This is a long post. I'm not sure if this is the right place, but I need advice. I've been a nurse for 5 years. Not long enough to be completely confident, but long enough to know when something isn't right and ask for help. I've been involved in countless situations with families and patients where education can make the difference between a good situation and a bad one.
My conundrum now involves MY family. MY love. My primary concern. And how to not be one of THOSE families that drive us all batty. But perhaps I need to.
You see, in Aug 2015, my husband experienced a perfed bowel. It was sudden, painful, terrifying and culminated in an emergency colectomy and temporary colostomy (Final verdict is bowel perforation related to migrated hernia mesh tacks...).
He's 50 years old, and fortunately very healthy. No heart disease, DM, HTN, etc, so he was able to have his elective reversal yesterday. His original surgery was performed at my former facility where he received excellent nursing care. His reversal was performed at the main campus of our facility and his nursing care could not be more different.
Last night, he came up to the floor from PACU with understandably saturated dressings and a full JP drain. He was transferred to his hospital bed from the stretcher using the PACU stretcher bedding. Although he had a dilaudid PCA, he was uncomfortable, so the nurse decided to wait to jostle him in order to change his gown, saturated dressing and remove the bulky bedding from under him. I get that. He was transferred at about 1930 in the evening, a crazy busy time for nursing. I left the hospital to get some sleep around 2300. He was resting and stable. I returned late the next morning after talking to him and letting him sleep after a dose of Benadryl (dilaudid PCA made him itch like crazy). When I returned, he was still in his bloody gown, still on top of his bunched up sheets, and STILL had the same saturated, dirty outer dressing in place, with a completely full Foley in place, although he had been asking to have it removed because it was starting to hurt as it filled up (this particular medical care center has a nurse driven protocol in place to remove unnecessary Foleys for CAUTI prevention. He met protocol). This was well past the really busy time from 7a to 10a. I helped him get comfortable by removing the excess bedding, changing his gown, and untangling his many different cords. WHen his tech came in, she was indignant about the dirty laundry. She didn't seem to care that he had no water, no toiletries, no clean linens, but of course, it's a busy floor. I asked to speak to his primary nurse to find out his plan of care.
When his primary RN came in, I asked about his saturated dressings. She looked at them and said "they weren't like that this morning". #1) it was old blood from the night before and #2) if he had bled that much in just a few hours, i would expect her to be more concerned. When I told her that these were the same dressings from the night before (they were marked), she said "oh yeah, this blood is dry" and backpedaled quickly and changed the outer dressings and reinforced the primary surgical dressings. Long story short, she hadn't assessed his abdomen after abdominal surgery.
WHen I asked about the foley, she stated she had to wait for the Dr. I'm sure this is just a case of needing to reinforce education, but again, this facility has a nurse driven protocol to remove the foley POD 1, particularly when the patient is independent, wants to walk and a/ox4. Hm.
Several small things happened in between, but in general his care improved throughout the afternoon. However, at shift change, when he asked his night shift nurse to check his dressing (his former stoma site is packed, but still bleeding), she stated that she didn't "have an order to change his dressing". He asked her again to please check it and she refused. My husband can be a total pain in the butt, and I freely admit it, (especially s/p open colectomy reversal. you know...pain), so she eventually told him that she would get the charge nurse. I get it. I don't like ornery patients either, but shouldn't she have performed a focused assessment for the beginning of her shift anyway? Without the patient asking? And certainly if the patient presents a concern, don't you address it? Especially for a patient that has quite a few risks for complications? GRRRR.
Anyway, another nurse took over his care, checked his wounds and changed his dressings because, yes, they were saturated.
My question is: How do I address this situation? I know nurses are under immense pressure. I also know at least one nurse in his care was probably negligent. This is my family. I'm relying on the quality and reputation of this profession to keep him safe. What do I do?
ambr46
220 Posts
The nurse being busy doesn't excuse the mess he was left in. If she had been in to see him any time in the last several hours she would have made some attempt to make him comfortable.
This kind of stuff drives me nuts.