I have a question about Scope of Practice. I have been working in a Cardiothoracic ICU for well over a year. I am no stranger to critical care.
A few days ago my father had a subtotal gastrectomy to remove a malignancy that was in his stomach. He had surgery in the hospital where I am employed. While visiting him in the recovery room around 9:30 or 10:00 PM, my father asked me what this thing was resting on his arm. I lifted up the blanket to see what was bothering him. It was a JP drain that was full. I explained to him what it was and what function it performed. He then asked me to empty it for him. Because there were no nurses nearby I did just that.
When a nurse finally did come to the bedside I informed her that I emptied the JP and what the output was so that the I/O would be accurate. This nurse threw a fit that I had done this and has complained to nursing administration and accused me of practicing outside my scope by emptying my father's JP to make him more comfortable.
I am a registered nurse just like her. I am as experienced in caring for a patients with a JP's as she is. I think we all learned that in nursing school. Is it me, or is this nurse crazy? How can that be out of my scope of practice?
I think I can understand her. She is the one who needed to chart the amount, color, clots etc. I would have found a nurse. But that's just what I would have done.
I would not have been upset with you had I known you were a nurse and capable of the JP and as long as you gave me the information I needed I'd be fine.
I had a mother of a labor patient pull out the internal pressure cath a few weeks ago because it was in the way when she wanted to help put the pt on the bedpan. I have no problem with helping get on the bedpan I do have a problem with pulling out things you don't know what they are.
The down to earth legal issue is that you were not on the clock. Thus the hospital is not responsible for any thing to happen (what? i don't know). It is for this reason or the one wanderingRN or cassioo said. OR this person is so anal retentive or full of her self that she cant say thank you for doing that. Some people, every now and then some nurse is so crazy you need a danger sign, "Do not help, may explode."
Some nurses are protective of their patients and rightfully so. Also, would this poster have emptied the JP on another patient? I have had family members in the hospital and it took all my will power not to "help" but at the time it wasn't my duty to. Of course if they were falling out of bed or something like that yes.
Sorry to say but I just think the poster has to accept the facts..IMHO
I think for my family member I would do that..I did adjust the monitor on my daughter when she was in labor...why else monitor if you aren't picking up baby. But I would not have done so on someone else. It's called common sense. I would not adjust an IV drip on my family but call who was taking care of them if the pump was beeping (ok maybe I'd hit silence before I called) but I wouldn't spike another bag.
That's my point exactly Cass there has to be a cut off .. Might as well make it "I won't do anything invasive".. Emptying a JP IMHO is invasive. Did she wear gloves. Did she wash her hands before and after. Many questions unanswered here.
WR,,, three commas for Becca
Actually, I'd want a nurse who protected my family member that much.
Yes I know she's an ICU nurse but we all know the old
ass u me theory. Never do it. When you do you're liable to get bitten in the arse..
I think we're both right here I'd just rather have an ICU nurse who is empting their families JP drain then someone who's not a nurse try and do it and mess it up. Like I said I did adjust the fetal monitor on my daughter but wouldn't have had it been an internal monitor (but then it had better have been picking up if it was internal). Haven't you all had the helpful family member who pushes the pause or silence on the IV because they've seen the nurse do it then they don't call or they help adjust the IV because it didn't look like it was dripping. Just depends on the circumstances.
Would the liscense be in any question if the family member is off duty or works at a different hospital? Another how far do you want to push it question. Call me a rebel living on the edge.
Yes we did have people silencing pumps and we lost IV's. So we started locking our pumps out..
WR,,, three commas for Becca
I actually had quite a discussion with a "nurse" who thought the IV wasn't working properly because I didn't have the sensor on the drip chamber. I couldn't convince her that the pump monitored the flow internally. She called in the charge nurse. So my contention is that not every nurse is up to date to take care of my patients. And shouldn't.
Although my reply above seems kind of flippant, I do agree with the two of you. I do not explode at the family members if they touch things, I would ask them just ask me to empty it. If they were a nurse, which I had similar thing happen, I would tell them, "You know better than that. Just ask me, I'm the nurse and you are a visitor. I do attempt to re-enforce the rolls we are in. But, I would still thank them for the help.
