Some nurses make you sick!!!

Nurses General Nursing

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hello everyone!! so here is my vent!!!:angryfire, i work at this lovely ltc , anyway i just got off working 11-7 shift, the supervisor calls me as i am goin home and tells me that the day nurse called her and complained about a resident whos feeding is beeping and the bottle is empty, this resident gets 600 ml every 12 hours and the feeding is supposed to start at 2am, so at 2 a.m i go to start the feeding but there is 400ml in the bottle from the previous feeding,which finished at 12mn the feed is diabetic resource which comes in a 1000ml bottlet! this unit has 40 residents about 8 feedings, so while i'm doing other tasks i wait for the feedings to beep so i knowmy next moves, the day nurse comes in and starts complaining about how heavy the floor is and the feedings. i give report and leave i am expecting that the feed is still running!seeing that i started it at 2am and my shift ends at 7am, anyway she calls the supervisor on me and the supervisor calls me on my cell phone, couldnt the day nurse have spoken to me first?? if the feed ends 15 min after my shift ends am i still liable?? why did she have to call the supervisor to report me vs. starting a new feed and giving the 200ml balance that would complete the 600!

the large, prefilled bottles actually have a 48 hour hang time....in LTC it is common practice to have feedings that are intermittent...therefore the bottle would be discontected and reconnected.....the tubing is changed with each bottle..

however the 48 hours only applies if the spike is left in the bottle....there is a filter for air to get into the bottle....if air is allowed in thru pulling the spike, than it reverts to a 24 hour hang time

when using the bags, you need to be careful...it is the coating left behind on the bag which is going to foster the growth of bacteria, so perhaps they shouldnt be refilled?...i have never heard/read about the four hour rule (dont doubt it applies, at least to some formulas) so i would fill the bag as full as possible, not wanting to "wash" the bacteria down into the formula..

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Specializes in transplant case management.

I also cannot get past the fact that the OP infused the 400 cc's that she found when she went to hang the new tube feeding.

But, my bigger concern is that the OP stated the patient receives 600 cc's of tube feeding q 12 hours, that @ 2 AM when she went to hang the new tube feeding is when she discovered that not all of the previous feeding had infused. Why was this not discovered until 2 AM? I may not be seeing the whole picture here, but it appears that the evenng shift missed this as did the OP until 2 AM. Does the oncoming shift do pateint rounds with the previosu shift?

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the large, prefilled bottles actually have a 48 hour hang time....in LTC it is common practice to have feedings that are intermittent...therefore the bottle would be discontected and reconnected.....the tubing is changed with each bottle..

Ah thanks for the clarification. Ours were specifically for 24 hours according to the inserts and our hospital policies. There were posters hung in the nourishment room, listing the types of formulas and for how long each could hang at room temp.

however the 48 hours only applies if the spike is left in the bottle....there is a filter for air to get into the bottle....if air is allowed in thru pulling the spike, than it reverts to a 24 hour hang time

Ah, now I'm a bit confused. If the tubing must be changed every 24 hours, wouldn't that make all bottles 24 hours as well?
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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

From the title of this thread, I assumed that it was about nurses who were not washing their hands, or were in some way contributing to the spread of disease. I find this to be misleading and extremely negative.

Maybe the nurse in question has found the OP unreceptive to being corrected and not willing to admit fault, but becoming defensive when mistakes are pointed out. That's my take on this.

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I also cannot get past the fact that the OP infused the 400 cc's that she found when she went to hang the new tube feeding.

But, my bigger concern is that the OP stated the patient receives 600 cc's of tube feeding q 12 hours, that @ 2 AM when she went to hang the new tube feeding is when she discovered that not all of the previous feeding had infused. Why was this not discovered until 2 AM? I may not be seeing the whole picture here, but it appears that the evenng shift missed this as did the OP until 2 AM. Does the oncoming shift do pateint rounds with the previosu shift?

