Another mistake..new grad.

[regerterb]

Hi everyone, I'm feeling a bit low this evening having made a mistake at work which has been reported I am new grad..week 4..one week supernumerary and now have been left on my own 4-5 pt's each shift..anyways….I started morning shift today 7am…I always always check the patients chart (where nurses notes, drs notes, physic notes are) and checked it this morning to see the night shift nurses report. About 2pm the Dr looking after the patient came in to review the patient…everything was fine until he asked how the patient was voiding in the bottle. I had no idea what he was talking about as the pt had a catheter (he was D1 total knee replacement). The Dr looked at me like an imbecile and asked why the catheter hadn't been taken out this morning as he had asked. I asked the nurse in charge about it as she said straight away she was going to put in an incident report about it. The night shift nurses on this ward always take catheters out at 0600 hours…and all the Dr's who do joints (knees, hips) I mean all of them, have them taken out day 2…except this one. The night nurse that was on had not documented it, nor said anything about it during handover…just said IDC draining well, patent, clear urine. It was only documented on arrival to the ward…about 4-5 pages back in the notes by the nurse. The nurse said it's not my fault purely..as she said the day nurses just do not have the time to read through 6+ pages on each patient they have for the morning and the night nurse should have at least documented it or handed it over. I took it out as soon as he reviewed the patient and he voided in the bottle straight away…but ugh, I just feel like an idiot….I have even printed out each Dr's orders copying it off the one in the unit for me to have on my clipboard…this particular Dr's orders were not on the list though. Anyone have any similar stories or mistakes they have made to make me laugh or lighten my mood?

[sallyrnrrt, ADN, RN]

some places have "protocols".....where standing order is to remove catheter 24-48hr post op, ideallly reducing number of catheter induced UTIs

[regerterb]

Yeah, they do, as I said I printed them all off onto my clipboard for each specific Dr (10-11). It was only this Dr's one whose name I had not come across yet. I guess I just assumed all IDC's are taken out Day 2…as all the other ones are..I guess assumptions make an ass out of "U" and "me"...

[UnbrokenRN09, BSN]

It's always a good idea to look at every patients orders before you start your shift, but sometimes it's just not possible. Night shift screwed up, so I wouldn't worry about it too much. Eventually you'll just know to make sure your foley was DC'd when it should have been. When you're new, you don't have that kind of thought process yet.

[regerterb]

Yeah, I will make sure from now on to check the Dr's orders for previous day as-well as day of. No harm done, pt is fine, just nags at the guilt and over thinking in my brain!

[_Skittles_]

In the grand scheme of things it was a couple hours. I can tell you stories of nurses forgetting to unclamp chemotherapy for hours or making poor judgement calls so honestly a foley is not the end of the world. Now you know for next time. As a new nurse only 6 months in I have learned that I will make mistakes but to learn from them (obviously I'm going to try my best to not though by using my resources). Even the most senior nurses make mistakes at times.

[Gooselady, BSN, RN]

In the great scheme of things, this is barely a mistake at all.

It slipped the mind of the night nurse to dc the foley, and you, as a brand new nurse, haven't been working on the unit long enough to have the 'red flags' pop up, and notify you that you have a patient whose foley ought to have been removed already.

This kind of event is a learning experience. It hurt no one, it was a mere oversight of a unit routine. And when this kind of 'mistake' happens to you, the good news is you are 'taught' (very thoroughly I might add ) and I'll bet it won't happen again on your watch :)

Even a seasoned nurse new to that floor could EASILY make the same 'mistake'.

A foley left in for a couple of hours past the 'out at 0600' unit routine doesn't even qualify for a true error that could cause harm to the patient.

As a new nurse, it's important to get a thorough understanding of what a true error or mistake is -- and when you make one of those, THEN kick yourself in the fanny, get remedial education and help, get tough with yourself, whatever it takes. But this isn't one of those, because 'foleys out at 0600' (on whatever post op day) is an ARBITRARY unit routine.

On another unit, the day shift may have the 'foleys out at 0900' on post op day whatever. Another unit would have another routine they adhere to. Do you see the difference?

[jadelpn, LPN, EMT-B]

And remember, an incident report is not always punishment oriented. Obviously, this MD is not really clear in his stray from the norm of when other MD's usually have you d/c a foley. So this will, hopefully, make it clear to everyone.

And truly, 0600 vs 0900....eh, sometimes a nurse can't even get to patient for a thorough assessment/meds/treatments until then.

[iluvivt, BSN, RN]

Thye are correct this is no big deal. The 0600 time is the worst, too close to change of shift and too dang early after a day of surgery when the patient needs rest. Foleys used to stay in for several days post op until the TJC NPSG to reduce urinary catheter related infections so don't even waste a drop of sweat. Just check your orders more carefully and don't assume the nurse has completed all orders.....check them!