What did piss me off is when family would tough monitors and equipment when I worked CVICU. We had vents that were touch screen to make changes. You know there are some family members who are so stupid they start playing with the settings and don't have a clue (I am sure I am the only nurse that has happened to0. Our space lab monitors you could place tape on the edge of the monitor and it would lock out the touch screen. I would go in the room and find my displays changed and the family would not say a word about they did it.
OK as I am talking about this I think I need my sign, "danger may explode." No, I never get mad, and always treat the family with respect no matter how many functioning neurons or tattoo/teeth ratio they have.
This kind of reminds me of the family member calling from a far off state.. Asking about Grandma or Grandpa. I had to tell them they needed to call the doc for any other information other than that they are stable. Then they would tell me "I'm an RN" And I'd have to say "Then you know I can't give out any more info." DUH..
and the family member calling might be the nut case neighbor waiting to break into the house. We do get lots of calls has Susie had her baby yet? ME, "Susie who?" I don't know her last name but my neighbor's sister's grandmother goes to church with her aunt's father's girlfriend's dogwalker. Even when they do know the name they get mad when I say I can't give you any information I'll transfer you to that room...."no I don't want to bother them"....but you just let the phone ring 5000 times to bother ME!!!! If they wanted you to know they'd have called you. Thank you call again. I had a 14 yr old delivering the other day and her 14 yr old boyfriend was with her and you should have seen all the helpful friends who knew everything about birthing babies...the girls mother was also mad cause the girl (who was raised by others didn't want her mom in there) Had spectator sports going on with many helpers.
Little off the subject but I love he high school kids. Let a football player or some one in the school get seriously injured and half the school is up in the ER. They will come in crying their eyes out asking about their good friend John. I ask John who? And the pathetic little person will say, crying her eyes out, "I don't know his last name." Talk about over emotional people!!!
Having lived mostly through 3 teenagers (21, 19 &18) with a 5 yr old yet to go. They make me CRAZY. My 19 yr old who's had some problems with "friends" called me today while I was at my parents. He said Larry would be picking him up Sat and he actually knew Larry's last name. He would meet people and it would be my friend John..John who I'd ask I don't know. Where does he live? I don't know Who are his parents (we live in a small town) I don't know. Then he's NOT your Friend you just met them. We talked about that he said I know I've figured that out now..thank goodness. Going on vacation again Friday and my 18 (ok 18 on the 30th) makes "friends" at the beach. With free cell phone calling, e-mail, & IM he has "friends" all over as he freely hands out his number.
I guess when they get a little older they will understand the true meaning of friends. You know the teen age years is like the time for acceptance, you know tasks for that age. So, every body is your friend and you must impress new friends.
I am sure glad I am out of that stage, took me 30 years to understand what truly is a friend. And in truth, I feel that a person is lucky to have one true friend, and you should now have to impress them.
I think that the nurses behavior was bang out of order. You could have told the nurse that if she would have emptied it when it was full that you would not have had to. It was not your responsibility to tell her to do it. And the word that most normal nurses would have used in a situation like this is "Thank you". This nurse is lucky you did not make a formal complaint against her for neglect and verbal abuse. Another fine example of nurses eating their own. Sorry you were treated that way.
Please address your posts to the proper poster. This was not my issue. And I believe the family memeber was out of order. Did she wash her hands before she emptied the drain? How did the patient's nurse know whether she did or not.. The nurse assigned to the patient was in charge of that patient not the family member irregardless of her experience. Aren't their laws about MD's treating family members.. All she had to do was find a nurse..
I believe the problem here is she knows she was wrong and wants us to rally behind her against the administration and I can't do that.. Not evey nurse out there is always right..Sorry...
WR,,, three commas for Becca
I am protective of my patients and that's a fact. Don't mess with my patients... JMHO,......
Had an incident similar in theory, was up in northern Michigan on vacation with my family.Dad got sick, drove over an hour to the nearest ER, they took him in and long story short the ER attending came in begin his exam. The IVAC was going off I was standing next to it but did nothing...until he asked. I hit the silent button. As he continued the alarm went off again, I shut it off and he began to chastise me. I looked at him like he was nuts at which point he asked me whether or not I had a problem, mind you Dad had just had an ICD placed and still came in with angina that was later DX as a mild coronary. I held my tongue but when I caught up to the Doctor later I let him know that I did not appreciate his attitude, nor his bedside manner. I also let him know that not only have I been a nurse for the last 14 years, but an RN with a Master's. I am a CNS that specializes in OB/GYN.
