I feel so incompetent!

canesdukegirl, BSN, RN · May 11, 2012

Where were the JP drains? Abdomen? Did you check for bowel sounds as part of your assessment?

When you are getting report from the OR, they should tell you:

Pt name, age, surgeon, procedure

What kind of anesthesia was used, (i.e., general, MAC, or local)

Any type of drain placed

Foley present-if not, then when it was pulled

Dressings

Isolation precautions

Allergies

If something is missed in report, you can always look at the intraoperative report, which breaks down every part of the surgery. There is usually a section documenting drains.

amoLucia · May 11, 2012

Your supervisor was right, it was your responsibility to thoroughly check. Take this as an opportunity to keep on learning! (I look up things that I see on this site almost daily.) And if it's any better, it's probably not incompetence, you just felt dumb (as in embarrassed). Take my word for this, we've all been there with you - and if someone pretends that it hasn't happened, just think 'LIAR, LIAR, PANTS ON FIRE'! :loveya:

sauconyrunner · May 11, 2012

Welcome to the club. I just started a new job and I get embarrassed almost daily by a variety of people, things I dont know,etc. Part of my job is to go one rounds with the ICU docs. One Doc always asks me questions he knows the answers to, to trip me up. I get all red in the face and tell him I'm going to look it up. A lot of times the questions are things that don't actually apply to my job....so I am not even supposed to know. I'm learning to smile a lot and say, Yup I'll know that next time.

I bet you will never send a pt to the floor without a really thorough inspection again!!!! Lesson learned and pretty painless, since the drain did not get pulled out or anything....:)

luckynurse_1234 · May 12, 2012

Thanks guys i feel like now i will alll but strip search the patient it was a rookie mistake and probably won't ever forget it :) and several people told me don't ever take the OR's word on dressings!

Morainey, BSN, RN · May 12, 2012

Ha. I missed an ostomy once. It wasn't mentioned to me in report (excuses, I know!) and the patient DID look at me pretty funny when I asked if she had moved her bowels since surgery. I'm pretty special sometimes. At least I figured it out before the end of the shift!

tcvnurse, BSN, RN · May 12, 2012

I had a social worker once document bilat BKA on a paraplegic. He couldn't move his legs but they were there!

You should always always do you own assessment because the nurse in front of you could have missed something. As you have already realized. :) Dont beat yourself up, just think, OK lesson learned.

canesdukegirl, BSN, RN · May 12, 2012

We ALL make silly mistakes. But we all learn from them too. Nobody came out of the womb with all the answers...well, with the exception of Steven Colbert.

allnurses Guide · May 12, 2012

Lord, if I wrote here all the things I have missed in the last few months you'd feel much better about yourself. :lol2:

The hardest part is not torturing myself with it on my days off and wondering what everyone must think of me. I assume most of the day nurses dread getting report from me given how much I miss/don't get done on my shift, even the ones where I didn't get a lunch due to busting my hiney all night.

I just keep praying it gets better.

sauconyrunner · May 12, 2012

I got report from a Nurse once which included, "I dont really know whats up with the crutches in her room" I peeked into the room and replied, "Could it be that she has only one leg?" THat Nurse was mortified.

Meriwhen, ASN, BSN, MSN, RN · May 12, 2012

The OR should have told you about the drain...that being said, you should always check the patient for yourself even if the report included everything.

Hang in there!

CheesePotato, BSN, RN · May 12, 2012

Today, i missed the fact a patient had a JP drain. I am a newish med-surg murse (1.5 yrs) and just switched to PACU. This is my 1st week off orientation the OR told me the patient had 2 lap sites and i looked and saw them so i didn't look any further. When we transferred him to the med-surg floor i discovered he had a jp drain as he moved from the stretcher. Nothing was documented as far as wounds from OR. My sup said well that is why you check head to toe and shrugged.

Bad OR nurse! No cookie!

I am sorry that the report you received from the OR staff was rubbish and in all seriousness, incomplete documentation ought not to be tolerated. My heaven help me, the drain is one of the most important things to be discussed--something about sudden bright red output, needing to emergently return to the OR and all that being important. I dunno.

Do not be afraid to stop the OR nurse and demand a proper bedside report. Frankly, both nurses should be looking at the wound together and discussing what took place during the procedure.

The good news? For the rest of eternity, anytime you get a patient in PACU, you will never forget to ask, "Any drains?"

As far as trusting the OR staff about dressings, you will quickly learn which nurses are spot on and which are not, sad to say.

For the most part, the OR nurses do their best to be accurate as we are the ones that know what lies between the wound and the outside world which can give you an idea as to whether to call the surgeon (red output soaking through xeroform, 4 x 4, fluffs, abd x 3, webril and an ace wrap), or hold your horses and reinforce (red out put soaking through steri steristips and a singular wimpy 3 x 3).

If you notice a trend of a particular nurse that skimps on this bit of info, please let the supervisors know so they can relay feedback appropriately.

Cheers!