Questioning "gut instincts"

Mulan · Aug 10, 2005

Some nursing homes won't accept patients with a foley or an IV access, found out when calling report, so in that case they had to be taken out before going back to the nursing home.

rn/writer, RN · Aug 10, 2005

Don't waste time kicking yourself. Your gut is one of the most important assets you have as a nurse.

With the benefit of your hindsight, I'd say it might have been better to transport the pt. with the foley in if there had been any chance of incontinence along the way. And you might have taken a set of vitals, in case a doc had to be called or to get the charge nurse up to speed. Perhaps an EKG or even a monitor strip from a defib unit could have provided some reassurance that there were no obvious irregularities going on, but you might have needed an order for that.

I can't see anything in your narative that violated any nursing principles. Most important, when you came up against a hinky situation, you called in the charge nurse--which is exactly what you are supposed to do. If you were expected to know how to handle everything, there wouldn't need to be a charge nurse. They get paid the extra bucks to make those tough calls. And it's always a tough call when you have someone who is chronically mentally impaired making a physical complaint. There's that nagging fear that even though Nelly has been out of her tree for years, the one time you don't take her seriously is the time she'll code in the back of the ambo on the way to the nursing home.

Had I been in your shoes and known exactly what to do, I STILL would have called the charge nurse (and maybe just talked the situation over on the phone) as a CYA maneuver.

Keep breathing. Live and learn. If and when you are the charge nurse, remember how you're feeling now and be a good teacher and advocate both for your patients and for the staff nurses under you.

This, too, shall pass.

Take care,

Miranda

UM Review RN, ASN, RN · Aug 10, 2005

Grinnurse, the rule in any nursing environment (including this one) is, "Ask and ye shall receive...at least fifteen different answers." :chuckle

Here's mine:

First of all, you were correct to inform your charge nurse. You had no idea that the patient was going to change horses in midstream and c/o pain in varying areas of her body after c/o chest pain initially. Even AD patients can have an AMI and you know that or you wouldn't have called for backup. So you took action appropriately and as a result, you're covered.

The Charge really didn't need to comment on the Foley in the first place, but since she did criticize you for doing what a lot of nurses would, it might be helpful for your case to find out if there's a hospital policy floating around somewhere to back you up on this.

In the meantime, I could back you up if you worked at my hospital. Our hospital policy is to DC Foley caths and heplocks prior to discharge, unless specifically ordered to leave them in. We usually try to DC the Foley with time enough to assure that the patient is able to void on his own and not immediately before transfer.

The heplock is DC'd immediately before transfer because we've had patients take a turn for the worse and need to be readmitted, sometimes just as they were leaving the unit.

Hope that helped. Don't beat yourself up over it, because you did nothing wrong IMHO. :icon_hug:

grinnurse, RN · Aug 11, 2005

Thanks Angie, RNwriter and Mulan for responding.

Before d/c F/C I usually do it where there will be plenty of time to make sure voiding is good but the EMTs were slow that day and as it happened, were in ER finishing up so came directly to the floor.

Vitals were great actually and in my hospital I can call for EKG and then get order signed and I thought about doing that but once I got a look at her vitals and other criteria when assessing I didn't think it was necessary.

I had 3 different preceptors and all 3 had different ways of doing things as you can well imagine and I was trying to do what was safe for the patient. I am glad that I called the charge nurse but it is so frustrating when they get upset b/c you don't know what to do at all times!! Or they make comments on how they would have done something when you are doing something the way you were taught by someone else. This is the exact reason why I guess they say nursing is such a grey area. I will just be so happy if I survive this first year without jumping out the window or doing bodily harm to myself :rotfl: :rotfl:

Thanks again for the comments, they are always appreciated!!

Bird2 · Aug 11, 2005

Here is the LTC perspective. We perfer the pt not have a foley r/t it putting them at a high risk for infection. BUT we assess why they need or do not need the foley when they return to the LTC. CMS guidelines are rather strict reguarding appropriate reasons for a foley cath. It is easier for you to leave it to the LTC to remove. This way we can remove it and monitor for retention.

grinnurse, RN · Aug 12, 2005

Hi Bird2-that makes perfect sense. What if something went wrong in between the hosp and the NH (pulled out when inflated etc.,) whose responsibility would it be then? Once my pt is released to whomever it is taking them, does my responsibility end? This probably sounds like a dumb question but I don't know the answer to it. Thanks for the tidbit!!

Bird2 · Aug 12, 2005

Hi Bird2-that makes perfect sense. What if something went wrong in between the hosp and the NH (pulled out when inflated etc.,) whose responsibility would it be then? Once my pt is released to whomever it is taking them, does my responsibility end? This probably sounds like a dumb question but I don't know the answer to it. Thanks for the tidbit!!

Once she leaves the hospital then you are done. The resposibility is the ambulance crew or who ever is doing the transferring because that pt was discharged from your facility. Have a great day.

grinnurse, RN · Aug 12, 2005

Thanks Bird2 and you have a great day as well.