shift wars in the middle of report.

[evolvingrn, BSN, RN]

Sigh......so our facility has acute care and ltc. I am hired for the acute care but when out lpn has the night off we take turns putting in our time . last night was my night. there were 20 pts are so. There is a lot of paper work to do that is left for the nights which takes several hours so i am busy throughout the night regardless of how the pts are doing. so there were several pts (five or so) that hadn't had a bowel movement in 4 or 5 days.all of them had gotten MOM on days with no results. for the two pts with scheduled suppositories (who were included in the five pts with late bms) I gave them. one i had to wake u p and it was upsetting to her. the other i found awake so i gave it early so i wouldn't have to wake them up. The others i told the cnas to tell me if they woke up and i would give them a suppository. nobody did. one did wake up and i had to do a full bed change on him but i didn't do that at that time because it was right at shfit change and we were rushing..

Anyway during report....there were three lpns (to my one person) coming on and when i was given last bm she started berating me for not waking them up to give them a suppository. she was being very aggressive. so finally i stopped report and said "im sorry your frustrated my thinking was that if they woke up i would give one but otherwise it was more appropirate and respectful to wait for when they were awake to do the intervention . she then made a snarky comment that " she thinks its very disrespectful to leave someone without having a bm for 5 days) (this is my first time working there in over a month) I stated nicely that we were going to have to agree to disagree about what was appropriate. She basically told me she was going to report me. I don't work ltc and on the acute side while we do intervene we just don't get excited about bms like this. I would never wake someone up to do a suppository. am I completley wrong ?

[Zookeeper3]

Well yes and no... in acute care when we only have patients for a few days, it's ok to begin a bowel regime at day three we'll say. For long term care.. day 5 can be impaction, obstruction, large bowel necrosis and even dead bowel. Long term care is VERY obsessive with BM's like our elderly.

Coming from the ICU, I can see it both ways, the alert and oriented patients I would have allowed to rest and given the suppositories when awake. But I've watched the deaths from necrotic bowels and bowel perfs and 5 days is a bit too long...

So in reality by day three this should have been addressed and you were in unfamiliar territory trying to do what is right, and i understand your rationale.

I've learned in critical care though... that I need to interrupt much needed sleep for much needed medicine.

Take it with a grain of salt, I think if this nurse approached you kindly, discussed the importance and the nursing implications from an educational standpoint... you might have thought... "oh, had no idea, got it, I'll be sure to be on top of it next float here, thanks".

No one can learn while being attacked, and I respect that you are looking back to double check on your decision, you sound like a caring nurse!

I may be wrong here and all the long term people please chime in and correct me, I'm coming from the aspect of caring for these folks after constipation has threatened their lives, and when we have acute patients that don't transfer for days.

Can't change what happened, but you seem very willing to learn, so If I'm right and you should have woke up the patients, you'll know next time. No need to beat yourself up, that other nurse already did. Like you, I HATE making the wrong judgement call and it just may be that you did. Food for thought in the kindness of ways.

[caliotter3]

I don't know if I would have done differently than you but the negative attitude of the oncoming nurse was uncalled for. Be glad you don't have to work with her daily.

[silverbat]

I think I would have gone with CNA's on turn rounds and gave the suppos to all of the ones needing it. The Big issue IMO, is that BOTH shifts let the BM days get to 5!! BOTH shifts were NOT on top of this and the day LPN knew that, so maybe she was being defensive--the best defense is a good offense sort of thing. I am afraid I would have reminded her of that, and said that if you hadn't ignored the BM status, then this wouldn't be an issue...... It annoys the heck out of me to hear in report that so and so is day 4 and needs MOM/suppos today. SOOOOOOOooo it could have been given with am pass or anytime they were awake during the night, or at a turn round, etc.....OR at first day pass or YESTERDAY, but it did need to be given before it got that far advanced.

[systoly]

If it was so important for the patient to have a BM, the day shift needed to take care of it the previous day instead of dumping it on nocs where only a fraction of the staff is available. Furthermore, one missed suppository isn't responsible for 5 or so patients with no BM in 4 - 5 days. LTC residents NEED their sleep, interrupted sleep can make the whole next day bad. The person you gave report to didn't care about the patient, but rather was concerned about a little extra work. Kudos to you for being nice, personally, I'd have had her for breakfast.

[itsmejuli]

With people like the one you mentioned, I just say "yes you're right, I won't do it again. thank you" and move on. There's no point arguing with them and no point in getting stressed about it. Some people are just rude....hmmm...reminds me of a certain nurse in my facility.

Or

Pretend like your ears are full of wax....la la la la I can't hear you.

[leslie :-D]

the way it worked where i was, is the nurse would give mom on 3-11.

if no results, the noc nurse would give suppository at 6am.

whether residents are sleeping or not, it's supposed to be a scheduled med.

leslie

[handyrn]

Whether 5 days is too long or not, it sounds to me like it is this facility's policy that on day 4 they get MOM, on day 5 they get the suppository. I have worked LTC a long time, and have always seen the policy be that you give a suppository early in the morning, and it usually means waking the resident up. One difference between LTC and acute care is that in LTC the residents are usually given time to nap during the day, so waking them up in the early morning isn't the end of the world. That being said, I also know that waking them up every 2 hours for rounds isn't always the best idea either. I think in your situation, after learning that I didn't follow the normal policy, I would have just taken 5 minutes after report to give the suppository myself.

[CoffeeRTC, BSN, RN]

Yeah, Thanks for helping out, HUH?

Srlsy, they should be more agressive and not letting it get to day 5. That is part of the problem.

[evolvingrn, BSN, RN]

Whether 5 days is too long or not, it sounds to me like it is this facility's policy that on day 4 they get MOM, on day 5 they get the suppository. I have worked LTC a long time, and have always seen the policy be that you give a suppository early in the morning, and it usually means waking the resident up. One difference between LTC and acute care is that in LTC the residents are usually given time to nap during the day, so waking them up in the early morning isn't the end of the world. That being said, I also know that waking them up every 2 hours for rounds isn't always the best idea either. I think in your situation, after learning that I didn't follow the normal policy, I would have just taken 5 minutes after report to give the suppository myself.

i don't know that it is the policy. and if it was i think she would have informed me of it. i actually talked to my supervisor and there is apparently a long history of her behavior. like i said i don't work in this part of the facility but once every couple months. they had 6 pts to each nurse on the days.....with cnas so while i could have stayed and done it it would have just been empowering her behavior i felt.

[retiredlady]

Hmm, thinking about my father in LTC and the nurse giving a suppository in the middle of the night, I would not want to be that NURSE, lol. A lot of yelling would occur and wake the whole unit up and then the trouble would begin.

[Mulan]

Okay, so you should have given it at 6, she gave it at 8 or 9(?). Is 3 hours really going to make that much of a difference in the patient outcome?