Am I at fault here?

[SarahRN2010]

I had a situation come up at work yesterday and I wanted to get some feedback from some fellow nurses.

I work night shift 7P-7A in the hospital on a tele unit. I received in report that one of my patients had had a bowel movement during the day shift and was incontinent. Upon assessment of the patient I asked them if they had a BM that day and they said yes, 2 of them. There was a BM documented in the computer for that day at 1130 am. While doing my 24 hour chart checks at 1am I came across an order written that day at 1430 that stated "Daily tap water enema until patient has good BM." I never received in report that this order had been written, and the day shift nurse had signed it off. I did not administer an enema because the pt did have a BM that day.

When I came back into work the next night I had a email sent to me from the charge nurse that day stating that the MD was very upset that this pt never received an enema and the pt still has not had a BM. It is clearly documented that the pt did and the pt even said so herself. Am I at fault here? The pt had a BM which is why I did not administer it. Personally, I think the Drs order is a little unclear in the first place.

And to make it even worse, the charge nurse sent a copy of the email to my manager. I am a new grad and that really made me feel awful. Now I am afraid that my manager is going to think I am incompetent...

[Esme12, ASN, BSN, RN]

I had a situation come up at work yesterday and I wanted to get some feedback from some fellow nurses.

I work night shift 7P-7A in the hospital on a tele unit. I received in report that one of my patients had had a bowel movement during the day shift and was incontinent. Upon assessment of the patient I asked them if they had a BM that day and they said yes, 2 of them. There was a BM documented in the computer for that day at 1130 am. While doing my 24 hour chart checks at 1am I came across an order written that day at 1430 that stated "Daily tap water enema until patient has good BM." I never received in report that this order had been written, and the day shift nurse had signed it off. I did not administer an enema because the pt did have a BM that day.

When I came back into work the next night I had a email sent to me from the charge nurse that day stating that the MD was very upset that this pt never received an enema and the pt still has not had a BM. It is clearly documented that the pt did and the pt even said so herself. Am I at fault here? The pt had a BM which is why I did not administer it. Personally, I think the Drs order is a little unclear in the first place.

And to make it even worse, the charge nurse sent a copy of the email to my manager. I am a new grad and that really made me feel awful. Now I am afraid that my manager is going to think I am incompetent...

nursing politics........hummmmmm......Sounds to me like the charge nurse got called on the carpet and found a quick scape goat. Even with a BM on days the incontinence makes me think possible impaction and weeping of stool. NO one likes enemas and usually tries to pass them to the next shift. But I would not give an enema at 1 am if they had one on days reguardless what time the MD wrote the order.

As a supervisor if you callled me and asked my opinion I would tell you not to give an emema at 1am and to be sure to have days clarify the order. I would ask to speak with your manager.....tell her you are upset. Ask her if you missed anything and ask for her advice for the future on how she would like you to handle a situation similar to this........tell her how you feel and that the documentation says the patient had a BM.......how should this be handled in the future. This cover several bases 1) you get your point across 2) she knows you care 3) she knows you are upset 4) she knows you will try to find a workable solution and 5) the charge nurse got chewed out a found a scape goat and you look like a team player who want to do it better!!!!

Don't sweat the small stuff!!!!! xo

[Katie5]

Hey I'm a new grad too. I wouldn't have administered the enema either! Clearly the order was written on dayshift so did the dayshift nurse administer one? She should have mentioned something about it in report. If a BM was charted, how are you supposed to know if it's good or not? That order is not appropriate in my opinion. I hope everything works out for you.

Don't pass the buck-pass the blame.So do the task if needed, It's a human life here.

[ChristineN, BSN, RN]

Usually when I hold a medication or an order to give something, I make sure to call the ordering doc to let them know why and also to document. Since the pt stated she had 2 bowel movements, I would not have given the enema especially if the pt is oriented but the only difference is that I would have notified the doc and documented what happened.

I really wouldn't see a need to notify the dr, especially when the OP states she works night shift. If anything, you could have simply put in your nurse's not "pt states bowel movement x2 during dayshift. Enema held."

[FancypantsRN]

nursing politics........hummmmmm......Sounds to me like the charge nurse got called on the carpet and found a quick scape goat. Even with a BM on days the incontinence makes me think possible impaction and weeping of stool. NO one likes enemas and usually tries to pass them to the next shift. But I would not give an enema at 1 am if they had one on days reguardless what time the MD wrote the order.

As a supervisor if you callled me and asked my opinion I would tell you not to give an emema at 1am and to be sure to have days clarify the order. I would ask to speak with your manager.....tell her you are upset. Ask her if you missed anything and ask for her advice for the future on how she would like you to handle a situation similar to this........tell her how you feel and that the documentation says the patient had a BM.......how should this be handled in the future. This cover several bases 1) you get your point across 2) she knows you care 3) she knows you are upset 4) she knows you will try to find a workable solution and 5) the charge nurse got chewed out a found a scape goat and you look like a team player who want to do it better!!!!

Don't sweat the small stuff!!!!! xo

Nobody does like giving enemas - that's why they are always given at 6 o'clock (regardless of shift) it seems. I would never give it at 1am either. It does depend on patient condition though really. I have had patients tell me they had a BM, then 5 min later it's the opposite. Who knows. It depends on the pt condition when you go to administer the tx, the assessment and the given parameters. But when in doubt, I would just clarify with the MD if he wants it given or not, and specific parameters. That's what's difficult about nursing sometimes, it's not always just black and white.

[NoviceRN10]

I don't understand why some people stated they wouldn't give an enema at 1 am? If someone needs relief from impacted stool I don't think they care what hour of the day they are getting their enema. If the dayshift didn't give it and it was necessary, I would give it whenever I caught the order. If the pt stated that they had already had a bm I would chart accordingly.

[GM2RN]

There was a very simple solution to this. Explain the order to the patient. If the patient agrees to have the enema, give it. If not, document as refused by the patient. End of dilema.

[rkitty198, BSN, RN]

What a crazy order. I wouldn't have given the enema either if the patient had a BM. Half the time the MD dosen't even look at the I's and O's to see if they even had a BM before they write orders like these.