Weaning from vents

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Specializes in Corrections, Cardiac, Hospice.

The management of our inpatient Hospice facility is wanting us to start weaning patients from vents. I have SERIOUS concerns about this:

We don't have a consistant source of suction. When they built the building they thought we wouldn't have a need for suction so they didn't put it in. ($$$$) Therefore we have to rent portable suction machines. Many times we have had them delivered, then had to call them back because the ones they sent don't work.

Our staffing stinks. We have 1 RN/1 Aide per 8 patients. It is so busy when we are full, most times don't have time to pee. Our director assured me that when we get the patients he would make sure that there is an extra RN on for "2 or 3 hours" that night.:rolleyes:

There is carpeting in the patients rooms! Can you say MRSA?:banghead:

We have been open almost 2 years and still have unresolved issues with the kitchen leaving early and the nurses having to pick up all the trays. The front door still won't lock at 8pm, so anyone can just walk in, AND when we are on a waiting list our director actually had a conversation with me that went like this:

Me: So, who do you have on stand by for the afternoon and nights to clean beds when we go to a waiting list.

"Clueless Boss" : Nobody

Me: Well, Who is going to clean the beds, if the patient needs to come in that night?

"Clueless Boss" : Well, you nurses are going to have to do it.

Me: Uh, Ummm, NO

"Clueless Boss" : What do you mean? I mean I am a team player, I would be willing to wipe down a bed.

Me: Well there is more to cleaning a room than that. BUT, aside from all that, you do realize on the off shift we have no support system in place, right?

"Clueless Boss" : What do you mean?

Me: Well, after 4:30 when you all leave I am the nurse, social worker, respiratory therapist, unit clerk, cook and since we only have one on the floor, quite frequently I am an AIDE as well. Sorry, but I refuse to be a housekeeper too. You need to make some decisions and have a plan in place. Besides, I am a NURSE NOT A HOUSEKEEPER, not my job.

"Clueless Boss" : :( :madface:

Our facility has an excellent reputation in the area and I would hate to lose that with inconsistant care. I am all for this plan, in the right time. But they want to do it by JULY! I keep telling him that isn't going to happen, get everyone trained and all the staffing up to par in a month and a half? He told me that is what the upper managment wants so that is what will happen. I really don't want to leave my job. I love the work and my co-workers are the BEST:heartbeat Is there any other argument I can present? HELP!

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Specializes in critical Care/ICU-traveler.

Sounds like your management team has no experience with vented patients and does not have a clue about what is involved in their care.

If they are to cheap to hire a proper cleaning staff, how are they going to feel about hiring round the clock resp therapists and a pulmonology staff? Most nurses are not trained in the details of ventilator management, especially the weaning process. To be done safely and correctly, this requires the expertise of a resp therapist.

Question for you...if you are "weaning" someone off of a ventilator, doesnt that indicate that they are improving? Dont you have to have a terminal illness to qualify for hospice? Sorry if that is a silly question, but it is way out of my knowledge base and I was just curious.

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Specializes in Corrections, Cardiac, Hospice.

No, I am sorry you misunderstood. We would be weaning them from the vent to allow the dying process to occur, not so they could get better. But my understanding is that we won't just turn everything off at once as that would be to difficult for the families.

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Specializes in Corrections, Cardiac, Hospice.

Any more thoughts? Hoping to hear from Leslie, Tazzi or Tweety. ALWAYS value everyone's opinions, but admire their experiences.:heartbeat

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