Recently at work, I had a really tough pt that needed a foley. Myself and a very seasoned PCT (they are allowed to place them where I work, and do so very frequently) tried to get it in MANY times and the doc was unwilling to try themselves.... (pt had a hx of urinary procedures, etc)..
The doc looked at the placement of the caths I tried to get in and said they looked correct and the pt was prob. "spasming"..
Long story short, they were in the wrong spot, and another nurse got it in for me.
My shift ended with the doc saying in front of all of the staff (who were standing around the desk) "Wow, I guess you really need an anatomy lesson down there, huh?!"
:imbar
Sooo... am I being overly sensitive (usually true) or was that kind of mean?
My confidence is really shot and it sort of tainted the way I feel toward this doc. They are great at their job, one of my favorites to work with, and now I feel almost .... degraded?
Specializes in CVICU, Burns, Trauma, BMT, Infection control.
What was the tone of the doc's voice. Was it a mean spirited tone or light-hearted. If it was mean-spirited, stand up for yourself next time you see him and very nicely but assertively ask him if he meant to come off across the way he did and that you'd appreciate that he not do that again and would like an apology.
Also, everyone is not laughing out you. For most of them it's yesterday's news and they aren't thinking of you at all never mind laughing at you so don't blow that out of proportion.
Every nurse has had their confidence shot at one time or another. Heck I've been a nurse for 17 years now and still fubb up every now and then and embarrass myself. Hang in there. You're a great nurse!
If his voice was lighthearted(hopefully) the others were probably chuckling because they've missed many a foley in older women. I almost asked the unit where I work for a mining helment so I could see down there. I usually have to sink one in the wrong place and I leave it there and get another so I don't do that again. We all have those days. You're doing fine.
Haven't met a nurse yet that can say they hit it each and every time. I worked with a male nurse, when I was cna, and we had about 5 foleys placed wrong and hanging there before he finally landed it. I never laughed because I could see how difficult it was. Don't worry, I can think of so many worse scenarios than this. I've never even had the chance to do one yet (except on the rubber one at school), and now I can hardly wait (sarcasm)
Hey foley placement is not easy especially on women. don't beat yourself up over this. Everyone at one time or another has missed and placed the cath in the wrong "spot". think of it this way... 90% of the procedures you can do with your eyes closed, that doc wouldn't have a clue where to start. He also didn't seem to know the anatomy very well himself so don't take it personally. I always wanna kick myself after a confrentation like the one you had because I always think of something really snappy to say that would have been perfect ... about an hour later. Just let this one go but if there is a next time, take him aside and tell him exactly how he made you feel. :wink2:
Everyone has horror stories about finding a hiding meatus. I have even placed my index finger in the lady parts to occlude it, then try to slide the foley over the top and it usually hits the spot. Sometimes it is just buried in there. I have been in a situation with 3 people, 2 holding back the lady parts and one trying to insert the foley....with overhead lights on, a patient in trendelenburg!
As far as having your feelings hurt....if you can learn to laugh at yourself, you will find that life will treat you better. I know the situation was frustrating, but if you can find humor in things, you will live a lot longer and suffer less! I have told stories on myself that has staff howling with laughter, and chiming in on similiar situations they have found themselves in.
Nursing is a tough job. We are humans working with humans, nothing is the same from person to person, job to job. Do the best you can, and learn to lighten up.
Don't worry about the doc laughing too, I have seen plenty of them make mistakes. The ones you love are the ones who can take things in stride, not try to blame others, and just get the job done.
If you can laugh at yourself, you will find you have a lot to laugh at!
Those intra-lady partsl urinary openings (meatuses ?, meati ?) are not that unusual-- a coude cath can be useful in those situations. If you insert a sterile, gloved finger into the vault you may be able to palpate your "target". Once you locate it, hold the tip of the coude cupped in your finger and guide it in.:nuke:
We recently were struggling to cath a morbidly obese woman (500#). She could not lay flat, it took 2 staff each to flex and raise her legs (we used the ceiling lift for one). Still couldn't see much. Then one nurse was trying to spread the labia just lifted the whole mons and whalah, target located, cath inserted.
The toughest one I ever assisted with--30 something yo gal with severe genital herpes. Anatomy swollen, vesicles on top of vesicles, screaming in pain before we even touched her:uhoh21:. Doc helped us by using an opthalmoscope as a pointer.One nurse to spread, one nurse to insert. 1, 2 ,3 go! Boy, propofol would have been handy for that one.
Specializes in Cardiac, stroke, telemetry,Med-surgical.
Everyone has horror stories about finding a hiding meatus. I have even placed my index finger in the lady parts to occlude it, then try to slide the foley over the top and it usually hits the spot. Sometimes it is just buried in there. I have been in a situation with 3 people, 2 holding back the lady parts and one trying to insert the foley....with overhead lights on, a patient in trendelenburg!
As far as having your feelings hurt....if you can learn to laugh at yourself, you will find that life will treat you better. I know the situation was frustrating, but if you can find humor in things, you will live a lot longer and suffer less! I have told stories on myself that has staff howling with laughter, and chiming in on similiar situations they have found themselves in.
Nursing is a tough job. We are humans working with humans, nothing is the same from person to person, job to job. Do the best you can, and learn to lighten up.
Don't worry about the doc laughing too, I have seen plenty of them make mistakes. The ones you love are the ones who can take things in stride, not try to blame others, and just get the job done.
If you can laugh at yourself, you will find you have a lot to laugh at!
Dixielee, thanks a lot! I was laughing :chuckle while was reading your post. And it has a great advise too for a nubee like me
I'm just a student, and I haven't had the opportunity to place a catheter yet. That said, every time I've watched a fellow student place one on a female patient, they've had to do it at least twice. Once the student said she didn't feel comfortable doing a second attempt (the patient was mentally challenged and incredibly distressed by the whole situation), so our instructor tried...TWO catheters in the lady parts! It seems to me that any health care professional who would give another worker a hard time about catheter misplacement is either inexperienced or delusional.
Specializes in Cardiothoracic Transplant Telemetry.
One trick that I always use is to point the tip of the catheter UP when making the attempt. most times it will then catch the edge of the opening and slide in, even in those cases where you are flying blind and praying for luck.
Rather than trying to put the patient in full trendelenburg, I have laid them flat and elevated the legs, thus tipping the pelvis, sometimes this helps
I even had a experienced charge nurse that would put patients with difficult anatomies on a bedpan in order to tilt that pelvis.
Over the years you will learn many tricks-sometimes you need to use them all to have a hope of success
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Just let this one go but if there is a next time, take him aside and tell him exactly how he made you feel. :wink2:
BelleKat, BSN, RN
284 Posts
If his voice was lighthearted(hopefully) the others were probably chuckling because they've missed many a foley in older women. I almost asked the unit where I work for a mining helment so I could see down there. I usually have to sink one in the wrong place and I leave it there and get another so I don't do that again. We all have those days. You're doing fine.