I am a new grad RN, working 12 hour nights, fresh off orientation with a lot to learn. Beware, this might be a novel-sized post here.
Last night I received word from my charge RN that he needed to speak with me. He stated that the charge RNs got an email from a physician who basically stated that I neglected my pt from the day prior. The MD stated that my pt had vomited all over her sternal dressing, ab binder and gown and that I let it sit for over 3 hours. I checked on my pt q 1 hr during my shift and she felt nauseous but never vomited.
She was having profuse serous drainage from an open sternal wound. The MD had removed one JP because it hadn't been working properly but left another in. He also applied a dressing. The evening shift nurse reported to me that he had not touched it. At the beginning of my shift, I noticed drainage (not from the JP but the wound itself) had soaked completely through the dressing, ab binder and to the gown. I changed the dressing, packed the wound per MD order and charted accordingly. The order was for a dressing change BID. Unfortunately, I didn't know I could order a new abdominal binder and due to the complexity of her other issues the idea slipped my mind, despite the binder being stained with serous fluid. Additionally, due to my stupidity, I didn't realize I could change the dressing PRN despite the order being written BID.
Towards the end of my shift I noticed that she needed another dressing change. I gave report to the day shift RN that my pt needed a dressing change. After report I went back to my pt's room to f/u on pain meds. I took one last look at her dressing when a PA I was unfamiliar with came in. I asked him to take a look at her sternum because the wound looked macerated. He seemed very uneasy and somewhat reluctant to look at it but agreed anyway. I showed him the wound and stated that day shift would be changing the dressing soon. I am wondering if he was inexperienced and confused the moisture with emesis, though he never asked about nausea or emesis. The area under the dressing was incredibly moist with serous drainage and I strongly regret not changing that dressing there and then myself.
My charge nurse just asked for "my side" of the story and told me that he'd let the other charge RN know. He also made some comment about how that particular MD was mad at the unit about something else. But I don't know. I am so scared. The anxiety from this I am afraid may have effected my performance tonight.
I feel like a horrible nurse. What if it was emesis and not serous fluid on that particular part of the binder/gown? She told the MD during the AM she had vomited at 0430 but during my rounds she denied emesis and I didn't see anything on her binder except for the previous dried stain.
I am probably being paranoid, but I am really afraid I might get fired.
Any thoughts or pieces of advice for future reference would be greatly appreciated. As an experienced RN what would you have done in this situation?
