Tell me this doesn't happen all the time.

[grannyrn65]

This past week my daughter had to go into the hospital for some female surgery. I didn't accompany her because her husband was able to and because she had been scheduled for 12:30PM. I called her, at 9AM to wish her luck, when my oldest granddaughter told me, her surgery had been moved up to 8AM. Unless something bad happened, I expected to talk with my SIL in the evening. Before saying anything more, my daughter does not like to stay in hospitals. She always ask for the earliest possible discharge time. She was admitted overnight. She saw a nurse when they made rounds to change shift 7PM. And when she asked for the foley to be removed. No one check her op sites or her packing. And when it half dropped out, the nurse grabbed it and jerked it out. She did have an IV but it was never checked. It inflitrated and she had to call for someone to remove it. Needless to say, by 10:30AM she was ready to flee.

I haven't worked on a surg. unit in twenty years but I am appalled at the lack of care she received. Because this hospital is a for profit I am encouraging her to write a letter to corporate headquarters. I was a patient, in the same hospital last Christmas. And I received excellent care. My status was assessed several times a shift. I saw my nurse regularly. My care was excellent.

Is the norm for a surgical unit or an overnight patient?

GrannyRN65

[etaoinshrdluRN]

Sounds like plain old shoddy care to me. My son just had an emergency appendectomy last August and the care was superb. My only gripe (which I let the mgmt know about) was a nurse whop wanted him to walk before getting his MS dose.

How tough is it to assess a wound or an IV site? Hope they hear you.

[carolmaccas66, BSN, RN]

Defintely not the norm! I quite often work on med/surg floors and am diligent with observation times & wound charting, etc. I check my patients every 15 minutes (some even c/o being interrupted all the time on their mobiles!) And no nurse should be 'grabbing and jerking' out a dressing! What about aseptic technique?

My mother was in our hometown country hospital and left in a bed for about 2 shifts, haemorraghing and c/o pain which none of the slack nurses did anything about. She demanded a phone and rang my Dad who came and got her out. She roundly told all of those nurses what she thought of them. We complained but because the hosp was govt funded, nothing happened. I worked back there 22 years later & nothing had changed! The same old, tired and old-fashioned people have 'run' this hosp for decades and the standards are very low.

These are the sort of nurses who give hospitals a bad name. I'm sure the corporate body would want to hear of this. I encourage you to speak to them and the NM in charge of that unit. I'm sorry she had to go through this, especially after sensitive, female surgery which is never fun at the best of times.

[perfectbluebuildings, BSN, RN]

No grannynurse, that's not the norm where I work.

[Orange Tree]

I've never been staring right at a patient's IV as it infiltrated. Unless the patient has a reduced LOC or a cognitive deficit, they're probably going to be the first one to notice that something doesn't feel right. I also can't imagine that a nurse would grab a dressing and "jerk it out". Maybe it seemed that way to your daughter at the time, though. I've had a patient complain that someone "slammed" into her knee (post up knee replacement). But I witnessed the "slamming" and it was no more than an accidental tap- like you would tap a keyboard. I don't think this patient was trying to exaggerate- I think they were in pain, tired, and hyper-sensitive. I probably would be, too.

And there is no excuse for not checking a patient's surgical site, but I find myself wondering how much time passed from initial rounding to the point the patient called about her "half out" dressing. Is it possible that the nurse had not completed her full assessment yet? There are times when I run in and out taking care of patient's immediate needs and requests before I really get down to business.

I guess I'm feeling a little "pro-nurse" at the moment, but I do realize that there are some really horrible nurses out there. And there is certainly nothing wrong with voicing your concern to the hospital. Maybe your complaint will be the hundredth complaint about the same nurse/same issue....and maybe something will finally be done about it.

