District Nurse complaint

[BecsCoburn]

So my 1 year old nephew has tumours in his brain and requires a feeding tube through his nose. Sometimes he pulls the tube out and the district nurses come out to put it back in at home, my sister doesn’t drive so the Drs at the hospital agreed it’s easier to be done at home.

Tonight, around 4:00pm my nephew pulled the tube out and my sister rang the district nurse...who refused to come out as she said it would go over her time but the district nurses don’t finish till 5pm? So I don’t understand the problem...have we got a basis to complain???

You could call,the district nurse manager to discuss it with them, are they saying they wouldn't be able to get to you until after 5 which is when they close, did the nurse offer an alternative.

She could ask for an explanation but it may be as simple as the district nurse already had a list of people to see that would get her to her finishing time.
Your sister may be better off complaining that there is no service after 5pm (if that is the case)

Hope your nephew is ok and it gets sorted.

All the DN teams I know are horribly overworked and understaffed. Calling at 4pm does not mean a nurse was sitting in the office with nothing else to do.

In my area they only make home visits on clinical grounds. A parent being unable to drive would not be a reason and the parent would be advised to get a cab to A&E.

She needs to find out what the process is for out of hours time. If they only work until 5 then realistically they probably won’t have time left at 4.

It sounds harsh but replacing a feeding tube may have been low on her list of priorities, was she the only nurse on duty? Don't be quick to complain without further investigation.
Ex district nurse here. The service is on its knees.

I hope this get sorted out, poor wee soul, is there nothing they can use that would stop the tube being pulled out, does he have his medicine through the tube as well. It is worth discussing out of hours services.

I would be very surprised to find that if you called at 4:00 that they would have spare time before 5:00.

I suspect they're slightly stretching a point to come out anyway if they'd normally expect you to come into hospital to do it.

Not able to drive isn't generally considered (when dd2 was little it took me 2 buses and 3 trains just to get to her specialist, whereas now I drive it takes 40 minutes) as a reason for home visits, so complaining would probably just have the effect that they'll say they won't come out at all and you'll be much worse off.

Thanks
The hospital had agreed with the nurses he could have the feeding tube changed at home as he has no immune systems he is neutropenic so going on public transport can seriously compromise his health, hence why they hospital agreed to him having the tube changed at home.

The nurse simply said ‘I’m not coming, I would be staying after my finish time’ Just to say, the nurse was in office not out on calls....it’s a 5 minute job, and my sister lives 10 minutes from the office so I don’t really understand her reluctance to come out. The hospital have given her a number to ring in order to complain so hopefully it gets sorted. Thanks all for the posts

But if that nurse leaves the office to change the tube there'll be no one in the office to deal with emergencies/ other queries. I imagine she was writing her notes, doing referrals, updating care plans etc. If every nurse came out straight away whenever someone called they'd never get their admin done (and it needs to be done that day)

Rather than complain first, I'd rather see you ask hospital and / or nurse service what the out-of-hours process is. It's easy to focus on complaining this happened just before surgery closing, and debating it's only a 5-minute procedure only 10 minutes away, so why didn't the nurse come out ..... the much more important point is what would you do if this happens at 6pm or 10pm tonight?

Sounds like the hospital are trying to pass the buck!

Even if that nurse was “just” in the office she is hardly going to have been just sat there drinking coffee!

I think I would try to clarify if they couldn't do it why wasn't it passed over to the out of hours team they do have district nurses th at work out of hours. Unless it's different for your area but district nurses are needed for nights / weekends so I don't know why they couldn't have passed to the out of hours who could have come. Does your sister have their contact or is that service not available ?

District nurse teams are on their knees. Although they work officially until 5 my mother often wasn’t home until closer to 7 in her last year or so of work.

TBH they’re not really set up to be an emergency service - so they wouldn’t generally be able to accommodate this sort of request. It sounds as if the hospital have said they’ll do something they can’t. This was pretty common over the last few years of my mum’s working life.

If that had been said to me I am pretty certain my mother would have been onto the doctor asking why they thought district nurses would be able to provide that service. And had they spoken to the DN team to see whether they could.

I would a) establish whether the district nursing service is ever able to provide this sort of care and whether it’s even in their remit. If they do then how long would you expect to have to wait for a nurse to come out.

And b) go back to the ward for a solution. I would have thought open access to the ward would be a better solution.

If you get nowhere go to PALS (as it’s the hospital that haven’t set up correct procedures)

Sorry I’ve just read that they will do it on other occasions, so it is something they will do.

