Ethical delema

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Specializes in LPN/Pallative Hospice.

I have a huge issue as a nursing student. I will describe the incident in question factually as possible.

Myself and another nursing student were instructed to insert a Foley catheter into our male patient. All was going well except we met with some resistance when inserting it into his urethra.

Nursing instuctor took over and. Was able to advance it further into his urethra. She stopped with at least 4-6 inches of the catheter lumen remaining from out of his urethra.

She then instructed the other student to inflate the balloon with 10 ml NS. I asked if we are in the bladder as no urine was produced from the lumen? She said yes and the other student began to administer the NS and the patient yelled out in pain. This patient was confused but my instructor said if it was still in his urethra he would have screamed in more pain. Being this the first time administering a Foley, against my instinct, I accepted her rational.

Still no urine from the foley, another nurse came in and proceeded to flush the catheter with 60 ml of saline. (lpn and out of her scope and no order to flush) This again was very painful for the patient. She tried to pull back the 60 ml and got nothing back. She had no idea where the saline went. So she removes the catheter and out comes a large amount of Frank blood.

I honestly believe the balloon was inflated in the urethra rupturing it and possibly injuring his prostrate.

Us students were kind of rushed out of the room and I noticed a Dr attend the patient.

We were given no explination but my instructor spend the rest of the day and the next blaming it on the second nurse who tried to flush the catheter.

My delema. We all know the nurses code and being a student in a smaller town could possibly get me black balled from the health athority if I report it. I also had issues with this instructor who is trying to fail me.

I think I know the correct thing to do even if it ruiins my career that I haven't even started yet.

What do some of you think?

Thank you.

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Specializes in Psych (25 years), Medical (15 years).

From one of many websites, these basic instruction state what should have occurred:

13.Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted

14. Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size)

15. Gently pull catheter until inflation balloon is snug against bladder neck

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Specializes in Oncology.

Who are you thinking of reporting it to? The instructor, floor nurse, and MD were all already involved.

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Specializes in LPN/Pallative Hospice.

As a student my instructor on campus first. I'm not sure what they told the Dr. As I wasn't there.

The secretness of the clinical instructor and how she ran around blaming it on the other nurse is what's concerning me.

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Specializes in LPN/Pallative Hospice.

It the balloon was in the urethra it would also be snug when pulled on correct?

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Specializes in Complex pedi to LTC/SA & now a manager.
As a student my instructor on campus first. I'm not sure what they told the Dr. As I wasn't there.

The secretness of the clinical instructor and how she ran around blaming it on the other nurse is what's concerning me.

If an incident report is necessary the hospital team will take care of it. If they feel the clinical instructor was inappropriate risk management will contact school administration. You don't need to do anything.

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Agree with the others - the hospital staff will handle it. The patient's nurse knows what happened, and the doctor is involved. The instructor was wrong, this is a learning experience for you. And yes, the balloon would be snug in the urethra. It sounds like the patient had an enlarged prostate, and needed a Coude catheter. Also, some facilities have standing orders to flush catheters, you may not have been aware if there was a standing order.

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Agree with the others - the hospital staff will handle it. The patient's nurse knows what happened, and the doctor is involved. The instructor was wrong, this is a learning experience for you. And yes, the balloon would be snug in the urethra. It sounds like the patient had an enlarged prostate, and needed a Coude catheter. Also, some facilities have standing orders to flush catheters, you may not have been aware if there was a standing order.

This is what I was going to say as well.

OP: Flushing a catheter is not outside of an LPN's scope of practice. I'm not sure why you would say that. Facilities such as these usually have a long list of standing orders that can be used in situations like these.

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Specializes in LPN/Pallative Hospice.

Different facilities have different scopes of practice regardless of the over all standing scope. The biggest deal is that there was no order standing or otherwise.

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Pick and choose your battles. If the patient is okay, move on.

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Specializes in LPN/Pallative Hospice.

Well he died 1 week and a half later so......

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Specializes in Oncology.
Well he died 1 week and a half later so......

I highly doubt he died because of a foley incident. I'm guessing he needed a foley because he was quite ill.

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