Tell me this doesn't happen all the time.

Nurses General Nursing

Published

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

Do you advocate giving pain med prior to dressing changes and letting it take effect for about an hour before doing the dressing?

Personally, I think privac, good pain relief (so one can strain to get the gas out, if need be) and an enema or putting the hind end uppermost if the patient can do it are best for gas, not walking.

Specializes in Pediatric/Adolescent, Med-Surg.

My thought would be if you daughter was a younger A&O x 3 pt, that it seems sometimes nurses don't check in on them as much. Not saying it's right, but it seems alot of times that the pt's that are younger than your average med-surg pt can get forgotten about.

Specializes in Trauma Surgery, Nursing Management.

When I worked med/surg, I gave a dose of pain meds (if they were due, or if I had a prn order) prior to the first ambulation. I did that with dressing changes as well.

Specializes in acute care med/surg, LTC, orthopedics.

There are two sides to every story and obviously we haven't heard the nurse's side. What I find curious is why patients, who have some disagreement about the level of care they receive, don't say something to the nurse at the time of the concern.

It always seems to be a complaint after the fact, which in my opinion, makes it less credible. Surely if the care was that bad, you would voice your distress immediately and not wait until after discharge?

my bil had the lap band surgery a few days ago.

when the nurse wanted to get him up and oob, he was complaining of serious abd pain.

she insisted that the pain would dissipate when he ambulated, as it was "gas pain".

he was keeling over as he walked and needed a wc to get back to his room.

i asked him to show me how he had been using his pca.

it turns out, he wasn't pushing it hard enough (this one was sticky) and hadn't been getting any pain meds.

goes to show you, it's not always post-op gas.

but do agree that if it is gas, ambulation is the way to go...definitely.

leslie

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.

This is possible.

2. The patient that was scheduled before your daughter canceled for some reason. This is also possible but if it was, why wasn't she taken to the OR until 12:30PM?

3. The surgeon had a scheduling conflict at the end of the day and needed to move all of their cases up. Again possible but again why move it up by four hours then make her wait four and half hours? Like I posted, I haven't worked surgery in twenty years but I have had numerous short stay surgeries that turned into longer stays. And if a surgery is moved up to 8AM, it usually is the first case of the day for that surgeon, is it not. Or that was my experience as both a nurse and a patient.

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? After her foley was removed she got up to void. I questioned her closely. Approximately five to six inches had fallen out her lady partsl opening. Did the nurse change the packing in a sterile manner? No Doesn't sound like it, but I would need more info before making that assumption. She was sitting on the edge of the bed. It concerned me because I felt the packing could have gotten hung up on sutures inside on the external portion of her cervix. 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?No Her op sites should have been checked at that point. She was not When did she arrive to the unit?4PM When did the packing fall out?8PM after her husband left. The foley was removed at 5:30PM I am trying to get a more clear picture of the time line 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.

She was not admitted to short stay but to the surgical unit. She was not suppose to be discharged until approximately 4PM the following day. She told them to get a discharge order or she would sign out. The order was gotten from the surgeon. She has informed me she will return to her for one post-op visit then never again. She, the GYN, never called her SO, who had to be in Court for a hearing. She had been given his cell phone number. She never learn that the ovary removed had a cyst the size of a baseball growing in it, something that had not shown up on the ultrasounds done previously.

This surgeon did female surgery on me. She did not impress me as someone who welcomed in-depth questions from her patients. I saw her twice and never returned. I pay out of service fees, rather then see her again. I disliked her so, I had put her name out of my mind completely. I never made the connection til after my daughter's experience or I would have advised her to go to someone else. I have lived in this county for almost thirty years. The orthopods are excellent but I would not allow any other surgeon here near me. I have travel out of county, for surgery, to avoid them. Unless I am at death's door, I have told my daughter, take me out of this county if I need surgery, other then orthopedic. Don't get me wrong, my FPP is excellent, as is my pulmonary and renal physicians. And the physicians who took care of me during an unexpected stay in ICU, which included renal, pulmonary, GI and I.D. were all excellent and willing to talk to my daughter about my illness. Surgeons are an entirely different story.

I talked to my daughter today going over the time line, looking at the IV site, looking at the small incisions, making sure she had no unusual discharge. Her IV was definitely infiltrated, it is still hard and quite swollen. I have put her times in my answers to your questions. I know my daughter can be a difficult patient but I do not think she was. Her roommate had a student and her care was very different, of course.