Check out what the arrangements are for out of hours or when they can’t.

I know a lot of tube displacements need to be replaced really quickly so there needs to be a robust plan. I think it is more usual for hospitals to do it? So if they are relying on DN good will then you need a clear back up.

I'm afraid that DN would indeed have been writing up the medical notes from that day, ordering medication and requesting or writing prescriptions for bandages, catheters injections, medication, etc (if s/he's a nurse-prescriber) for other patients, doing care plans, referrals, planning routes, dealing with issues that have arisen - Mr O has had another fall in the night and had to be lifted back into bed, concerns about his ability to live independently; Mrs S hadn't eaten for 2 days, the carers haven't been in but they are supposed to have been, need to chase social services; Mr R needs to have his leg ulcers looked at by a GP, he isn't doing as he's told and they are becoming infected etc.

I'm not saying you're nephew doesn't need his treatment too, what I'm saying is that perhaps the DNs are not the best option here.

What would have happened had your nephew pulled his tube out at 5.05pm? The nurse could - and probably did - have a whole day of unexpected call outs, many of which will have had follow up actions. If she hadn't done those, that would have led to those patients suffering. And perhaps she had to leave on time to collect her DC from childcare, go & work her second job, visit elderly relatives - or just go & meet mates in the sunshine.

Have to agree with other posters here, just because the nurse was IN the office does not mean that she was sat twiddling her thumbs and watching the clock until home time.

She was likely sorting the myriad admin jobs on her to do list or may have even popped in for something before a final planned visit.

Unfortunately your sister can't expect to call up towards the end of a working day and expect someone to appear within minutes.

I'm surprised at how many people seem to think nhs community staff can run to their beck and call. They can't - they usually have large caseloads and have to manage workload based on clinical need, route planning, clinics and emergencies.

I'm surprised that you're shocked that the nurse wanted to leave work on time, especially considering that she won't be paid for overtime and may also have her own personal responsibilities, such as her own kids to care for.

The hospital and nursing team might have agreed to do home visits but it also has to fit with the available resources at the time - it sounds like they just weren't available and that's not the fault of that nurse.

It's not the nurse's fault your sister does not drive, neither is it her fault that she couldn't get to your nephew. It's a shit situation, I totally recognise that, but there was an alternative.

My advice: complain that the service doesn't meet the needs of its clients, because the fault here is with lack of resources for service provision. Then look for alternative ways to get DN to hospital if it happens again.

Come and spend a day with us. I work on the Complex Care Team looking after children who have complex care needs, it is not just feeding tubes we do, it is blood tests for children on treatment for cancer, it is children who are at the end of their lives, it is children who are ventilated at home and so much more besides. We sometime have to tell a parent "No, we haven't the resources to replace an NG tube, sorry", we don't like doing it, we will do all we can to go and help but sometimes we just can't. I can't remember the last time we sat in the office doing diddly squat and all of us have notes that we need to write up from days ago.

The sensible thing would be to train you and your sister to be able to replace the tube. I'm sorry this happened, but you don't have grounds for complaint. He wasn't at risk without it.

I bet the nurse didn’t leave at 5pm tbh

I thought that vivarium but I think some tubes need to be replaced by a medic (although if a DN can do it that may not be the case for this one). Is it possible for your sister to be trained OP? It would save waiting around or struggling to get to hospital

@Devilishpyjamas probably not. She was probably still working on late, playing catch up.

I used to be part of a community phlebotomy team. We had to get the GPs to agree and document that lack of transport was not a valid reason for home visits. The work load was huge and impossible to manage.
The frustration of arriving at a patient's house to do a booked blood test only to find they had gone shopping or to the hairdresser was a regular occurrence.
I am not suggesting that your dn falls into that category OP, but there needs to be a more appropriate solution found.
Hospital staff tend to be a bit cavalier in the assumption that district nurses are available 24/7 for anything and everything.

Parents wirh unwell kids do all sorts of care procedures after training.

NG tube in the wrong place is a problem, so, yes, you'd have to be very careful and know what you are doing, and the Wee boy is only a year old so, the ewuipement will be tiny and fiddly - but if the parents are capable then they should be offered the opportunity to gain the skills their baby boy needs.

I'm sorry your family is having to deal with this, OP. In an ideal world you'd get what you want. If I see Jeremy Hunt I'll kick his shins for you.

Get them to put a bridle in as well next time they do the tube.

It makes it harder for a child to pull said tube out.