Easy to blame the new nurse?

[nursebri]

Okay so I will try to make this as short and sweet as possible. I work the night shift as a new grad RN at an LTAC. I've been off of orientation approx a month and last week I was assigned a pt who was a quadriplegic for over 30 years. He was admitted for Resp failure. He was actually getting ready to be discharged soon and had his trach capped. Now when I recieved report I was told he had a distended abd and physician was aware. when I did his assessment he was VERY distended. SO distended he looked pregnant. He told me that he had not had a BM in a really long time. I looked up what they did during dayshift- they gave him an enema, lactulose along with ducolax and still no BM. He had hypoactive bowel sounds. Well a little over half way through my shift I noticed he had blood tinged urine. I immediately checked his foley placement and it looked to be in the same position it was when i completed my shift assessment. I notified charge nurse and she said that the foley might have been tugged on while we were turning this pt. (There was always 2 people turning this pt.) I was pretty sure that he hadn't had his foley tugged but decided to go with what the charge nurse had said. As the shift went on he began to have more hematuria. this was around the time that physicians began making rounds so i notified physician when he came up. the physician told me and the pt that the foley had been tugged on and didn't seem to care. I gave report and left for the day. I was off for one night and came back the next and before I could put my things away a nurse came up to me (smiling) and told me that the Dr. was mad at me and the pt was very upset with me b/c he was having severe hematuria. So severe he had to have several blood transfusions and a CBI. Believe me I wish I could've turned and walked right out of work that day. I talked to the nurse that had been my preceptor and she stated that there was no way a foley being tugged could have caused that much bleeding and that I shouldn't worry. Believe me I was upset that whole shift wondering what was going on. When I got off I requested that I be called off the next night's shift. I took the night off and tried to calm down and came back the next night (4 nights after I had originally had this pt). When I came back in I noticed the pt was no longer there and the charge nurse that was there the night all of the hematuria began was working. She caught me and stated the pt had been sent to ICU with a ruptured bladder d/t a huge blood clot in his bladder and stated of course I didnt do anything. We reviewed his CT scans to find his entire colon was approx 4x larger than his previous scans and he had a HUGE blood clot at the neck of his bladder. I felt relieved that I had proof for all the other nurses that I didn't cause this. Well, later on in the shift as the physicians began rounding the charge nurse asked the physician about all of this. THe pt did have a history of severe bladder spasms so the charge nurse was thinking that maybe he had such severe spasms d/t his mega colon that a blood clot formed. The physician stated that no the foley balloon was inside the mans urethra and that the blood had nowhere to go but up into his bladder and eventually it came out. BTW the pt had perfect urine output throughout the shift I had him so I'm not sure why they are saying this. It also started out blood tinged and became frank so Im not sure that this story really holds up in my eyes. I just think that they may be trying to blame the new girl. I'm still not sure why it took 4 days for a CT to be done to find out the cause for all of this hematuria that was so severe that he needed blood transfusions. I'm really not sure where to go from here but everyone is now blaming me and I know that his foley hadn't been tugged. Obviously the pt was told that I was the one who has caused him all of this and now he is quite upset with me. I'm just not sure how to feel any better about this.

[Florence NightinFAIL, BSN, RN]

That's stupid. They're trying to find someone to blame. You informed the charge nurse & physician and even if you DID cause it - they chose not to do anything about it and now that the sh!t has hit the fan - you are the perfect target.

Let it roll of your back and don't apologize or act scared.

[Sparrowhawk]

No. Don't act scared or apologize. I'd quit over something like that..that's true eating your young.

[CrunchRN, ADN, RN]

What Florence said......

[Mulan]

The balloon was in the urethra?

Who inserted the foley?

[gigglymo]

Did you chart that you'd informed the physician and the charge nurse? From what you're saying here, it sounds like you did everything you should have, and as long as you charted what you did, you're fine.

[Katie5]

Did you chart each and every action you took and the responses of the charge nurse and doctor?

[Katie5]

. I'd quit over something like that..that's true eating your young.

Quit and go where?She would be quitting for a long time then, if she chooses to remain in the nursing field.

That might not be the best option.

No one has outrightly accused her, they preface every sentence with, "It's not your fault..." LoL:D Continue with it at that.

On taking a day off, again, you might not want that to become a habit. You must try to weather some storms. GOD Forbid but what if the patient had passed away, would you have take a vacation or resigned?

[netglow, ASN, RN]

Before you forget the sequence of events. Sit down and write it out longhand at home including every last detail: date and times, what you did, who was there, what everybody said throughout, and what everybody did or did not do throughout.

That serves two purposes. One that you don't have to hold it all in your head, which tends to alter things and tires you. Two, that in case anything comes of it you can whip out that log of events for a solid clear memory. Never let anyone have hold of that paper tho.

[A&OxNone, MSN, RN]

First, let me say Im sorry. ((hugs))

Second, let me say that this ISN'T your fault. Can you learn things from this? Yes. But every nurse has cases that they say,"you know, I could've done that better..." but you learn from it and you move on. Now, when you went in and did your assessment, what were his vitals? How was his color? was there blood around the meatus, not just in the bag?Think about the things that you saw, and maybe didn't think it was a big deal, but now looking back you see the signs. Just file that stuff in your memory so you can know better next time.

Also, like the other's said, did you chart that you told your charge and the doctor? Because if you didn't, it's not the end of the world, but I hope now you understand how important it is to chart stuff like that, because then you have something other than just your word that you told somebody and "no orders recieved."

I did my preceptorship in the OR and one of the most valuable things I learned was the you never blow up the balloon on a foley until you are all the way in on a man, not just when you get urine. You put it all the way in, every time, because this is a complication of blowing up the balloon too soon.

Lastly, let me reinforce that every nurse has that first patient they feel gut-turning guilty about, and feel like they may or may not have been able to help them. When i had been off orientation in the ER for about 2 months, I had an older man put in my room with back pain. I did my assessment, his BP was a little up (165/90-ish), and he said he was having back pain between his shoulder blades. I palpated it, and he said it did hurt a little worse when I did that, asked if it hurt worse when he moved, ect... no red flags. Not to the doc either. Well, he was having an aortic dissection. He completely dissected about 20 minutes later. He didn't make it. I learned from it. It terrified me.

Just know everybody has that first patient. You will probably have to prove yourself again over the next few weeks again, but that's okay. Obviously you are a good nurse because you are hear to talk about it because you care. Good luck.

[nursebri]

Did you chart that you'd informed the physician and the charge nurse? From what you're saying here, it sounds like you did everything you should have, and as long as you charted what you did, you're fine.

Everything was charted. The Charge Nurse actually went back over all of my charting to make sure it was all there and it was!

[nursebri]

Quit and go where?She would be quitting for a long time then, if she chooses to remain in the nursing field.

That might not be the best option.

No one has outrightly accused her, they preface every sentence with, "It's not your fault..." LoL:D Continue with it at that.

On taking a day off, again, you might not want that to become a habit. You must try to weather some storms. GOD Forbid but what if the patient had passed away, would you have take a vacation or resigned?

Actually all of the nurses except the Charge Nurse has said "they think you pulled on the foley". I don't plan on making it a habit it fact I was in line to be called off in the next few days d/t low census so I actually just told them to call me off early.. It served 2 purposes I got to have a day that my husband was actually off and a day to clear my head after all of the drama. I don't plan on making it a habit.