Needless to say he still didn't care. Some people think we can't walk and chew gum at the same time.
we had 3 throw clots this year 2 at home that died (post c/s) one in the hospital 2 days post vag ended up in ICU for a couple of weeks then rehab for another week.
My daughter is due anyday with her 2nd child and I know I might have a hard time if someone doesn't do things "right" I don't like my daughters OB either so hopefully she'll deliver at night when someone else is on call. She won't be at the hospital I work at d/t insurance so we'll see
Cass I just think when the patient is not ours and we are not on "duty" we should butt out.. If we can't maybe we shouldn't be in the room... JMHO.......I think we are too close and can't think logically.. And throwing clots is not a "mild cornary" ..When was the last time you even heard that term?? Did you use a nitro drip on them???
WR,,, three commas for Becca
The first time the doctor had asked me to silence the pump I would have told him to get the nurse..Just who I am. I guess.... And ya know administration is gonna be right here no matter what.. This nurse was not on DUTY at the time. It was NOT her patient. She wasn't working in PACU.. That's the issue here.
well heck no we didn't use any drip 2 died right away at home just after discharge the other we got out of there. If someone has chest pain they are gone just like we had a woman on a vent with us cause ICU wasn't going to deliver a baby either.
I won't do anything with my daughter just have a hard time keeping my mouth shut especially if she has one of the nurses I know who are there just to be warm bodies. But there really shouldn't be a problem she did fine last time but I don't like her doctor. He's one that doesn't tell her anything and you ask and she says I don't know he didn't say..I tell her you have to ask. My docs do lots of teaching/information giving.
The practice I work for has multi-specialties, Family, OB/GYN, Cardiology, Urology,I have been fortunate not to have dealt with coronaries, as it were,just L & D and the asociated risks, but to my knowledge, and I did ask, the ER attending was a urologist. I was told, small hospital, not equipped to handle major problems. Majors are air lifted to a larger facility about another 90 minutes away.
I've thought it strange at our hospital they will do cardiac caths but don't do open hearts...call me stupid but can't you block the only blood flow during a cath and have to go right to open heart?
Cath's that are only diagnostic don't need OR standby, but if they are doing any interventions, then they should have an OR readily available in case an artery starts to disect, then that patient will need to be in the OR STAT! Or if they find unstable left main, then they need immediate surgery and that patient may or may not be able to be shipped. --SHN
As a PACU RN , I never leave family unattended at the bedside in PACU. There always seem to questions regarding vital signs,what all the monitors are, what the transfer (to floor/ICU) plans are..etc..It is my duty to monitor everything regarding the patient...I&O included, especially a surgical drain. It's too bad your father's nurse was too busy(?) to notice that it was full or that she wasn't around to empty it. As for scope of practice..in Orlando we send patients home with Jp's and teach them how to empty them!Your dad was lucky to have you care enough to visit, and to be invlolved. good job.
well heck no we didn't use any drip 2 died right away at home just after discharge the other we got out of there. If someone has chest pain they are gone just like we had a woman on a vent with us cause ICU wasn't going to deliver a baby either.
I won't do anything with my daughter just have a hard time keeping my mouth shut especially if she has one of the nurses I know who are there just to be warm bodies. But there really shouldn't be a problem she did fine last time but I don't like her doctor. He's one that doesn't tell her anything and you ask and she says I don't know he didn't say..I tell her you have to ask. My docs do lots of teaching/information giving.
Can we all just get along, Nobody is perfect and often people do things that we do not agree with. A nurse is a professional so respect everyone. Ian.
I never realised that you needed special training to empty a JP!hahahahaha
I think she was probably grumpy because he was fresh post op and she wanted to assess it herself. But to say you are out of your scope makes her look like one of those nurses that work in an area so long they forget about that the rest of the floors and nurses are trained to empty these drains and stuff!
Please give me some feedback....CTU_RN 
(I am sure I am the only nurse that has happened to0. Our space lab monitors you could place tape on the edge of the monitor and it would lock out the touch screen. I would go in the room and find my displays changed and the family would not say a word about they did it.
