When Nurse Training Fails

Nurses lacking training dealing with general population, the public by phone, patients specifically and staff can lose their performance rating or even their jobs by letting their “slips show”. There are some examples where proper training, research and learning might have saved the day. In many cases the motivation for a patient to care for themselves and look forward to recovery can be affected. Assertive nurse supervisors may care to review the following real-life scenarios.

1. Proper Device Maintenance

Recently a patient approached the ward office and asked for a blood sugar reading. But the patient was made to wait 45 minutes while the lost battery to operate the device was found. But it was never found. A line formed in the nursing area while the incompetent nurse floundered around asking other nurses what to do. The nurse responsible could not make the blood sugar machine work because they did not know what a “C” battery looked like. This is evidence of lack of training.

They didn’t know how to replace the battery. They didn’t know how to find a new “C” battery, replace it in the device, and return it to the ward counter. The patient stood there in shock. No other nurse could do it either. The blood sugar count machine, the reason for their admission actually, was never derived upon discharge because the nurses were not sufficiently trained to replace a required battery in a critical piece of hospital equipment used on the recorded vitals for every single patient on the ward.

True Story. They couldn’t find the key to the room with the battery in it. The nurse went twice to the room but could not identify the correct battery. The nurse got bored attending to the task and went off to do something else..

Now, imagine you are the patient. Is this chronic ineptitude at a crucial moment? Poor nurse training or laziness? Or merely habitual inattention to detail that costs a patient time and energy? These things matter. Proper nurse training is a needed element for contemporary hospital care that patients need.

2. Backing Up New Admissions

Emergency rooms all over the nation are overfilled. This is due to administrative shortfalls in overall hospital design and throughput which cannot be addressed fully in this arena. Yet the only route almost all patients have is through the Emergency Room, and through general care and primary care admissions to the a hospital or wards. Nurses must process these admissions. Nurse without proper training and support to do the best job possible do a disservice both to themselves and others.

Unprofessional nurses stave off new admissions because they are lazy and do not want the additional responsibility. When an administrator calls the ward to see if they can accept a new admission, the charge nurse must assess the condition of the wing. Poorly conditioned equipment and nurses creating patient/nurse disputes put their ward at risk for lowered ratio caregiving and lost hours. Supervisors tend to assign less effective, poorly trained nurses fewer hours and shifts,

The admission process involves a careful review of all needed medications and the programmed timing of each. Patients who are admitted are dependent on the nurses to fulfill their medical needs via pharmaceuticals in a capsule. Therefore as time passes, properly trained nurses are on a time clock from the moment a new admission is announced. Better trained nurses address their patient admission tasks promptly. Poorly trained nurses go smoke cigarettes and delay patient tasks as long as they can.

Nurses must submit the medicine orders for each patient in time for them to be administered to the patient on time. The patient may not have any other medications on them and be in pain or distress without this assistance. But the attending or resident physicians may not be the same primary care physicians familiar to the case. And many of the medications the patient needs require physician approval due to their qualities and restrictions(narcotics). Sitting on these orders and coordinating poorly with the pharmacy is a sign of poor nurse training.

In the incidence of the above example, a nurse the ward had tasked with restoring batteries to the devices on the ward was never completed. This had not been done overnight on the night shift. (We’ll call her Sue). When the new nursing shift came in for duty, all of their patient vital statistics recording were delayed until the battery issue could be addressed. This extended hours of all the nurses on shift, a further cost of inadequate nurse training.

This was not part of the nursing handoff report because it did nt accord to any patient records. But many blood sugar readings were not tracked because the machines were not working. The nurses (though their ineptitude) made sure that enough machines were offline to delay any incoming admissions. This would give them a break between new admissions and handling current patient cases.

3. Patient Baiting

The removing any standard of case with or without ward notice constitutes patient baiting. Since the onus of treatment ends when a patent discharges themselves, malicious nurses or simple even careless ones can harass a patient into leaving by providing care that is substandard enough to make a patient believe they are better off out of a hospital or doctor’s care.

Patient Baiting takes place largely while doctors and physicians are out of circulation. Since the current staffing model of any healthcare facility is spread so thin doctors are rarely hanging around, the patient can be long gone before the physician has noticed there is any problem. Since an onsite nursing administration faculty is prone to covering up the problem, only the patient loses.

Except in this era of online reporting, increased institutional oversight, and streamlined problem solving, a nurse’s performance may come up for review. Nurses cannot pick and chose which patients they want to be nice to, or respond to handsome or pretty people in preference to others. Nurse training should orient the caregiver to apply best nursing practices and standards to every patient, not just the “favorites”.

If two nurses, (Let’s call them Cynthia and Neemar), decide not to administer standard care to a patient and make them all a doctor or come to the nurse’s managerial wing to address problems, they have been guilty of patient baiting. It speaks to the poor training of a shift charge nurse that they let this happen. This drains nurse power because the attention of other nurses and the supervisory staff is distracted from care issues.

But this places more of a burden on other nurses, who must make up the shortfall if the charge nurse assigns them to the patient or if the patient is moved to a new wing. The time and energy this drains from other personnel can never be repaired.

4. IV Maintenance

Intravenous therapy was invented to deliver treatment to the vein. The IV machine is now used for everything from infection to hydration. The care treatment plan for any patient now requires in almost every state an IV plug/PICC line so at any time emergency administration of fluids or other medicine can be transmitted this way.

An IV machine placed in a patient room is under the operation of the nurse at all times. Visitors, patients, and family members must be made to know this. Dehydration drips are administered for patients even not under the care plan because changes in their condition may require it. Nurses who are poorly trained cannot handle the responsibility of checking the IV line periodically so that shifts in patient arm or hand positioning may change its effectiveness. Properly trained nurses will instruct patients how to rest their arms and hands so as to not disturb medical product distribution.

