that you lived through and still kept your license?
Last night was horrible. I work the 11-7 shift and I'm a fairly new nurse (about a year of full time work) Anyway, I brushed off a patients symptoms as "normal" for his dying/disease process and that is apparently the WRONG thing to do. He had an order for suctioning PRN and had been gurgling for many days now~ it was my first time on that hall and my 2nd day back at this facility after originally quitting for other reasons. I know the nurse the previous night had to suction him and was nervous because the daughter was in the room. Last night, I didn't think anything of the gurgling. I suctioned but he fought so I stopped, I attemped a neb but he took off the mask. I sat him up higher and turned down the air and he almost yanks out his g-tube. He is/was on hospice support but was not a DNR. I didn't think his condition was any worse really so I didn't act on it. The patient went from groaning and combative early in the night and trying to yank out his g-tube (all common things for him) with stable VS to respiratiory distress by the end of the shift and an O2 sat of 2.. yes 2. The nursing superv walked in to find him and called for a crash cart because he had so much discharge coming from his mouth. I had just finished a crazy med pass that I started at 5 but had only taken a 7 minute lunch because the rest of the night was filled with pt drama. I didn't check on him during my medpass and that's when it got even worse.
*** He had orders for everything from anxiety to restlessness to sleeping to excess secretions ect***
I feel useless and like a failure for letting the facility and my peers down as well at this man and his family (that I couldn't get a hold because both numbers were disconnected). I feel like I'll be the "talk" of the facility for the next few weeks and there will always be those who lie or make themselves appear better to make me seem 100% incompetent. I don't want to show my face there again but I have 3 more days this week. I don't want to lose my nursing license and I don't want the CNA's to lose trust in me as a nurse. I'm really beating myself up over this but you can bet I'd never make that same mistake again.
Who knows if the hospital can save him now? I sure don't.
Any words of wisdom or stories to share so I don't feel alone in my lack of nursing experience?
Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.
What!? Don't beat yourself up about this-- Look at all those interventions you did. Go back to work feeling confident. Now you know that hospice is on-call and you can always notify them of pt changes and for advice.
To share an embarassing story: One time as a brand new nurse I was working night shift and a pt was in bed moaning like a ghost, flailing her arms, eyes rolling around in her head... I was like *** is this? The pt is normally alert and oriented. Tried to get her to look at me or answer me and she wouldn't. 3 of us were holding her down so she wouldn't roll out the door. When I notified the on-call MD to get orders to send to ER I said "I have a pt that is flailing her arms and legs in giant circles, moaning rolling her eyes and unresponsive and I cannot figure out what the problem is." The MD says real sarcastically "Ok she is moaning and thrashing about and unresponsive, I didn't know that was possible...." Of course by unresponsive I meant she was not oriented at all but he made me feel like an idiot. MD gave orders to send to ER since she was a dialysis pt. EMT's came and asked what her Bg was. I didn't even think to take it, I was thinking it was ESRD related or aneurysm or some type of seizure.... I took it then on the spot... 46! I gave some IM glucagon and spared her the trip to the ER. The EMT's walked out with the empty stretcher looking real annoyed for that uneccesary trip. I can't believe I didn't look into her chart past the ESRD to see type 2 diabetes. :imbar Lesson learned.
I agree with cape cod mermaid. I am a new nurse as well, and my second day on the job i had a brittle diabetic be non responsive with a blood sugar of 74 and stable vs . What i didnt know was the woman normally ran between the low 300's and high 600's. Chalk it up to a learning experience
Specializes in Adult and Pediatric Vascular Access, Paramedic.
hi,
sorrry you had a bad shift
I am a little concerned that patient was on hospice, but not a DNR. That makes absolutely no sense what so ever. If you on hospice it means you want to go see god, not be resucitated. Sounds liek this gentlemes had pulmonary edema.
Anyway you should be concerned that your facility is having patients on hospice who are not DNR status, that should not happen. If a paitent is on hospice they do not want to be resucitated.
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
I don't think you should beat yourself up about this situation. LTCs are notoriously short staffed and they load up nurses with an unreasonable amount of patients. There is no time for anything to go wrong. A safe med pass can only be accomplished if nothing out of the ordinary happens. Unfortunately in healthcare something out of the ordinary is always happening. When I worked LTC I used to care for someone who had frequent seizures. Invariably he would seize during my 2100 med pass. I couldn't very well leave him alone. Neither could I pass all my meds late. Heaven forbid there would be a patient fall during the same med pass. I just point this out to say that you have other patients that you have to think about.
