tx nurse responsibilities

[txnursegiggles]

Hello! I've been working as a treatment nurse for about year now in a LTC. Recently, my DON has told me I have some new responsibilities.

First: logging skin tears and bruises in the unusual occurrence log. The restorative nurse had been doing this before.

Second: In addition to updating the log, she wants me to document all bruises weekly on our "miscellaneous wound" flow sheets. I don't understand why I'm now expected to something that was already somebody else's responsibility but my real concern is documenting the bruises. I believe this is something that falls under general nursing and not under the wound care program. When I told my DON that bruises were not part of skin care she simply replied with a "Yes it is." I have told her I am uncomfortable with it. She hasn't really given me a chance to tell her why.

I was very careful to ask "these are all my responsibilities and all the paper work I will have to do?" when taking the position after going through the policies with the ADON and company consultant. I brought this up to my DON and she told me that job responsibilities change. This was not told to me when taking the position but I can understand if there were responsibilities that fell under the appropriate scope of skin care that were added.

Do bruises fall under skin care?

Is it appropriate to give me these extra tasks?

[amoLucia]

Sorry to be saying this, but you're asking "is it appropriate...?" Yes, it is. In your job description, there probably is a line that says "other duties as assigned". Well this is being assigned.

Unless you are an independent contracted consultant, you are an employee of the facility and they can determine who does what all they please. You may not know it but the restorative nurse may be having her job duties juggled also. Again, management's prerogative.

Just a word of caution - "methinks thou art protesting too much". In today's work environment (esp LTC), it seems like everybody is doing more with less and you're just one more person to be doing more.

You might be protesting yourself out the front door and someone else may come in who doesn't think as you do.

[tktjRN]

Unfortunately, every job description that I've had stated "and duties as assigned." Yes, bruises are part of skin care, but I do agree that it should be separate charting from wound care. Bruises of known or unknown origin should be monitored by staff nurses, not wound care. This can be documented, to assess area daily, in the treatment book, until resolved. Skin tears should be monitored by wound care on a weekly basis.

Good Luck!

[TriciaJ, RN]

It does not surprise me that you would be told one thing about your responsibilities on hire, then get more added once your foot is in the door. Classic bait-and-switch. Probably everyone is overloaded, so squeaky wheels get a bit of grease now and then and work is dropped into someone else's lap. Good luck.

[Bandages]

When I was a treatment nurse in a LTC, my DON had me do the same thing for bruises. But when I got accepted in a Sub Acute and was doing treatment all they did was monitor bruises for increased size or any deterioration. I know each facility has they're own policy on how things are run. See if you can find out if its your facilities policy that the wound nurse is only delegated to monitor these bruises. But the charge nurse or floor nurse also needs to monitor these bruises as well but then again depends on the facilities policy. Your DON reminds me of my DON when I worked in a LTC. Try talking with the DON and let them know how you feel.

[txnursegiggles]

We currently do 72 hour incident charting on all bruises. I haven't been given a policy or guideline but am guessing I'll have to start writing and d/c'ing orders to monitor bruises to clarify the onset/discontinuation of monitoring.

[amoLucia]

We currently do 72 hour incident charting on all bruises. I haven't been given a policy or guideline but am guessing I'll have to start writing and d/c'ing orders to monitor bruises to clarify the onset/discontinuation of monitoring.

If you'd like to earn some positive acknowledgment from mgt, try writing a P&P/protocol for bruise care by yourself.

I'm guessing that you also have some type of investigative process re new bruises, like statements from ALL previous caregivers (nurses & CNAs).

[txnursegiggles]

I've started this project and doing my best to go above and beyond! Thanks for the input.