I went against another nurse... did I make the right call?

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Specializes in PMHNP.

Ok... I started a new job and I'm still orienting to this particular hospital. I have a patient I've been caring for this week who has BPH. He retains pretty badly and there's an order in place to straight cath for any PVR over 450cc. The order states to check pvr q 12 hours. Well, I checked him at 2:30 and he voided 100cc and retained about 400. I didn't cath him for multiple reasons, including that the order calls for 450. The urologist wants him to feel the urge to go which is why they won't put a foley in (which I have asked for). He has no distention, and no discomfort. I told the nurse coming on the situation and if he stated any discomfort, check him again. Well, the nurse training me (who I wasn't very impressed with) yelled at me as I was leaving and demanded that I go and cath him before I leave. I told her why I didn't feel comfortable doing that and she got all ****** off and said, "well then I'll go do it". I said, "that's your call... I am going to follow the orders as written."

Was I wrong???

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Specializes in Hospital Education Coordinator.

of course not. Your are the patient's advocate, then the MD's order-filler. She is WAY down the list of people you need to worry about.

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Nope.

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Specializes in PMHNP.

Nope as in, I was wrong or nope as in, I was right?

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Specializes in Cardiac Telemetry, ED.

If the order states to straight cath for a PVR of 450cc, and you scan 400cc, then no, you don't straight cath. I might have encouraged this pt. to attempt to void, though.

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Specializes in PMHNP.

I did and he got out 100cc. He states it's been like this for him for years. Not to mention that all the cathing has given him hematuria pretty bad. I didn't want to cause him more trauma if I didn't need to.

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Specializes in Med/Surg, ICU, educator.
I did and he got out 100cc. He states it's been like this for him for years. Not to mention that all the cathing has given him hematuria pretty bad. I didn't want to cause him more trauma if I didn't need to.

Good call. Just because someone is precepting, doesn't mean they know it all. I will say, though, that since you are on orientation, maybe having him void and scanning him again before leaving and making a decision based on that may not have been a bad idea. But if he has hematuria, he is probably having discomfort as well. As stated before, you are the patient advocate first and foremost.

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Specializes in PMHNP.

Thanks. I'm sure there are a million and one different things I could have done differently. I checked him at ten of three and my shift ended around 3:20. I was really trying to go by what the urologist said about trying to get him to feel the sensation of having to void. I cathed him 3 days ago and he had 650 in and didn't feel a thing. He's very used to having a lot of urine in his bladder so I didn't cath him. If he was at all uncomfortable, I would have cathed him, period. I think she was just getting a kick out of bossing me around. She was a really lousy nurse based on some of the other decisions she was making... I guess I have my first enemy at my new job!

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Specializes in psych. rehab nursing, float pool.

What was the patient's bladder scan after voiding? You gave us what he bladder scanned at 2:30 before voiding but not after. If it had been me in your situation. I would have told my preceptor yes, I will scan him again and if he is 450cc I will cath as per doctors order. I do not believe in splitting hairs in a ******* contest.

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Specializes in PMHNP.

At 2:45 He urinated 100ccs. I then scanned him and found 400ccs left over. My shift ends at 3 so this was done at the end of my shift. I wasn't trying to split hairs, I was trying to avoid causing my patient more harm by straight cathing him. He has had multiple UTI's (And has one currently) because people are so quick to cath him. If I were the nurse coming on I would have taken my report and monitored him throughout my shift. If it seemed like he was in pain and unable to void, I would call the doc. I know this patient and that wouldn't have been the case. He would have continued to void small amounts and probably never exceed 450.

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Specializes in Med/Surg, Home Health.

I think you did the right thing. You followed orders and put your patient first.

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Specializes in PMHNP.

Thank you everyone for replying. I know in my mind I was trying to do right by the patient but I just wanted to hear from other nurses that I in fact did. Thinking of it now, (as I have been all night), I'm wondering if the nurse coming on complained because she might have to do it later herself. I assure you I wasn't being lazy, I've cathed him a million times and I don't mind doing it. In fact, I would rather do it than have someone else do it because I'm really gentle! I guess I could sit here and perseverate over it all night or let it go and see what happens when I go back on Monday. :jester:

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