I wish that LTCs would hire float nurses whose sole responsibility is to respond to patient events--falls, change in LOC, etc. This would help the floor nurses to continue to care for the other patients. I'm sorry that you had such a bad experience. To me it sounds like you did what you could do. Its unfortunate that patients pay so much to receive care in nursing homes and they just don't get the staffing that they deserve.
I don't think anything you did or didn't do could cost you your license. You attempted to suction and he refused. Were you absent the day they taught fortune telling in nursing school? We all make mistakes and hind sight is ,as they say, 20/20. Lesson to be learned...if you have a big floor with a hard med pass and one patient needs extra attention--call your supervisor. Most of the patients take way too many meds and most of them wouldn't be harmed by missing any or getting them late. Sometimes you just have to prioritize your tasks. Don't beat yourself up over this please.
I totally agree with CapeCodMermaid. Let me add document that you attempted all of these interventions and the residents response. In your case it was a clear refusal. I would have to agree with the OP that asked if the probe was even on the resident with an O2 sat of 2. I never heard of someone being that low.
Once the nurse super found the resident at 7am like this, she called for backup and a crash cart and told someone to call 911.. everyone ran down with her so I ran the other way to call~ I was the only one who ran to call and no one asked if 911 was called for about 5 min into the whole ordeal.
As I was getting the vitals from down the hall to tell the operator, they were saying his BP was 195/136 (of course they used a digital wrist cuff) and his pulse was 126- again from a battery operated wrist cuff.. the respirations were something like 30+ and temp was a normal range but I don't remember. I remember the BP because I was surprised at the number.. I know things can change fast. 3 hrs earlier, he was 134/90 with a 96 pulse rate and normal resp. In the whole ordeal, I heard the super go he has an o2 sat of TWO. I thought what? 2? The the other super from the other hall said "2? He's a goner." I have no idea since I wasn't in the room. Could drowning in his own secretions cause such a low 02 sat?
Of course as I was on the phone with EMS, someone from the other side of the building was like "why was it never announced over the PA". I mean seriously. I know the have a protocol but there were literally 4 nurses, 1 nurse super, 3 CNA's and 2 experienced nurse orientees in the room. If I get questioned about that I'll tell them that no one else came the nurses station to make calls- only me and I thought 911 was more impt knowing enough staff was in there. Argh!
I go back to work tonight so I'm going to feel like a sheep. This situation made me realize I do not know the paperwork needed to send someone else for this facility. I guess I'd better ask as each place is different.
Specializes in Gerontology, Med surg, Home Health.
Being on hospice does not,as one poster wrote, mean you want to go see God. This is archaic thinking. Hospice is a wonderful benefit for people who are near the end of life but this doesn't mean they can't still have quality. Hospice patients no longer have to be DNRs..get over it. That's the way it is.
Being a nurse in a long term care unit for 5 years and having 60 patients and working nights. We all make mistakes in everyway. Charting is a major thing you need to remember. One of my good friend who is a nurse was accused of placing a foley catheter in someone and into the urethra with the ballon inflated. This happen at shift change. She informed them the catheter was placed and needed a U/A she was coming off duty and giving report to a new nurse, RN, and the other nurse on the other side. We have to wings to the LTC A hall and B hall.
They never checked the foley catheter until four hours later. The resident needed assistants with all ADL's. The resident needed an IV, feed breakfast, and turned and repositioned and changed that morning. The resident was uncooperative and was not happy about the catheter being placed. They never noticed the resident did not have any out put until four hours later. The resident was sent to the ER because of trauma to the urethra.The nurse on the other shift deflated the balloon and red color substance flowed out of the bag. Now the nurse is being accoused of not knowing what she was doing and required to take a inservice on catheter insertion by the facility. Even though she had inserted the catheter to the hub and received rust colored pinkish slough colored output and inserted 10 mls of sterile water into the ballon. Removed a foley catheter before inserting the new one which was full of rust colored particles and pinkish colored slough. My friend charted everything she did. I don't know how she is doing at the present time. This just happened to her. She has been a LPN for 6 years and has inserted a lot of foley catheters in her job duty and this is the first for her being accoused she does not know what she is doing. She wonders if when the resident was transferred or repositioned did someone pull the catheter further into the urethra. Because the two new cna's came into the room after she was done to repositon the resident and turn him. Could this have happened? Now I am worried about my friend.:urgycld:But she did chart perfectly:flowersfo
Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.
