Looking for advice about what happened on my last shift

[RN171621]

I'm a fairly new RN on a Med-Surg unit. I've only been off orientation and on my own for 2 months. My level of anxiety for the whole day before going in to work and during my entire shift is pretty high. I'm just so terrified that something will go wrong as a result of my not noticing something wrong with my patient, etc. After last night, I feel like a horribly negligent nurse. I'm ashamed of myself, and I just wanted to hear what some other nurses thought about the situation.

During the beginning of my shift (around 2200), I helped the tech put my 80 year old obese patient on a bedpan because she told the tech she had to urinate. I went about my shift and everything seemed totally fine. She got meds from me throughout the night, we chit-chatted, I checked on her every hour, and she slept for a total of about 7 hours throughout the night. I go in to give her 0600 meds and she asks me to put her on the bed pan again, so I go to get the tech to help me since she is very hard to move. We go into the bathroom and see that the bedpan isn't in there. My heart sank. I ask if he took her off the bedpan in the beginning of the shift, he says "No, I thought you did." Well I didn't because I thought he did. Because the techs are normally the ones to handle toileting, linen changes, etc. Not that I'm unwilling to do it, I just assumed he was going back to take care of it. I'll never make that mistake again.

The thing is that I had been talking with this woman throughout the night, and it didn't seem like she was confused at all. She was coherent and didn't seem to have any sensory problems. After apologizing for someone not coming back right away to take care of it, I asked her why she didn't ask someone to take her off the bedpan, she said "Someone did take me off before, but I don't remember who." Obviously she was confused. So, bottom line: my poor patient was sitting on a bedpan from 2200 to 0600. Eight. Freaking. Hours. There was some redness and indentation on her legs and buttocks, which disappeared within an hour after taking her off the bedpan. Skin was still intact. She didn't even know she was on it... I feel absolutely terrible. I told my charge nurse as soon as I realized what had happened, and I filled out a variance report. Now I'm terrified that I'll get a call from my manager to chew me out, fire me, I don't know.

Anyway, thanks for reading, and I would really appreciate any advice, encouragement, criticism, etc.

I should also mention, before anyone tells me I'm an idiot for not assessing my patient and finding the bedpan under her, that I did my head-to-toe on her before any of this occurred.

[AJJKRN]

What about repositioning every two hours or less? Stuff happens but if you had to get help to put here on the bedpan, your HCT should have needed help to take her off as well. Better communication I think would have solved this issue.

[AJJKRN]

Prevented is a better word than solved!

[ProgressiveActivist, BSN, RN]

I had the exact same scenario happen many years ago and the marks from the fracture pan were deep.

The cna lied and said "you said you were going to do it."

I wrote the incident report and that cna, who was beyond lazy, lost his job, as he had been reported numerous times for negligence.

It happens and it is a hard lesson to learn that some people are just not to be trusted with even the simplest task.

[MPKH, BSN, RN]

I always make sure to check back on the patient to see that they're off the bedpan. Or I'll ask the NA for the characteristics of whatever the patient did on the bedpan so that "I can document it". But I think the best thing to do is just to recheck your patient after putting them on the bedpan.

[VANurse2010]

A lot of obese people tend not to notice them. I'm not being snarky - it's true!

[MunoRN, RN]

This isn't an uncommon problem, on the plus side you must have pretty comfy bedpans. There are a couple of options I've heard of that can work so long as everyone is on the same page. One is to use those lights that are often above the doors to patients rooms to signify what staff are currently in the room and instead use one of the colors to show that a patient is on a bedpan. Another is to leave the water on the sink running until the patient is taken off the bedpan, although this doesn't work with motion operating sinks.