I had this patient today that just made me feel like the most incompetent nurse. That's my button. I usually handle myself really well when it comes to emotions. But when I feel bad about myself because I feel like I can't do my best in this situation. I can't help it, I get emotional. So lets get to the story...
This patient was in a severe accident and has had multiple surgeries to reconstruct his left extremities. The last time I was his nurse, there were several orders to question. The patient remembered being told one thing, but the orders said something different. His surgeons office was called, message was left, follow up fax was also left. No response was received that day and I didn't have him as a patient again until today almost a month later, they ended up with clarifications but the next nurse probably got the credit in the patient's eyes. A month ago, his dressing to his left hand was to go untouched until the next follow up appointment. This time around, I got in report that he went to his appointment 2 weeks ago and the nurses have been changing his bandage without an order. This patient is very involved in his own self care and most likely told the nurses that the doctor wants us to change the dressings now. I can only presume that. I walk in the room hoping to see a dressing, take it off, clean the wounds, and redress it the way it was. But I walk in the room and the dressing is not there. He had just taken a shower and apparently was allowed to have it washed in the shower. Now it is sitting open to air and I have nothing to look at. So I ask the other nurses I was working with if they knew how it was being dressed. No one knew. My next option was to ask the patient. So I did. He was perplexed that I didn't know. I explained, we don't have an order. So I don't know what we're supposed to be doing. You are involved in your own care, so tell me what has been done the last several days and that's what I'll do. He tried to describe a piece of hardware I was totally unfamiliar with. He said it came from the ER. I went to the ER, no one knew what it was. I came back to him and asked him to describe it with different words and maybe it would click. Finally another nurse said, I think I know what you're talking about, she went to the ER and finally the patient said yes that's it! We had what we needed. As I'm applying the dressing and following his instructions, he's grilling me saying "how is it there are no orders for this, I brought papers in from my appointment and no one else has questioned this before, just you. In my head I thought, well they were probably communicating but no one told me, someone should have asked for an order between then and now, so situations like this didn't occur. I honestly don't remember how I responded. He was just very demeaning in his tone. The remainder of the day I was very busy with my other patients too, I tried to make it back in the room before he went to physical therapy to change the leg dressings as well. I came later than I hoped because I was pulled in a million directions. When I got there is was too close to his appointment time so he wanted me to wait until after. Then I got an admission that needed a lot of attention and I ended up telling him I wouldn't have time to do it and night shift would have to follow up. He didn't like the night nurses doing it apparently so made the choice to wait until the nurse tomorrow morning came on, and thank god it wouldn't be me. 30 min before end of shift I was drawing up an antibiotic for another patient and he is at the nurses station, and asks for a pain pill. I say I'm in the middle of something and I can't get it at the moment but I will when I'm through with what I'm doing. He replies "Come on, you have GOT to be kidding me!". I mean clearly, this guy did not approve of me and the way I had handled him the entire day. I just felt aweful and was so unhappy all day because of his attitude. I've had patients who are just plain mean to everyone and for some reason I can handle those guys, piece of cake. But this guy is different. He has that favoritism type of attitude like only one or two people can do a certain thing right. He seems very passive aggressive too.
In hind site, I may have been able to find specific details on his dressing change in the nurses notes or called one of them at home but it's not something I thought of until after the fact. I did end up requesting specific dressing change instructions from the provider. So then I'll be the only one who looks bad and anyone else who comes along will know what to do.
