How to approach this situation from management standpoint?

Nurses Professionalism

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It was reported to me, as a manager at a nursing home, that a nurse hasn't been doing her dressing changes on a person who has a stage 4 pressure injury. The dressings are every shift.

The issue? The nurse who is reporting it works the following shift of the person who isn't doing her dressing changes. Naturally, nurses are always worried about "ratting out" their co-workers and their lives being made more difficult after doing so... but SHE IS LOOKING OUT FOR HER RESIDENT just like she is supposed to do.

I'm asking for guidance in how to approach this nurse, from a management standpoint. I was thinking about just asking her what was going on in the way of being able to change his dressings because we have noticed them not being done regularly.

Are there many dressings on day shift? No. And his dressing change is not a complicated one, at that. That's beside the point anyway. ;)

Advice?

Thanks in advance! :nurse:

Petty or not... I guess it's ok to ignore orders rather than discussing them with the M.D. That's acceptable???? That's not how I was trained.

Why would she remove the dressing when it's not soiled? The only answer that comes to mind: THAT'S HOW IT'S ORDERED TO BE DONE.

There's no need to get sarcastic or agitated with any of us here. This thread has been going along just fine in a pleasant conversational manner with people trying to help you think through what might be going on....that's all.

:)

ETA: Just realized that when I wrote the previous message I was thinking of daily dressing changes for some reason. My mistake. Still, no one is trying to argue with you but rather just talk it through.

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Specializes in Critical care.

My thought on this is ... poor care. How did the resident develop a stage 4 pressure ulcer in the first place? Poor care. Why is the pressure ulcer not healing as expected? Poor care. There seems to be a consistency trend in this patient's outcome. Needs to be dealt with before you get the reputation of "The long term care facility where residents always get admitted to the hospital with stage 4s". I can tell you in our area which facilities consistently admit patients to our hospital with multiple pressure sores.

Cheers

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"I'm asking for guidance in how to approach this nurse, from a management standpoint. I was thinking about just asking her what was going on in the way of being able to change his dressings because we have noticed them not being done regularly."

Are the nurses expected to date and time the dressings on the bandage? Are they expected to document in the chart the date and time of the dressing and their observation of the wound appearance? I would try to collect more concrete information than one previous shift nurse's complaint.

If you have information that supports the other nurse's complaint, then I would recommend having a meeting with her and her shift manager in which you provide her with the information showing that she isn't following the wound care orders, and educate her on the importance of following the orders, with clear explanation of the consequences going forward, whether that leads up to termination.

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Specializes in Psych, Addictions, SOL (Student of Life).
Well, this wound has been on-going on a person who is nearly 100 years old for over a year now... We have tried nearly EVERYTHING to heal it... we even have a specialist wound care team come in once a week to do some minor debriding and stimulation of tissue growth. It's a clean wound bed, overall... but it's in the coccyx area and he's incontinent of stool and the dressings become soiled very regularly. The once a day dressing changes were pointless as they were needing to be changed anyway. It's a very hard place to tape and secure... and a wound vac would potentially suck stool up into the wound bed OR be alarming constantly and useless as you can't really get a good seal there right above the butt crack. ;) We have definitely thought of all of these options and it would be ideal to have a once a day or every other day dressing change so the wound stays nice and toasty and can do some healing but... poop is an issue... a big one. The person likes to eat... and what goes in must come out. :( Thank you for your comment and concern.

I had a patient like this is LTC and ultimately they did a colostomy to route the stools completely away from the wound. It did heal after that and the bowel was repaired, but that was a much younger person and it probably wouldn't be appropriate for someone 100 years old. Have you thought about a transparent dressing to allow visual inspection foe contamination? Just a thought.

Hooy

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Regardless if the dressing truly requires an every shift dressing change, if you really want to know what's going on: be a manager and do an audit on your staff's work. Easy peasy. No need to even mention hearsay. If something is truly not being completed, don't you want to know as the manager? You don't have to screw anybody if you find anything wrong, or micromanage them, but counsel about what's being missed, follow up and make it known that you'll be checking work.

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Well, this wound has been on-going on a person who is nearly 100 years old for over a year now... We have tried nearly EVERYTHING to heal it... we even have a specialist wound care team come in once a week to do some minor debriding and stimulation of tissue growth. It's a clean wound bed, overall... but it's in the coccyx area and he's incontinent of stool and the dressings become soiled very regularly. The once a day dressing changes were pointless as they were needing to be changed anyway. It's a very hard place to tape and secure... and a wound vac would potentially suck stool up into the wound bed OR be alarming constantly and useless as you can't really get a good seal there right above the butt crack. ;) We have definitely thought of all of these options and it would be ideal to have a once a day or every other day dressing change so the wound stays nice and toasty and can do some healing but... poop is an issue... a big one. The person likes to eat... and what goes in must come out. :( Thank you for your comment and concern.

How about pro-active toileting? Don't let him be on his back in bed or the chair. Get him onto the toilet q 2-3 hours. LOL I know this is NOT going to happen. It's a lot of extra work and it just won't happen, unless family can be convinced to hire a private duty person to get him to the toilet.

Is he having diarrhea? Can you give him something to change that?

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My thought on this is ... poor care. How did the resident develop a stage 4 pressure ulcer in the first place? Poor care. Why is the pressure ulcer not healing as expected? Poor care. There seems to be a consistency trend in this patient's outcome. Needs to be dealt with before you get the reputation of "The long term care facility where residents always get admitted to the hospital with stage 4s". I can tell you in our area which facilities consistently admit patients to our hospital with multiple pressure sores.

Cheers

Don't forget nutrition, pressure relief, and similar factors.

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