i've read your post like 10 times and still cannot decipher what happened.
she cathed the resident, got this funky return and didn't notify the md? maybe that's what she's in trouble for. and what is slough colored output?
yeah catheters can be pulled out, but i've never heard of anyone cathing a pt with an inflated balloon.
why was the pt sent to the er? was she bleeding profusely after the removal by the 2nd shift?
received rust colored pinkish slough colored output and inserted 10 mls of sterile water into the ballon. removed a foley catheter before inserting the new one which was full of rust colored particles and pinkish colored slough.
I too am confused about what happened, but I really don't think a foley can be inserted with a 10cc balloon inflated. Think about doing it, you wouldn,t notice when it wouldn't insert that the balloon was already full? Something doesn't add up. I hope your friend is a detailed documenter. No output? Many people were not doing their job.
I think what this poster is trying to say is that it's suspected that the nurse didn't insert the catheter far enough and that she inflated the balloon while it was in the urethra instead of the bladder, which caused trauma.
I think she's asking if perhaps the balloon was inflated in the bladder and it was then pulled down into the urethra later while the CNAs were giving care or repositioning the patient.
It sounds like instead of urine the nurse got some kind of sloughy discharge and assumed she was the bladder.
I was taught to insert the catheter on a male all the way the the Y (even if you already have urine return) then inflate balloon and gently pull to verify placement in the bladder.
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
I was taught to insert the catheter on a male all the way the the Y (even if you already have urine return) then inflate balloon and gently pull to verify placement in the bladder.
Inserting all the way to the Y even after urine return seems unwise to me. I once cared for a patient with a fistula between her bladder and lady parts. When I inserted her suprapubic foley it came out her lady parts. Very alarming thing for a new grad to do! Anyway, this is just to point out that it would be very damaging to insert a foley into a fistula or ureter and then inflate the balloon! You are inflating the balloon "blind" so to speak. I want to be as close to 100% sure as possible that I am in the bladder when I inflate that balloon. Generally I wait for the first flash of urine return and then advance another 1-2 inches. Then I slowly inflate the balloon.
Now I am worried about my friend.:urgycld:But she did chart perfectly:flowersfo
Very alarming thing for a new grad to do! Anyway, this is just to point out that it would be very damaging to insert a foley into a fistula or ureter and then inflate the balloon! You are inflating the balloon "blind" so to speak. I want to be as close to 100% sure as possible that I am in the bladder when I inflate that balloon. Generally I wait for the first flash of urine return and then advance another 1-2 inches. Then I slowly inflate the balloon.
pielęgniarka, RN
490 Posts
What!? Don't beat yourself up about this-- Look at all those interventions you did. Go back to work feeling confident. Now you know that hospice is on-call and you can always notify them of pt changes and for advice.
To share an embarassing story: One time as a brand new nurse I was working night shift and a pt was in bed moaning like a ghost, flailing her arms, eyes rolling around in her head... I was like *** is this? The pt is normally alert and oriented. Tried to get her to look at me or answer me and she wouldn't. 3 of us were holding her down so she wouldn't roll out the door. When I notified the on-call MD to get orders to send to ER I said "I have a pt that is flailing her arms and legs in giant circles, moaning rolling her eyes and unresponsive and I cannot figure out what the problem is." The MD says real sarcastically "Ok she is moaning and thrashing about and unresponsive, I didn't know that was possible...." Of course by unresponsive I meant she was not oriented at all but he made me feel like an idiot. MD gave orders to send to ER since she was a dialysis pt. EMT's came and asked what her Bg was. I didn't even think to take it, I was thinking it was ESRD related or aneurysm or some type of seizure.... I took it then on the spot... 46! I gave some IM glucagon and spared her the trip to the ER. The EMT's walked out with the empty stretcher looking real annoyed for that uneccesary trip. I can't believe I didn't look into her chart past the ESRD to see type 2 diabetes. :imbar Lesson learned.