The administration of an IV line is the charge nurse’s alone. If the nurse observes a technical problem with the device, they should report it or exchange for a properly working one. There variable settings for IV usage that a nurse should be trained to use. In nursing practice, where patients are lodged more than one to a room, the noise should be kept to a minimum to afford proper rest for others.

Alarms on an IV machine go off when the power is disconnected or battery winds down, or the treatment product runs its course. The alarm setting on an IV machine is usually denoted by a small bell, which should be set to “off”. IV fluids can run concurrently. Set an alarm for when it will finish!

But when a machine is not running properly the noises and alarms can buzz in an annoying manner and create a need for the nurse to constantly return to the same room. Setting one or all of the medications to “Gravity drip” can assist in providing rest for all the patients in the room and reduce the need for technical review of the equipment through the night.

5. Inability to Admit/Report a Mistake

If a nurse notices they have made an error or committed a breach of institutional or care treatment policy, their best practice to to report it or advise a supervisor who can take action. Patients can report this to nursing administration. Simple mistakes can be rectified by peers if necessary. More important errors concerning medications, treatment, or patient interaction can be addressed by a supervisor. Without this accountability nurses should think of working in other professions.


The Mechanics of Nursing

nursing equipment

vital statistics 

One of the realities of every profession is that an occupationally trained worker must provide some part of their own tools of the trade. Perhaps they prefer a certain brand or model, and/or the facility hospital or nursing home does not provide up-to-date or working machines at all. Officially, a hospital or long term care facility will monitor the medical equipment, but this does not always happen. Nurses are often “stuck” using equipment that is borderline inoperable or unreliable. This is a very serious medical issue because the nurse must be able to trust the statistical metrics to assess and record the patient’s condition.

Due to low budgets and straining costs, many facilities may not have the money to replace aging or broken equipment. Thus the patients are relying on the nurses to be able to do a manual job of taking blood pressure stats every time. This can be time-consuming and a stressful part of the nurse’s day, when conflicting patient needs stress the limited time a nurse has to finish tasks. A professional nurse must be able to contend with broken or inoperable equipment and yet smoothly transcend this challenge for ongoing patient care.

One of the parts of nursing that always gets nurses technically caught out is the working and proper maintenance of the medical equipment. Many a testing and practicals skills environment training stresses the use of blood pressure tests using the old-fashioned lub-dub method. But many professional nurses grow to rely on the wrist machine, used to calculate digitally the readout of the patients blood pressure and oxidation. Investing in this mechanical device can save time and trouble taking vitals readings.

A nurse working at a hospital or long term care facility should catalog the errors they observe using a particular piece of equipment and report this in writing to the charge nurse or to the Director of Nurses. They should note for the record in the licensed nurse progress notes how many times the attempted the vitals test and what the time was from beginning to end. This can be verified using a video camera or the notes of the charge nurse.

It is important for any nurse to immediately report a malfunctioning piece of equipment to the working charge nurse per shift, additionally. Taking a digital picture with your cellphone may also show the strange result or wrong code on the LED that multiple attempts can give. This advise is not just boilerplate for an in-service or training video. A nurse should use their own judgment and be ready to submit this letter anonymously to whistleblower line or local ombudsman or patient safety suggestion box.

Documenting the issue with the nursing equipment that it is not operating correctly and the serial number or identification tag will also assist inventory staff using this complaint to take the unit in for repairs. This way the nurse has a concrete record of their own observations and the method they used to pass the information up the chain of command. Sometimes the persons in charge of purchasing and equipment maintenance don’t have any interaction concerning the operability of the equipment, when in fact a vitals cart or heart monitor may need replacing.

Other equipment related to patient safety is elevators, stairs, fire escapes, visitor chairs, bed rails, bathroom safety rails or bars, light fixtures, air conditioners or heaters, and more. Elevators should work without strange or unexpected delays, or stops on unselected floors. Lighting and access to floors using fire escape doors or flights of stairs should be reviewed for safety practices. Lack of integration of security responses for patient alarms and wheelchair alarms can make a nursing ward seem like a zoo of noise, buzzes, and call light alarms.

But specialized equipment is not the only device that a nurse should review for safety. A nurse should always give the equipment a “weather eye” and see if the cord goes in smoothly and does not pull away from the electrical socket, or that the wheels or runners turn and move smoothly. A tray table or table-based electrical equipment aid to nursing may need to be monitored for electrical discharge. A nurse should report when a patient organize belongings or possessions in a manner that conflicts with safety standards.

Even finger protectors made of plastic can prevent paper cuts. This is a serious problem for blood contamination of medical records and documents, as well as droplet contamination between nurse and patient. Given the amount of time that nurse spend handling the chart pages, even a small paper cut can become painful upon repetitive action.

As always, the most highly scrutinized equipment for nursing use is the needle. Privacy, calm and well-lit circumstances in administering patient care, and a good understanding of the patient is required. Advise the patient when you are going to stick them, how long it will be, how the site looks, and ask them again before you inject the needle if they are ready. This use of courtesy centerlines patient dignity even during a difficult procedure. Improving stick skills should be paramount. Causing bruises or painful injection sites repeatedly in a patient can result in being written up by a supervisor. Continuous disregard of patient dignity and skin fatigue or tearing, bruising or discoloration due to improper needle skills can be means for dismissal.

All in all, there are numerous challenges to safeguarding patient safety and mechanical device security in the occupational nursing workplace. But with attention to detail and a good attitude, the professional nurse can overcome obstacles while providing excellent patient care.