All about the tubes... reflections of a new ER nurse

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    I have these moments where my entire life flashes before my eyes. As if everything I’ve ever done, all the people I’ve met, all the decisions I’ve made have led to THIS moment in time where I’m about to shove a tube up someone’s urethra. Sometimes, in those moments, I realize that I've been undervaluing things in my practice. This is a reflection of a new ER nurse

    All about the tubes... reflections of a new ER nurse

    I blame nursing school for beating the “reflection dead horse”. However, on this particular day where I needed to straight cath an 88 yo woman, I found myself with all kinds of new reflections.

    As a brand spanking new nurse in the ED, I feel that every day is trial by fire as I make tiny mistakes everyday. For example: 1) changing IV maintenance bags from the pole and forgetting to clamp resulting in fluids pouring all over me, 2) starting IV’s and forgetting to apply distal pressure leading to a bloodbath, 3) removing an IO for the first time, accidentally scraping my hand with the needle (not sure it happened but I was required to check in), and being admitted to the ED as a patient for needle stick precautions.

    It’s frustrating.
    It’s embarrassing.
    It’s overwhelming and terrible at times.

    But I keep coming back. And I never make the same mistake twice. Usually.

    My patient was being worked up after having three GLF. I had already made another mistake earlier in the day with her IV. I succeeded in putting an 18g IV in her RAC. I drew her labs and left the room to send them. Yet when I returned, the catheter was hanging out. The patient was alert and oriented x4 and her neighbor was in the room. Both denied messing with the IV. Regretting my decision not to stat lock, I put in another line (without a bloodbath).

    We also needed a urine specimen. Since she was incontinent and the likelihood of acquiring a midstream uncontaminated sample was low, the only option was to straight cath. I found my preceptor and she agreed to assist with the procedure. Since the patient expressed her urgent need to go, my preceptor suggested using a bigger 14fr because it would drain faster. I washed my hands. I set up my sterile field. I had my life reflections. I was ready to go. The opening was visible and I cleaned enough to make ‘Monica’ from Friends proud. And then I inserted the tube.

    Nothing. I start to inch the tube farther and farther in. I’m starting to get concerned when it’s taking longer than usual. My patient is calmly watching basketball on the TV. She denies any pain. I keep advancing. It’s in as far as a male. Still no drainage. I’m thinking it has to be in the bladder curled up. I wonder can it possibly be in the ureter?

    She would have to be yelling right?

    She suddenly yells something and I look up. She’s mad at the TV and still denies pain. There’s nowhere left for my tube to go and I look at my preceptor. She shrugs and says it’s in the vagina.

    We leave the tube in. I repeat the setup and I’m all ready to go again. I assess the area and….. there’s nowhere to go. I feel ridiculous telling my preceptor that but I do. We turn on the overhead light. She points to an area and I try to access it and the tube curls right back. My preceptor opens another kit (she doesn’t have life reflections) and we open the site as wide as possible. We see another hole that we both agree is, quite clearly, the vagina. I remove the first tube, my preceptor repeats the cleaning, and inserts the smaller tube and urine streams out. Apparently, big tubes aren’t always the best tubes.

    At the end of the day, I felt pretty defeated. I apologized several times to my patient for my mistakes and she only laughed. She told me I had done a wonderful job simply by listening throughout the day. She told me she felt comfortable and safe under my care. In fact, she told me that several times before she was discharged home. Now, I’m not one who ‘fishes for compliments’. However, it made me realize how much I undervalued the non-technical skills I had performed. It’s interesting because it’s not ‘doing the skills’ that bring me back to the ED. The humor, the wit, the stories, the empathy, the being able to turn one of someone’s worst day into something manageable,… those are what brings me back. Hope you think about that the next time you shove a tube up someone.
    Last edit by Joe V on Mar 18, '15
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    About stephen1219

    I'm a new ER nurse. If I'm not working, I'm worrying about how I will have be ready on my own. I love my job. I'm just not good at it yet.

    Joined: Mar '13; Posts: 14; Likes: 125
    Specialty: 1 year(s) of experience

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  3. by   rearviewmirror
    sounds like another successful day. no one starts knowing everything! you get better, and better.
  4. by   JoseQuinones
    It is not corny to say that nursing is not so much what we do, it's what we are.
  5. by   Cheers_G
    Thank you for sharing. I can tell that you are a great nurse!! Keep on growing
  6. by   AZQuik
    School gives you a very broad experience. The ED is a tough place to start, but so long as you keep learning, and don't make the same silly mistakes over and over, you are moving forward!

    BSN GCU 2014. ED Residency

    Sent from my iPhone using allnurses
  7. by   BecomingNursey
    I also am a new nurse (graduated may 2014) and started in the ED right out of nursing school. It's terrifying and exhilarating all at the same time I love my job and you're right. Those rare moments where we actually have time to stay and talk to one of our patients and brighten their day are few and far between, but seeing that smile after they've been vomiting their guts up is priceless

    I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.
    Author: Art Williams
  8. by   RookieRoo
    I'm graduating this summer and the ER is where I want to be. Or, I thought it was... this article pretty much terrifies me! But, I have a feeling I'm going to be terrified wherever I go. Have to rip the bandaid off and jump in!
  9. by   Mully
    Well written. We've all been there!

    Those 88 y/o vaginas.. you don't know which way is up!

    I've had so many catheters in there, at times, that it resembled the lake monster from lord of the rings!

  10. by   stephen1219
    Reminds me of a quote from my nursing school instructor. If you're having trouble finding it, "stop and remind yourself that they have to pee somewhere down there".

    AGE87 this isn't meant to frighten. It's one of those "be comfortable being uncomfortable for awhile"
  11. by   warriortac
    I love how honest this is. I am entering nursing school this May and I know I will make mistakes and we are all human. Thank you for writing this for students and future nurses just like myself. Best of luck to you in your career! Oh and thanks for the laugh