[wooh, BSN, RN]

Agreeing with orange tree, there's shoddy care, but there's also often the perception of shoddy care. Not that she's making things up. But when you don't feel good, one's perceptions are a bit altered. I've gotten to where I tell patients/families when I work a night shift that I tell them I'll be sneaking in, and will do my best to not wake them when I do, so hopefully they'll be able to get some sleep and won't see me the rest of the night even though I'll be seeing them. (Although typing it out, now it sounds creepy.) But I can't tell you how often I've got complaints about nobody coming in "all night long." That's a sure way to make sure the next night I come in and throw the lights on every time. So they can instead complain that they didn't get any sleep.

And well, M/S units these days have 7+ patients at night. Like orange tree said, it's not possible to be staring at everyone's iv simultaneously to catch it infiltrating.

Sounds like plain old shoddy care to me. My son just had an emergency appendectomy last August and the care was superb. My only gripe (which I let the mgmt know about) was a nurse whop wanted him to walk before getting his MS dose.

Was your son my patient? Because I've done that quite a few times. The worst of the pain post-appy (and I speak from experience as a patient and having lots of post-op patients) is gas. Ambulation works better for relieving that pain than morphine. Here's the scenario where you give the morphine first: "Ok, and we'll let that work for a few minutes then we're getting up to walk." OK! 15-30 minutes later, "Let's get up and walk." "But I'm too slee..." And then the morphine sleepiness wears off. They wake up, want the morphine again. Repeat the cycle. They're still FULL OF AIR! So now they feel like crap for a long time, every time you wake up. Or, you can do it the "mean nurse" way: "Ok, it's going to be tough, but you HAVE TO GET UP AND WALK, and you'll be too dizzy if I give you the medicine first. So we'll do a walk across the room/down the hall/around the nurses station. And then you can come back to bed, we'll get you that pain medicine, and you can rest." They walk. They get the pain medicine. And now we're on a cycle of getting closer to feeling better. And avoiding atelectasis and all those other great post-op problems. So we suffer for 15 minutes instead of for hours and hours all day and night long.

But hey, report the nurse for getting the kid up and out of bed. She'll get in trouble, because customers are always right, and the next post-op patient will end up with an extra couple weeks in the hospital with the fabulous chest pain and such that goes along with pneumonia because to keep them happy she let them lay in bed.

It's much like the parents that draw out procedures or just taking medicine with a 4 year old bargaining with them. We can get the pain and suffering over with in 60 seconds if you let me be a mean nurse, or drag it out over 60 minutes while we negotiate with the kid who in the end will need the exact same quick and dirty mean nurse for 60 seconds.

[canoehead, BSN, RN]

Assessing IVs and surgical dressings happens without patients realizing much of the time. During gown changes and position changes, or vital signs I can see what is where, and if it's still working. I don't go poking at it unless something is wrong. You didn't mention if she got vitals done- I'd consider that a nursing check.

[totallackofsurprise]

Was the surgery originally supposed to be outpatient surgery, or was your daughter supposed to be kept over night? That would determine what unit she went -- or was supposed to go to -- after she was out of PACU.

My boyfriend just had a sigmoidectomy a week and a half ago. They did not change the surgical dressing for almost 24 hours. When I asked why, the ICU nurse explained that the surgical team had left instructions for the wound dressing to be left in place unless it was saturated. Because his wound was stapled with 28 staples, it didn't need changing for almost 24 hours.

His first dressing removal/change was done by the surgical resident and team, not the ICU RNs. Perhaps this was supposed to be the case with your daughter?

I can't say why your daughter was treated the way she was, but if you (and she) are that concerned, you/she should have talked to the nurse manager on the floor, and possibly paged the surgeon/surgical team to see if the post-surgical care orders matched up with the care she was receiving.

Also, you have a perfect right to complain and demand some answers. Most hospitals now are afraid of lawsuits and malpractice -- they will want to know about poor treatment, and they will probably want to know the name of the nurse who cared for your daughter.