To everyone else who has responded, thank you. I didn't think her care was that good but was willing to see what others thought. And to ignore my own prejudices.:down:

GrannyRN5

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

I am not sure what you mean. If one is upset and angery about something, generally they may speak without thinking. My daughter attempts not to do this, really. The only time she made a demand was upon her discharge and for removal of the foley. Had I been there, I would have requested a nurse intervene, by deflating the ballon and pushing the foley more gently in(the neck of the bladder can cause painful spasms). Or checked the taping of the foley itself. If I were ignored or reponse delayed, I would havegone to the station.

My daughter is writting letters. Her anger is very much in control. And she will be specific as to her complaints, as well as to her suggestions on making improvements. Not only is she my daughter, she was once a nursing student. For a variety of reasons she changed her occupational goal.

GrannyRN65

Specializes in LTC, OB, psych.

@wooh: I appreciate your perspective on a rationale for just having him ambulate sans morphine. I myself needed almost nothing and really did not hurt much at all s/p c/s. But I know my son, I know what a gas pain is and is not, and I know the standard of care. Another nurse stuck her head in the room and politely suggested thinking about giving him MS first, and honey, I took courage from that and ran with it. I do not give a darn what happened to the nurse afterward because in my world, as a nurse, I can give a pill to ease pain, and I like to do that. A lot.

To GrannyRN65:

I'm sorry you're daughter had such a bad experience. I would like to think that never happens, but it does.

I had a nurse taking care of my husband after a subtotal colectomy that didn't even recognize he was bleeding. I finally demanded she call the physician. He had all the classic signs, dropping bp, elevated hr, no urine output. All she kept saying is "his belly is soft". I kept telling her that they removed most of his bowel so it would take along time to feel abdominal symptoms.

That's not the only problem I encountered either. He went to LTC then had to go back to the hospital. I requested my own unit. I know the nurses, I know how they take care of their patients and I trusted them. They gave him excellent care and made me feel good about nursing again.

I have found you have to have an advocate for you or your loved one in the hospital. If you find out it's not going to be the nurse then you have to stay there, which I did for 2 months.

Specializes in ICU, Telemetry.

I've seen a lot of post ops on my old floor; and as others have pointed out, a nurse is usually instructed NOT to do anything but reinforce a dressing until the first time the surgeon looks at the site. This is what would have happened if I'd been her nurse. I'd have looked at the site, told her there was some packing protruding, and it was normal, and when the doc came around he would either have me replace it or leave it as is. Had there been frank bleeding, I'd have been on the phone to the doc in a blink. The patient could have interpreted this as "that lazy nurse didn't want to change the bandage" not "that smart nurse didn't want to start a hemorrhage she couldn't fix." I've also seen nurses get so frustrated about being called into a patient's room half a dozen times for a dressing that they have orders NOT to change that they probably would want to yank the dressing off or out out of sheer frustration. I've also had a family member who was so certain that her hubby was being ignored by the nurse who wasn't taking off a 3 hour post hip replacement bandage go rip the original dressing off to "make" the nurse take care of the dressing. Luckily, the surgeon was on the floor, we got the bleeding stopped, and the surgeon chewed the wife out when she started "reporting" the nurse to him for letting hubby have that "nasty dirty bandage" on.

I know this wasn't the case with your daughter, but I spent all of last shift with someone trying to tell me how to do my job, right up to them changing the lead placements because we didn't "need" all 5 lead when they only used 3 in the ER, demanding that I change an IV that I'd just started 2 hours earlier because it was in the way (uh, this lady only had a few useful veins, and was getting levophed for pete's sake, and I was trying to keep her heart beating, I didn't care if she couldn't wear her bracelets). The site had great blood return, and then she pitched a screaming fit when I had to give her a KCL rider -- she said I was deliberately trying to hurt her. I explained, explained, and explained. I'm sure she'll tell everyone that I was a horrible mean nurse, but she'll be alive to complain....*sigh*

as a nurse, I can give a pill to ease pain, and I like to do that. A lot.

Believe me, there's very few nurses as generous with the narcotics as I am. I've been assigned patients because I'm the only one with the guts to give the doses needed. But I absolutely WILL get a patient's butt out of bed. Because NOTHING will get better until they're moving around. And I'd rather have someone mad at me for being mean than be stuck in the hospital for a few extra days or weeks because they get atelectasis or pneumonia or any of the other bajillion post op complications that something as simple as ambulating can fix.

Specializes in CTICU.
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.

You notified management about a nurse who wanted him to walk before his meds? Why didn't you just say something to her? What is this culture of "telling" on people to their bosses instead of just speaking directly? I do not understand it.

OP - I recently had an op and received excellent care, but I also had an IV that infiltrated.

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