New to the ICU setting and to a radical neck surgery post-operative patient; I allowed emotions to cloud critical thinking and it led to possible harm to the patient. Knowing my tendency to please others reminds to me focus on patient priorities.
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.
Specializes in Trauma Icu, circulating or daysurgery.
I think I would have an issue with this doctor as well. There is no need for public humiliation. The nurse with the order should have followed up on it in the first place. I'm guessing because of the increased risk for secretions and the more increased risk for those secretion drying and plugging his stoma as the reasoning for the suction. But q 1 hour seems extreme. I would have based it on his breath sounds as well as his O2, but as long as the patient wasn't compromised. Now if the patient was in RD and you failed to suction yeah, I get that. Or if he was becoming increasingly more coorifice because he wasn't getting stuff out, well we are supposed to be the proactive bunch. But just because the doctor was an ass.....no. Being a people pleaser had nothing to do with it, you honestly did not know how, and no one was there to educate you. Thats the hospitals wrong, not yours. In my humble opinion.
Oh yeah, I've made plenty of mistakes in my 15 years of nursing as we all have...we are human. I've been in the critical care areas for the last 10 years. But, I made a lot of mistakes my last shift caring for my ICU patient. I have a had a worsening back ache for 2 weeks now and was diagnosed with a lumbar facet inflammation on 2 lumbar vertebrae and was told it was caused by all the lifting/turning/pulling/ pushing I do at my ICU job. On this night, I go to work with my back brace/ice pack and a 3-4/10 pain which progressively got up to about an 8/10. I started physically slowing down soon after the start of my night shift but didn't realize it b/c I kept thinking I could handle it while at the same time wondering if I'm gonna make it..I know it sounds totally crazy. Made alot of mistakes with this one patient...giving meds late, not checking a H/H for several hours afterwards which he needed blood, not covering a bsg until 3 hours later, not turning, and worst of all..there was a medication in the e-mar listed as intravenous for which I was about to deliver intravenous when the resp. therapist stops me to tell me it is supposed to be given via inhalation then showed me the 'xx' on the e-mar which means by resp. therapy. I didn't keep up with my VS charting, paperwork or anything that I normally would have had already done several hours earlier. The real bad thing is that I didn't realize I was so far behind and that I was missing stuff left and right until the charge nurse comes to help me and starts asking me about this stuff. I couldn't focus, pay attention, concentrate, I wriggled around in my chair trying to chart but could barely do that even after giving report to leave. I will probably get written up and possibly fired for endangering a patient. I wouldn't blame them.
rcd9229
11 Posts
I think I would have an issue with this doctor as well. There is no need for public humiliation. The nurse with the order should have followed up on it in the first place. I'm guessing because of the increased risk for secretions and the more increased risk for those secretion drying and plugging his stoma as the reasoning for the suction. But q 1 hour seems extreme. I would have based it on his breath sounds as well as his O2, but as long as the patient wasn't compromised. Now if the patient was in RD and you failed to suction yeah, I get that. Or if he was becoming increasingly more coorifice because he wasn't getting stuff out, well we are supposed to be the proactive bunch. But just because the doctor was an ass.....no. Being a people pleaser had nothing to do with it, you honestly did not know how, and no one was there to educate you. Thats the hospitals wrong, not yours. In my humble opinion.