better been stated- how can I NOT be part of this conspiracy of silence? The answers so far have been defensive, passive, or mocking. Thank you for reminding me that internet forums may not be the best place for random advice. :) Thank you very much for the replies. I will be going with my gut in good faith, because as nurses we are each responsible for our own actions and decisions.

jadelpn, LPN, EMT-B · Sep 22, 2013

i don't believe my answer to you were any of those things, however, you did not see what or what not occured with the nurse prior to you and the wound. That is hear-say. If you documented the wound correctly, and the nurse in question debrided it (and was there a general "wound care" order? If there was, then that is subjective--and hard to prove--witness or not--that what occurred with the wound was out of the realm of the order) then you can only provide a new assessment that you observe. And this may be laughable, but perhaps an attempt at an order for a wound vac? A suggestion of MD surgical debridement? This could come back on you in that you assessed and observed necrotic tissue in a wound--and did what exactly? Did you document this observation and did you notify the MD? This scenario could play out in a bunch of ways, however, bottom line is that it could be negligent to not have advocated on the patient's behalf when observing the necrotic tissue to begin with. As well as basing a report on hear-say.

Additionally, as awful as it is that I can not get over that one washcloth and one towel is given to a resident with no other peri care options.....is this a policy? Are other items not available? Is there no other laundry available? Because again, hear-say. You are told to only use one---do people get written up for using more than one? Do they do a laundry count? This could also come back and haunt you as you say "we could only use one" and DON says "I never, ever said that!!! That is not policy, that is not written anywhere, and honestly, I can't believe that Christina 12345 was using washcloths over and over for peri-care!! No WONDER the resident had necrotic tissue in the wound!!!"

If the place is a pit, there are many other options for reporting without getting into he said /she said/ that one did stuff. State agencies. The ethics hotline of your parent company. The omsbudsman of the facility. If the facility accepts state/federal insurances, then that is also a thought. Finally, the DON's boss, as apparently this is all going on and the DON is not doing anything to change it.

Christina12345 · Sep 22, 2013

Jadelpn- I like you! Thank you for being so engaging! Let me clarify a bit more. The patient has a malignant melanoma tumor ( about the size of a volley ball) it opened up on the 11th and he was seen in the hospital due to the profuse bleeding that occured when it aelf opened ( grew so large it split the skin). Nurse in question who trained the new nurse worked the night of the 18th. No wound documentation in chart

. Next day dressing removed an there is a soft ball size whole in the valley ball size would. When the new nurse was asked what happened she said the nurse who was training her manually removed to necrotic tissue. Pictures taken, DON notified. NEXT shift orders taken to change wound care to a packing- still no narative or updated skin assessment. I saw this patient on the 21st. And got the "story"- i get that its hearsay to say " I kbow nurse A did this!" But this home had a current F tag and they are at risk of not being able to accept medicade payment- so the DON isn't addressing what has happened. I have previously (last week) reported to the DONs boss that the ADON is committing fraud with her falsified wound resports. That's why I feel like the silence needs to be broken. :)

On the topic of the towels. This for- profit company runs its departments that if they come in under budget the department head gets bonuses. $$$ that includes laundry. Less staff + not ordering linens= bonus. We do not reuse the wash clothes. The cnas take from other floors, use paper towels and toilet paper- even diapers- to do peri care.

xoemmylouox, ASN, RN · Sep 22, 2013

Sounds like a place on the brink as it is. I hope when you saw the wound you did a skin assessment sheet, notified the MD, and documented this all well. Good luck with your remaining month there.

Esme12, ASN, BSN, RN · Sep 22, 2013

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You need to understand that the right path isn't always an easy one. Be prepared to be fired for your actions. Facilities do not like whistle blowers or tattle tales. I know there are laws to protect whistle blowers....do not count on them to help you.

You can contact your local Bord of health, the state ombudsman, medicare and the medicare fraud line, your states elder abuse line, and if you re accredited by The Joint Commission....you can file a report with them.

Thread closed for staff review.

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