Know Thyself: Prevent Mistakes

ne1410us, ADN, RN

I am a people pleaser. I consider it a fault at times, especially when it compromises my goals. I realized this need to be liked early in my life, and it led to an aversion to confrontation and an inability to be assertive.

I am not "quick on my feet" with verbal quips, and sometimes my silence is interpreted as concession. Being mindful of this trait, I make the effort to set boundaries at work and voice my opinions. I do lapse at times into my old habit of "not making waves" and one recent situation forced me to refocus my efforts.

I had to care for an "off-service" patient; he was a radical neck surgical post-op day zero. I had never seen this type of surgery and the night shift nurse I picked up from had care of him for only 3 hours. She also had never cared for this type of patient.

The patient had an open neck stoma, and a rubber catheter sewn into the stoma which ended in the stomach. Bulb drains surrounded his neck. I had two I.C.U. patients that day, and the neck patient was sleeping soundly when my shift began. There was a written order to suction the patient q one hour.

I questioned the night shift nurse about the order, how exactly was it to be done?

She could not answer my question, she just told me, "just leave him, he is saturating fine."

It was at this time, I should have paged the M.D.on call to clarify the order. Instead, I deferred to my co-worker's expertise since she was a more experienced nurse than I. I asked my peers on the current shift, none of them had ever cared for such a patient.

I asked the respiratory therapist who was assigned to the patient, did she know how and when to suction?

Her answer was, "just leave him; don't touch him."

The day went on; the neck patient used a writing pad to communicate his needs. I gave him pain medicine, and checked on him frequently.

Each time he answered, "I'm fine."

Then his family came to visit. They were intrusive and full of questions. To my knowledge at that time, the surgical team had yet to visit the patient. The night shift R.N. had told me that an on-call resident had seen the patient briefly that morning around 5 a.m. but did not speak to the nurse.

The family became frustrated at the situation. The complaint began with me and ended with the room's temperature and the too small screen of the television. At this time, I should have paged the M.D. on call to address the family. Instead, I did my best to accommodate the family's wishes. I did speak to the charge R.N. who notified the nursing supervisor and patient relations.

I did my best to control my patience. I had read up on the brief history of the patient's laryngeal cancer necessitating a tracheostomy only a month before. Intellectually, I knew the family was angry at the diagnosis and this was their way of dealing with the situation. Emotionally, I was ready to dump the patient on another nurse.

The surgical team finally came to see the patient that evening. I had not even suctioned the patient one time. He was in no respiratory distress but the point was moot. I was verbally disciplined quite sharply in front of my peers, and I could do nothing except agree with the doctor that it was neglectful nursing. Fortunately, the patient came to no harm.

Unfortunately, I had allowed the situation to control me, rather than the other way around. I was distracted by non-essential issues and had spent my time trying to please. The final blame lay with me, because he was my patient and my sole responsibility. This event reminded that I am in charge of my patient's environment including visitors and that my job is patient first regardless if I am to be "liked" or not.

Know Thyself: Prevent Mistakes

About ne1410us, ADN, RN

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