I blame nursing school for beating the "reflection dead horse". However, on this particular day where I needed to straight cath an 88 yo woman, I found myself with all kinds of new reflections.
As a brand spanking new nurse in the ED, I feel that every day is trial by fire as I make tiny mistakes everyday. For example: 1) changing IV maintenance bags from the pole and forgetting to clamp resulting in fluids pouring all over me, 2) starting IV's and forgetting to apply distal pressure leading to a bloodbath, 3) removing an IO for the first time, accidentally scraping my hand with the needle (not sure it happened but I was required to check in), and being admitted to the ED as a patient for needle stick precautions.
It's overwhelming and terrible at times.
But I keep coming back. And I never make the same mistake twice. Usually.
My patient was being worked up after having three GLF. I had already made another mistake earlier in the day with her IV. I succeeded in putting an 18g IV in her RAC. I drew her labs and left the room to send them. Yet when I returned, the catheter was hanging out. The patient was alert and oriented x4 and her neighbor was in the room. Both denied messing with the IV. Regretting my decision not to stat lock, I put in another line (without a bloodbath).
We also needed a urine specimen. Since she was incontinent and the likelihood of acquiring a midstream uncontaminated sample was low, the only option was to straight cath. I found my preceptor and she agreed to assist with the procedure. Since the patient expressed her urgent need to go, my preceptor suggested using a bigger 14fr because it would drain faster. I washed my hands. I set up my sterile field. I had my life reflections. I was ready to go. The opening was visible and I cleaned enough to make 'Monica' from Friends proud. And then I inserted the tube.
Nothing. I start to inch the tube farther and farther in. I'm starting to get concerned when it's taking longer than usual. My patient is calmly watching basketball on the TV. She denies any pain. I keep advancing. It's in as far as a male. Still no drainage. I'm thinking it has to be in the bladder curled up. I wonder can it possibly be in the ureter?
She would have to be yelling right?
She suddenly yells something and I look up. She's mad at the TV and still denies pain. There's nowhere left for my tube to go and I look at my preceptor. She shrugs and says it's in the vagina.
We leave the tube in. I repeat the setup and I'm all ready to go again. I assess the area and..... there's nowhere to go. I feel ridiculous telling my preceptor that but I do. We turn on the overhead light. She points to an area and I try to access it and the tube curls right back. My preceptor opens another kit (she doesn't have life reflections) and we open the site as wide as possible. We see another hole that we both agree is, quite clearly, the vagina. I remove the first tube, my preceptor repeats the cleaning, and inserts the smaller tube and urine streams out. Apparently, big tubes aren't always the best tubes.
At the end of the day, I felt pretty defeated. I apologized several times to my patient for my mistakes and she only laughed. She told me I had done a wonderful job simply by listening throughout the day. She told me she felt comfortable and safe under my care. In fact, she told me that several times before she was discharged home. Now, I'm not one who 'fishes for compliments'. However, it made me realize how much I undervalued the non-technical skills I had performed. It's interesting because it's not 'doing the skills' that bring me back to the ED. The humor, the wit, the stories, the empathy, the being able to turn one of someone's worst day into something manageable,... those are what brings me back. Hope you think about that the next time you shove a tube up someone.