What would you do if this happened to you?
I work in a snf/rehab facility, worked there for little more that 3 months. When I came on shift one of the long term patients was having a problem since the 3-11 shift (I work 11-7). I received report that Pt.X had severe abdominal distention, had not had a bm in a couple days and was complaining of pain in his upper abdominal areas. I was informed that he had already received 2 kinds of laxatives (enulose and MOM) during the 3-11 shift and that he refused an enema and going to the hospital. I was told that the Director of Nurses was informed (as per hospital policy for change of condition) and that I was to monitor Pt.X for BM's. It was obvious the 3-11 nurse assessed he was impacted and needed to have a BM or two.
As the night progressed so did the patient's pain level and inability to move about. We put a diaper on the patient so he would not have to try to get to the restroom in a hurry. I encouraged him to drink H2O to aid in elimination. V/S were taken, bowel sounds assessed, still no BM @5:30AM. I asked to patient then if he would like an enema and explained procedure. He agreed to enema. The solution would not stay in his rectum so in effect it was ineffective. I then called on the RN in the building to please assess the patient due to increasing discomfort of patient and what I was to monitor for.
The CNA and me(an LVN) and the RN after assessing him all agreed this was serious and immediate action needed to be taken since he had been c/o pain for over 10 hours and his distention had become more prominent and no BM despite the laxatives and enema attempt.
The RN, my supervisor told me to call 911 and get him to the hospital. I did that.
I also called the D.O.N. to inform her that someone was being sent out(as per hospital policy).
Here comes the hard part -- She told me in no uncertain terms
how lazy and incompetent I and the RN were for sending the patient out
because all that was wrong with him was that he needed to have a BM!
I was hurt and ashamed because I thought we were using our best nursing judgement, we were the ones with the patient all night, and 3 people confirmed the severity of the problem.
It turned out that
it was more than a BM problem because Pt.X was admitted into the acute hospital and is still there since yesterday.
How do I continue from here at this job knowing how the D.O.N. feels about me and my nursing?
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