OK- just let me say up front, this is NOT a flame of LTC nurses. I want your opinion about something.I'm an ED nurse who has worked in your shoes as well, and I understand how hard your job is, and how much good you do on a daily basis. There is a certain amount of discourd at times, between LTC and Hospital nurses- I've heard (NEVER SAID) that people who can't "handle" the pressure of working in a Hospital have to go to a LTC because they don't have the necessary smarts, skills, coping mechanism, ect. to "hack" it in the real world.(I disagree with that statement). I've precepted students who have actually said things like this, so I'm not sure exactly where it comes from? I also understand that our priorities are different from LTC nurses, based on what we do for our patients. Something happened the other day involving a LTC pt. that left me flabbergasted!
I got a 62 yo male with acute/rapidly advancing dementia. His wife of 2 yrs is at the bedside. He is aggressive, aggitated. According to the wife, he was "normal" 2 yrs ago, but the dememtia is rapidly getting worse. So much for the man she married (sigh...) So this man was sent to me from his LTC facility for "UTI". He had had a Foley cath placed 2 weeks ago d/t inability to void/prostate issues, and is supposed to be waiting for a Urology consult to be arranged by the LTC faclitiy. The report I got was that the man had an indwelling Foley cath, foul smelling urine, temps, ect. OK- good pick up by the LTC place, right?
I undress this man, and find no leg bad- he's wearing sweat pants, with underwear, and 2 briefs on underneath that. THE FOLEY IS STILL IN...OPEN...without any type of bag/collection device, ect. draining right into the adult diaper. It's not clamped in any way- What the &%$#!!!!! I question the wife- according to her, the staff told her the leg bag/drainage bag "aggitated" the patient, so they just took it off. No way ANYBODY with a nursing license would do something that stupid, right? So I called the NH, spoke with the RN Supervisor. SHE KNEW about the situation- informed me that the NP had ordered it to be dealt with that way. I basically called her a liar (professionally, of course)- She said she'd fax me the written orders. She did, but all it said was that the man should be placed on a clamping schedule- So I called her back-told her that a clamping schedule would be appropriate, but was NOT the same thing as leaving Foley cath open. HELLO???? SHe then proceeded to backpeddle, saying that it was probably clamped, but that the man must have taken the clamp off. 1. There was no way the man could get to it with all of those layers, 2. the man's wife told me that they were lying, and that she had questioned it multiple times. How could ANY nurse think that was a good idea? I understand that the NH is their home, and things are done a bit differently than in a hospital, but seriously? Leaving a Foley open like that..then wondering why he got a UTI....I'm still amazed that anybody, let alone several nurses, could forget their training and think that would be appropriate? What do you guys think?
After my daughter, still in diapers at the time, had bladder surgery, we were sent home for a day or two with a foley in place.... open and with no bag. She was "double-diapered" during this approx. 36 - 48 hr period. That means that the first diaper was in place against her body to collect feces, and then a second diaper was in place over it. The end of the foley ran out the leg of the first diaper and into the second where it would hopefully be safe from contamination. We had to keep the tubing clean and be diligent with diaper changes.
It was done this way to prevent our baby from pulling out the catheter and possibly causing damage post-operatively. She was likely on prophylactic antiobiotics at the time.
I know it's not at all the same situation as the OP's, but without knowing details from the caregivers of this patient then we're all just guessing here.
Not two weeks ago, had a urologist order exactly that for a patient. No dumb nurses came up with the idea, it came straight from a urologist. And a good urologist at that.
Sometimes there's not a perfect solution. Sometimes we have to do the best with what we have.
Whatever the practice setting, there's going to be someone who graduated with the lowest possible passing score, the most attempts to pass the NCLEX, etc. I've seen patients in LTC/telemetry/ICU settings where the report I received included pedal pulses on a double BKA, full IV fluid/rate data on an IV that the patient didn't have, an "incontinent of urine" patient that I promise you dayshift didn't change the brief on, as the patient had a suprapubic catheter and no brief at all. Undocumented accessed port-a-caths that were ignored while I was told the only IV access was a 20 in the left wrist. DNRs that I was told were full codes, and I've walked in on two patients who were in the middle of an "elephant on my chest, can't get my breath" ST elevation on the telemetry MI while the prior shift said, "oh, they're just nervous." PTTs never drawn on heparin drips where the patient had to get protamine to reverse it (didn't help, pt still died from HIT). I've seen central lines that slipped in and out of the entry into the LSV as the patient breathed, and couldn't get anyone to understand why that was a problem -- and why a central line dressing should be changed in a sterile fashion. And then they got upset when that same patient came down with raging sepsis.
Nurses can be ignorant or stupid -- let me explain. I'm ignorant of surgical procedures, having never worked in an OR. Ignorant doesn't mean incapable of learning, or having no desire to learn, it just means you don't know due to lack of knowledge or experience. Stupid is a word I reserve for people who don't want to learn the right way to do something, are sure their way of doing something is the only way to do it when it's patently wrong, and will actively fight any attempt to help them do the right thing for their patient out of a false sense of pride or superiority. If I had a MD tell me to leave an open pathway into a neurologically limited patient (open foley, "loose" central line, leaking A line), I'd get it exactly spelled out in the order if I had to call him/her 30 times. I'm not losing my license by myself.
You know the first three rules of nursing. 1) everybody dies eventually. 2) you can't change rule 1. 3) you can't fix stupid.
they dont think in a nursing home, many may be there, because thats the only job they could find.
interesting findings: a doctor friend of mine, told me the only reason why patients are lined up in the halls in hospital wards, is become people in LTC are not dying fast enough. Looks like the higher up's, whether politicians, or CEO's did not think far enough ahead, to anticipate a lot of seniors, refuse to die. Thusly did not build more LTC warehouses, when money was plentiful.
they dont think in a nursing home, many may be there, because thats the only job they could find.
interesting findings: a doctor friend of mine, told me the only reason why patients are lined up in the halls in hospital wards, is become people in LTC are not dying fast enough. Looks like the higher up's, whether politicians, or CEO's did not think far enough ahead, to anticipate a lot of seniors, refuse to die. Thusly did not build more LTC warehouses, when money was plentiful.
Is this a serious post? Just curious.... are you really a nurse?
DH.nurse
20 Posts
After my daughter, still in diapers at the time, had bladder surgery, we were sent home for a day or two with a foley in place.... open and with no bag. She was "double-diapered" during this approx. 36 - 48 hr period. That means that the first diaper was in place against her body to collect feces, and then a second diaper was in place over it. The end of the foley ran out the leg of the first diaper and into the second where it would hopefully be safe from contamination. We had to keep the tubing clean and be diligent with diaper changes.
It was done this way to prevent our baby from pulling out the catheter and possibly causing damage post-operatively. She was likely on prophylactic antiobiotics at the time.
I know it's not at all the same situation as the OP's, but without knowing details from the caregivers of this patient then we're all just guessing here.