Old school nursing practices....

[dukesgal]

So all I know as new or recent grads, everything we were taught in theory and lab is still relatively fresh in our minds. I know we are still learning how to adapt to the real world of nursing vs. school and the perfect NCLEX staffed facilities of our textbooks. But I've come across a few practices that have rubbed me the wrong way.

1. Giving narcotics to help clients sleep/keept them quiet. Granted, I work in a skilled nursing facility and we have many patients who cannot verbally express pain, we must rely on non-verbal cues that our patients are experiencing pain. However, I have had older night shift nurses insist that I give a client narcotic pain medication so they will sleep. In fact, clients have even come up to me and requested "a Vicodin, so I can sleep. Nurse X says they help." Upon further questioning and some education that the purpose of narcotic pain medication is to relieve pain, not for use as a sleep aid, the client did complain of pain. At this point I gave the medication as I wasn't going to withhold pain medication.

2. Another new nurse was getting her supplies together to d/c an indwelling foley cath. The charge nurse on duty was there to assist, but when the new nurse came back to the room with a syringe, the charge nurse cut the catheter, pulled it out (without properly deflating the balloon) and a moderate amount of blood followed. The client is non-ambulatory and is cognitively impaired.

I wasn't aware this was ever recognized as an acceptable way to remove a catheter and we certainly never learned this way in nursing school.

When one of the supervisors was informed about these incidents, we were told that "this was the way we were taught" (many years ago) and "you haven't worked night shift, you don't know how many people can't sleep at night"

I know this is wrong, and I am beginning to think I am not comfortable working at a facility where this kind of behavior by nurses is condoned.

What would you do?

[netglow, ASN, RN]

Try to get out of there.

1. snowing

2. abuse/intentional injury to patient

[DedHedRN]

I have seen doctors D/C foleys in that way and if you think about it, it deflates the ballon just as well since the line is cut that holds the water and there is no way a popped ballon is going to hold fluid. I have also seen this method used in OB many times. It may not be what you were taught but its functional and works without causing harm to the patient. I believe that the blood you saw was more likely caused by something else, perhaps the pt. had a infection, or had been pulling on the cath?

And many people who are in pain cannot sleep at night because of there pain and if they need some pain medication to help them sleep then let them have it. If someone has chronic pain problems that pain is usually worse at night. Many older people are also more aware of the pains in their body at night and giving them pain medication makes sense.

There are many ways to achieve the same outcome in a safe way and as a new nurse you really just need to know what the correct way to do things, and if its not what your used to be able to rationalize what is happening and if it is really going to cause harm to the patient. This is the where the critical thinking that they could not teach us in school comes in handy.

Anyways, I am just a new grad as well, and this is just my two cents so you can take it or leave it.

[nursel56]

I would have said exactly the same thing you did, Isis. Congratulations! You're old school! (kidding).

To the OP - have you ever shared your concerns with the nurses you believe to be unsafe? It concerns me that you mention "we" went to our supervisor to complain about them. I hope they weren't blindsided by that. It can cause that unit morale to evaporate. When that happens, the ultimate victim is the patient or resident.

[nursen02]

mm interesting .... but i dont think either practise is unsafe-

an exp nurse giving analgesia on night shift prior to sleep is a good because it stops overnight peaking/ breakthrough of pain ...and sleep in pts with pain increases healing - i think that if its a long term habbitual use by a pt that maybe that is an issue - but for inpatients in an acute facility - i have often recommended analgesia pre sleep to ensure the pain does not break thru - if you look at the reasearch people who have well controlled pain recover better and heal faster - if i have a patient who is settling for 8 hrs and i give them analgesia cover overnight i am stopping breakthrough pain and in the end we all win..... the nurse may say its to aid sleep - but really it means to cover your pain and aid sleep :) - i will often encourage pts to have analgesia before settling to stop pain at 3am when they are really bad because they have layed in one position for a couple of hrs etc.....

reguarding the idc removal - i dont think that is unsafe either it may be unusual and not the way you were taught but it the ballon is going to deflate - there is no risk of back flow of urine via the idc into the bladder etc... the risk i percieve is that there might be issues if you cannot remove the idc due to it being stuck etc....and there might be a risk of urine contact if improper ppe is used when cutting if urine splash occurs and this is a potential occupational health risk ....

[DeeAngel]

I have seen doctors D/C foleys in that way and if you think about it, it deflates the ballon just as well since the line is cut that holds the water and there is no way a popped ballon is going to hold fluid. I have also seen this method used in OB many times. It may not be what you were taught but its functional and works without causing harm to the patient. I believe that the blood you saw was more likely caused by something else, perhaps the pt. had a infection, or had been pulling on the cath?

And many people who are in pain cannot sleep at night because of there pain and if they need some pain medication to help them sleep then let them have it. If someone has chronic pain problems that pain is usually worse at night. Many older people are also more aware of the pains in their body at night and giving them pain medication makes sense.

There are many ways to achieve the same outcome in a safe way and as a new nurse you really just need to know what the correct way to do things, and if its not what your used to be able to rationalize what is happening and if it is really going to cause harm to the patient. This is the where the critical thinking that they could not teach us in school comes in handy.

Anyways, I am just a new grad as well, and this is just my two cents so you can take it or leave it.

I have seen it happen where the foley was cut and the balloon did NOT deflate necessitating a urology consult with a hospital visit about an hour later. You deflate the balloon with a syringe and then remove the Foley, seriously is saving two or three seconds worth the risk of having this happen? I wasn't the one that did this because I was taught never, ever to do this, apparently the other person was given different information.