The feeding starts at 2am and stops at 2 pm. If they are using cans to refill the bag someone added more feeding than needed. It should have just been thrown out after it was taken down at 2pm. As far as not catching things....there was the 2pm till when ever for someone else to throw the feeding away. Normally (at least in all the LTC that I've worked in in the last 12 yrs) night shift will start the feeding with a clean bag/ bottle/ tubing and syringe. When it is done infusing, if it is just for a few hrs, the nurse that disconects it will throw it away.

As far as rounding every hr...in a perfect world on perfect shift...I might have layed my eyes on everyone in that time period....In LTC, you might be the only nurse on for 40-80 or so on an 11-7 shift. When something hits the fan...you physically can't be in 20 places you need to be all at the same time.

I still stand on my other post that 1. This was petty to call her at home. 2. this nurse needs to review the facility's P& P reguarding tube feedings and might need help with time management. 3. a PP was right....this won't be the last time that stuff like this happens. Getting a tough skin and moving on/ learning should come out of this situation.

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I also cannot get past the fact that the OP infused the 400 cc's that she found when she went to hang the new tube feeding.

But, my bigger concern is that the OP stated the patient receives 600 cc's of tube feeding q 12 hours, that @ 2 AM when she went to hang the new tube feeding is when she discovered that not all of the previous feeding had infused. Why was this not discovered until 2 AM? I may not be seeing the whole picture here, but it appears that the evenng shift missed this as did the OP until 2 AM. Does the oncoming shift do pateint rounds with the previosu shift?

if you read my post above yours, you will see that it is common in ltc to have intermittent feeds....it isnt that "the previous feed didnt complete" it is that there is more in the bottle than is required for one feeding, and the rest is used for the next.....

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From the title of this thread, I assumed that it was about nurses who were not washing their hands, or were in some way contributing to the spread of disease. I find this to be misleading and extremely negative.

Maybe the nurse in question has found the OP unreceptive to being corrected and not willing to admit fault, but becoming defensive when mistakes are pointed out. That's my take on this.

I agree.

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if you read my post above yours, you will see that it is common in ltc to have intermittent feeds....it isnt that "the previous feed didnt complete" it is that there is more in the bottle than is required for one feeding, and the rest is used for the next.....
Found this, morte.

http://www.novartisnutrition.com/pdfs/us/moreproductinfo/nutrishield_brochure.pdf

That explains the 48 hour hang time, as opposed to what I've experienced. Neat.

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Specializes in Emergency Dept.

Okay, original poster said 600ml q 12hrs - so the bag had not been up over 24 hours - only 12. So those that have complained about the length of the time it hung, it could have been perfectly within her guidelines. I know at the hospital I work at, bags are not to hang over 24hrs, so she would've been within our guidelines. I can completely understand the original poster. As new nurses we are always under the scrutiny of everyone and trying our hardest to do everything correctly. It sounds like this other nurse was just being a pain. Yes, the OP should have stated about the tube feeding in report, but if the nurse who received the patient had a problem - she could've called and asked the night nurse. If the night nurse's explanation was unsatisfactory, then she could've called the nursing supervisor. I'll tell you what, I learn a whole lot better from my fellow nurses pointing out things to improve my practice (It's called Constructive Criticism) vs being called by the nursing supervisor to tell me I'd screwed up with something.

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This one, however, did not do even the most basic and cursory assessment on her pt. Any new grad should know enough to do that.

How can you make that "assumption" from her post?

I have no idea from reading that post what assessment she did or didn't do on the patient.

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I hope you will take this the way I mean it. This will not be the last time another nurse complains about you :uhoh21:. It is a fact of nursing life, for various reason, many that have less to do with you and more to do with other nurse, or the working situation, we pick at each other. Hang in there, learn from this and do your best.:welcome:

Very good point!

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Don't expect this to be rare. It seems to make some people feel good to kick others down with no mercy. Sad.

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