My facility does not have a policy or procedure instruction nursing staff how to re-insert a well-established gastrostomy tube. This psychiatric patient pulls out her tube (foley No. 16) intact weekly despite interventions. Management is asking nursing staff to re-insert the tube if there is no MD/PA/APRN coverage 10 p.m. to -7 a.m. to save on ED costs. Some nurses are doing this, some are not. Can I get fired for refusing to do it?
Dear Nancy replies:
It would be difficult to know with certainty what your employer’s reaction would be to your refusal to re-insert a GI tube. The possibilities for a refusal, however, could include a write-up for insubordination or a termination.
A better approach would be for you and those colleagues of yours who are uncomfortable with this requirement to ask for an in-service on the re-insertion of the tube, especially on your shift with no medical/APRN coverage, and standing orders to allow you to re-insert when the tube is removed by a patient or by other circumstances.
The above approach assumes it is within the scope of practice of the RN in your state to perform this procedure. You also might want to check your state nurse practice act and rules for any guidance, as well as any opinions your board of nursing has published about this issue.