Some nurses make you sick!!!

[gt4everpn]

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!

[dotherightthing]

I agree with the mention of "continuity of care". There are 3 shifts for a reason, care goes on. I have a problem with nurses who think that everything should be perfect by the time the next shift starts. Sure, don't dump on the next shift, but **** happens. Resolve as much as possible but if you have 5 patients, getting them ready for the next shift is going to start, for instance, before 3p. By 3p, patients have had BMs, thrown up, IVs infiltrate, etc. Just because you clean up what you can between 2p and 3p doesn't mean the patient stopped living for an hour. You prioritize and continue working. And she didn't mention what she checked or changed at 2a, this is a post, not charting. Give her a break and some help. She is a newer nurse.

[labvampire]

I myself am 40 and have been practicing for 4 months. I work in an ER and also a Nursing home. The nursing home trained me for two days and then cut me loose with a wing of four halls to take care of by myself. I am an LPN. 112 people to pass meds to, 4 CNA's to manage. Thank the lord my CNA's rock. They have helped me so much with the patients. I was able to handle this, stressed at first, but it has become alot easier. I had 8 yrs hospital experience behind me before I was a nurse. I feel for those who have never worked in healthcare because alot of nurses are ruthless. They eat their young. You have to have a hard skin to be in this profession and don't be afraid to ask questions. Always ask if you are unsure, if that person doesn't help find one that will!!!

[husker_rn, RN]

I too work in geriatrics and all too often newbies are thrown to the floor with no one else to ask questions of. It can be very difficult to handle 55 residents { that's what I have responsibilty of } 2 vents, 3 tube feeders and then throw in falls and prns and such. I agree that the situation should have been differently handled but I also know that if you are new and overwhelmed with no help, brain overload can happen. And sometimes in the beginning you don't know what you don't know. Thank God I had wonderful mentors in the beginning....

[frenchfroggyAPRN, MSN, LPN, RN, APRN]

:yeahthat:

Ditto

[lamazeteacher]

".........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 resident gets 600 ml every 12 hours"

the way i read it, each night at 2 am a 1000ml bottlet goes up, and 600ml should infuse by 2 pm, at a 50ml/hour rate. the remaining 400ml in the bottlet at 2pm would infuse until 10 pm, at that rate. then another ?1000ml bottlet goes up then, and by 2am, 200 ml goes in, leaving 800ml in the bottlet. so, if the feeding rate increased, the patient got an extra 400 ml. by 2 am. since the patient is diabetic, the medications for that disease would have to be adjusted, as the patient ingested too many calories during the evening. the night supervisor should have been called at 2 am, glucose testing should have been done, and depending on that facility's infection control guidelines, a new 1000ml bottlet wouldn't need to go up until go up until that one was finished, having the rate adjusted until the patient's glucose level returned to an acceptable level.

the night supervisor should have called the ordering doctor, reported the faster rate during the evening, told him/her what diabetic meds had been given at bedtime, and asked what adjustment to make, giving the glucose test results.

i think the gt tubing change policies would not be the same as iv tubing, which does have 48 hour changes.

it would have been helpful if we knew what the i&o sheet indicated, and what was written by the evening nurse when she checked the infusion; and gt site for inflammation (at least every 4 hours).

in home health, after gt feedings (usually boluses are ordered), gt extension tubing is detached from the gt, and that and the bag is washed, rinsed, and put to dry on a towel bar, and used over and over. remember we're dealing with the stomach here..........it's not a sterile organ. i imagine the patients in ltc had gts, and those stay in until the doctor decides to change it - usually once/month, unless it pops out (whereupon someone - hopefully an r.n. immediately pushes it back in). of course, if it's just been surgically placed, that's another thing......

didn't the nurse say she put up a new container at 2 a.m., 5 hours before the end of her shift? there must have been something very wrong with the infusion pump (he/she did say that a bell went off when the bottlet ran out), to make the feeding go in so much faster. (800ml in about 5 hours, which was more than 4 x that ordered!) if the oncoming nurse hadn't been into blame, and focused more on his/her patients' wellbeing, corrective action would have happened.

the emphasis/priority here, is the extra caloric intake for a diabetic who would certainly have to be given extra insulin to cover the added calories; the tubing change is incidental.

by the way, the nurse who originally wrote in, on 11-15-07, had to have been an lpn, as her/his age is given as 19 years and she was a year away from her training. so she graduated high school at 17, immediately took the 1 year lpn course, graduating at 18 years of age. considering her level of training and little experience, the night supervisor should not have left her alone all night with so many patients and feeds, especially having a diabetic on infused feedings! r.n.s are responsible for the lpns. culpability here is squarely on the supervisors and administrative shoulders there, for improper staffing/supervision, and the evening nurse (however trained and experienced he/she was) for not realizing that the diabetic patient's infusion was too rapid). did anyone check loc, dryness of skin, etc.? geez!

[kansasnurse51]

Give her a break! Most of us dont even remember being 19 let alone a new nurse. My suggestion is get a different job where you have someone working with you to support and intern you. You would probably get more experience and support as a new nurse in a hospital, and if you prefer working with the elderly, try a skilled nursing unit or acute care. And I hate to say it, but I think some of these coments show that there are a lot of nurses out there that would report their fellow nurse in a heartbeat rather then give advice and encouragement! Keep working at it hon and you will be a great nurse someday!:balloons:

[cooblu]

after thinking about this, i have to give "the venting nurse" the benefit of the doubt for 400 cc whatever...but to the point of this issue is going to the supervisor for this small matter of a beeping/empty feeder is malicious. true enough finding empty iv bags, feeders.etc is a pia, but who has the time to go whine. i work nights and i find many mistakes and questionable issues but i fix them if i can and go on. But, i am no florence nightengale - should some nurse following try to gain points or just mean and bring matters like this up. i will make every effort to find their errors and it usually won't take very long as we all make mistakes. who enjoies being called at home by the supervisor?

[doe9181]

I'm just curious if the feeding bag was labeled with the patient name, date, time, started, etc. Where I work we label the bag and the tubing and the same goes for IV fluids and piggybacks. This might of helped the situation some.

As for the day nurse running to the supervisor and snitching, I personally feel she handeled it wrong knowing that her coworker is a new nurse.

[twotrees2]

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..

many places use this rule so they are sure that the bags are flowing and the patient is tolerating the feeding . personally - what i do is add enough for my shift- however i set the timer to beep at the 4 hour level so i dont forget if something else shoudl come up.

anywhere i have worked tube feeding are required to be changed every day unless as stated it is one of those newer big bags which can run for 48 hours - i have never seen anyone use the big bag for bolus and swuch - only for constant feedings so i dont know what the rules would be for the ones not hooked up in the big sealed bags.