As for yanking the dressing/packing out -- I have been changing my boyfriend's dressings and I can tell you, it's much more painful for him if I slowly pull tape and dressing off, than if I take it off quickly. Maybe that's what the nurse was trying to do?

You need some answers; go get them. Get some satisfaction. Your daughter has a right to get her medical file for that admission and see her chart. If you choose to do so, then you can compare what was ordered with what was done.

[canesdukegirl, BSN, RN]

I can state with relative confidence that the reason your daughter's surgery was moved up was because:

1. The surgeon was given a second OR to operate in so they could do her case earlier.

2. The patient that was scheduled before your daughter canceled for some reason.

3. The surgeon had a scheduling conflict at the end of the day and needed to move all of their cases up.

I feel badly that your daughter didn't receive the care that she should have had. I am not surprised that she was admitted if she had to have packing after surgery. Why on earth was it falling out? Did the nurse change the packing in a sterile manner? Doesn't sound like it, but I would need more info before making that assumption. IV infiltration happens, as you know, and I hope that this was taken care of in a timely way. She should have been checked immediately post of upon arrival to the unit. Was she? Her op sites should have been checked at that point. When did she arrive to the unit? When did the packing fall out? I am trying to get a more clear picture of the timeline because if she was admitted for 23 hour obs, most of this should have been taken care of since her d/c would have been relatively fast.

[KSU-SN]

It was probably lady partsl packing that the OP is talking about....its not totally uncommon for it to begin to work its way out. There is usually the tail end of it sticking out anyways so when its time to come out you can get a grip on it. Ive had a few patients who, once they start moving around their vag packing begins to fall out a bit. I would not take it out without a doctor's order, especially not YANK it out because theres a risk of hemorrhage. I would have paged the doc and gotten an order to DC it. It would not be replaced, thats something done in surgery by the doctor. Its no big deal that it came out, but that nurse should have had an order first and not yanked it out if she really did yank it like described.

And to the person saying her son was made to ambulate before receiving pain medicine....yes thats common and totally ok to do. Unless hes in 10/10 excruciating pain it is important to get up and ambulate to encourage the passage of gas and wake up the bowels. I dont feel comfortable giving a patient pain medicine right before getting them up, usually they are too groggy and unsteady and its not safe.

[canesdukegirl, BSN, RN]

AH! Thanks for shedding some light, KSU. I was thinking abdominal packing.

[Kooky Korky, BSN, RN]

Was the surgery originally supposed to be outpatient surgery, or was your daughter supposed to be kept over night? That would determine what unit she went -- or was supposed to go to -- after she was out of PACU.

My boyfriend just had a sigmoidectomy a week and a half ago. They did not change the surgical dressing for almost 24 hours. When I asked why, the ICU nurse explained that the surgical team had left instructions for the wound dressing to be left in place unless it was saturated. Because his wound was stapled with 28 staples, it didn't need changing for almost 24 hours.

His first dressing removal/change was done by the surgical resident and team, not the ICU RNs. Perhaps this was supposed to be the case with your daughter?

I can't say why your daughter was treated the way she was, but if you (and she) are that concerned, you/she should have talked to the nurse manager on the floor, and possibly paged the surgeon/surgical team to see if the post-surgical care orders matched up with the care she was receiving.

Also, you have a perfect right to complain and demand some answers. Most hospitals now are afraid of lawsuits and malpractice -- they will want to know about poor treatment, and they will probably want to know the name of the nurse who cared for your daughter.

As for yanking the dressing/packing out -- I have been changing my boyfriend's dressings and I can tell you, it's much more painful for him if I slowly pull tape and dressing off, than if I take it off quickly. Maybe that's what the nurse was trying to do?

You need some answers; go get them. Get some satisfaction. Your daughter has a right to get her medical file for that admission and see her chart. If you choose to do so, then you can compare what was ordered with what was done.

And try to be nice while "demanding". This isn't always easy when angry, but do try.