First off, I'm six months in. I know just enough to know that I know nothing. I did well in school, but now I'm second-guessing myself a lot and it is interrupting my sleep. I don't even know if what I'm stressing about really is something that was worth worrying about, or if I'm making mountains out of molehills.
Three nights ago I was giving report on a patient that had been on our unit for about a week. She had a perforated bowel that had been corrected, which involved several drains (most of which by this time were clamped) and many rounds of IV antibiotics and ongoing IV fluid. Our unit doesn't generally have patients with bowel preforations, but the hospital was full and so we got a lot of med-surg overflow. Despite not being our usual patient, I think we had been handing her needs pretty well. This patient had been on a normal diet for a few days and had a foley catheter out two days prior. The previous day, she suddenly started having diarrhea all day and chose not to eat at all because of the diarrhea. Day shift notified the physician who said to start measuring all output and notify in 24 hours if diarrhea is ongoing.
When I got shift report for the night shift on this patient, she was exhausted. All she wanted to do was sleep. The physician was at the bedside when I took report, so I made sure that he was updated everything I got in report and he seemed unconcerned. No new orders, just some discontinued ones that were no longer pertinent, but nothing regarding output - just monitor. I got the patient comfortable and let her sleep, beyond the usual interruptions to hang antibiotics and take vitals, etc. It was a really busy shift and we were understaffed so we each had 1-2 more patients than usual for this unit and mine were particularly needly. At 5 AM, I noticed that she hadn't had any output at all this shift, neither urine nor stool. I asked her if she needed to use the bathroom when I hung the 5 AM antibiotics, but she said she didn't need to yet. IV fluids were running all night at 75 mL/hr, with 200 mL/hr intermittent antibiotics. I mentioned it to my charge and she said not to worry about it but to let day shift know.
I somehow got everything that needed to be done taken care of with my other patients and felt great going into report. The patient with the perforated bowel was my last one to hand off. The nurse that I handed off to seemed very upset about the lack of output. She wanted to know why I hadn't notified the physician, why I hadn't bladder scanned the patient, why I hadn't just gotten the patient up and forced her to use the bathroom. All I could say is "I'm sorry" over and over again and I felt awful. I knew that a bladder scan was warranted, but I honestly was racing to get all the other stuff done, and it slipped my mind. The ongoing nurse looked at the previous day shift totals and was pointing to the unmeasured output, but completely ignoring the measured stools and telling me that the patient hasn't had enough output of any kind. I remember the day shift CNA mentioning that neither she nor the patient knew if urine was mixed with stool in those measured occurrences, so it was measured as stool only as a "best guess". I can't remember exact totals, but it was over 2000 mL. Then the ongoing nurse was asking me why a C-diff test hadn't been done. I could only answer that there hadn't been any output my shift. When we went into the patient's room together, she continued to talk about the problem of the low output and that I should have gotten the patient up. This was in front of the patient, and I felt like I was being humiliated purposely. The patient was still groggy from being abruptly woken and stated that she really didn't need to pee yet, but might be able to in a couple of hours. This nurse also went on to correct me on how to properly clamp these particular drains, which had been managed the same way by 4 other experienced nurses earlier in the week. Again, her attitude was suggesting to me (and to the patient) that I was incompetent.
I haven't been back to work, but this has been on my mind the entire three days since work. All I could think about was that it might have been dumping syndrome, but how do you even manage dumping syndrome? It might have been dehydration which is entirely reasonable with diarrhea, but I know that I checked oral mucous membranes and there were IV fluids running all night. I know that lots of patients just pee less at night and I know she peed just before I took report on her. I work again tonight and I dread interacting with that day shift nurse. She has a pretty stern demeanor and is generally difficult to read. I have seen her straight up bully other new nurses, but I've not been on the receiving end of that kind of treatment. I'm also dreading being in this patient's room, if she's even still there, because I feel like our raport was shattered.
I'm just a nervous wreck and I haven't really slept well because I keep thinking about this. I can't shake the feeling that I really screwed up here.