Andrew is a registered nurse (RN) working on a newly opened brain-injury rehabilitation unit. One of his clients who arrived on the unit two weeks ago, suffered a traumatic brain injury and is slowly progressing through his recovery. The client is unable to consume any solid or liquid food orally and is fed through his gastrostomy tube (G-tube). When providing morning care, Andrew notices that the client’s G-tube is dislodged, but not completely out. He assesses the site, stabilizes the G-tube with tape and covers it with a dressing as a temporary measure.
Andrew calls the client’s physician to let him know about the dislodged G-tube. He communicates the situation and assessment of the client to the physician, and the physician orders the G-tube to be re-inserted by the RN at the bedside. Andrew has not encountered this situation on this new unit before so he is unsure whether RNs are able to (or should) replace G –tubes.
Based on Andrew’s knowledge about the CARNA Practice Standards for Regulated Members, he knows that he:
Andrew also knows that he is responsible and accountable to adhere to CARNA’s Restricted Activities Standards. Specifically:
Andrew communicates his concerns to his unit manager and asks for further direction. Given that the intervention has not been performed by RNs at the bedside on the unit, the unit manager decides to call the unit educator as well as a CARNA policy and practice consultant for further direction. In the meantime, in the absence of written employer requirements, Andrew contacts the physician to re-insert the G-tube.
CARNA’s policy and practice consultant refers the unit manager to CARNA’s document Incorporating a Restricted Activity into Practice Guidelines (2019). Specifically, the consultant highlights the decision making framework to support the unit manager in determining whether the restricted activity of replacing G-tubes by RNs should be incorporated into the unit:
The unit manager works through the steps identified by the Policy and Practice Consultant at CARNA to determine if G-tube insertion should be an intervention the staff on this unit are educated and supported to perform. Based on a review of evidence and best practices, the unit manager communicates next steps to the staff.
Disclaimer: Our case studies are fictional educational resources. While we strive to make the scenarios as realistic as possible, any resemblance to actual people or events is coincidental.