Now, this isn’t the guns and combat kind of war stories, I think we have enough of that with our schools today. I’m talking about the stories experiences that a new nurse has or an old nurse when working the floor.

I know I have a few of them over the years I think for fun this morning I’m going to talk to about catheters. Now I know no one here believes the catheter sounds like a fun idea (except to masos).

In nursing school when you learn how to do any skill, you have a dummy (no not another student) or simulator would be a better term to practice your skill on. In the case of the catheter we were given our own little catheter kit, and we were told to practice set up and sterile technique. Now sterile technique done correctly is strict. I have seen very few nurses or physicians that can consistently maintain a sterile field. That doesn’t mean you’re at risk when someone’s doing a sterile procedure, it just means that it is a tough situation to be in. After many practice sessions of setting up the sterile field, we get to the day to practice on the simulator. I’m in a tell you straight up, the simulator for the vagina looks nothing like a real one. And I’m gonna tell you why.

I had been a new nurse for about six weeks, my orientation had just been completed, and I was finally taking 1 to 2 patients per shift that were all my own. I must tell you how very nice at that point not having someone looking over my shoulder and critiquing every move I made. Anyhow, I  get a call from the emergency department that they are transferring a patient who has a hip fracture to our floor who will be an add-on for surgery in the morning. We just need to stabilize her, keep her comfortable, and let her get rest before the procedure in the morning. Boy did we not know how tough a task that was going to be

What’s the deal with the ER? Here’s what happens when you get a patient from the ER.  A stable patient is never stable, and someone who is alert and oriented is not. When I got the report from the ER on the patient status, those were the two words they used stable and oriented. Oh, boy, did they lie to me, this patient was far from oriented or stable. I can’t say as I blame her, she does have a pretty good fracture on the femoral head and is in a severe amount of pain and baseline she has some issues with delirium. So, I have a delirious older female patient screaming bloodied murder because they’re in pain and not able to follow commands.

A Foley catheter is ordered for this patient and being the new nurse they send me in to do the honors. When I get in the room to begin setting up, I noticed that she cannot separate her legs more than about 10°. I am not even joking I could barely see the labia let alone visualize the urinary meatus. For those of you that don’t know you don’t pee out of your vagina, it comes out of your urinary meatus. Well, I called the charge nurse and told her what I was visualizing, which she didn’t believe until she went into the room. As best we could with one of us prying this poor woman’s hips just a smidgen more apart we got the area clean and went to insert the catheter. There was so much atrophy that her meatus was actually at about 9 o’clock on the vagina. So the first attempt was a miss, meaning the catheter ended up inside the vagina. Hey, it happens to the best of us, and in this case, I was literally standing on my head to get a good visualization. Luckily right about this time, she begins to urinate. Now when I say luckily, I mean it actually. Because of the atrophy of the vagina, I was having a great deal of difficulty finding her urinary meatus. Well, thankfully, “Old Faithful” showed me right where the meatus was. Of course, we were hoping not to have to clean up a woman who’s in extreme pain that’s delirious, but you take what you can get sometimes.

The next day, after her surgery, she had been so delirious she doesn’t even recall us taking care of her. All the better I guess since I think remembering that level of pain would be unbearable. She thanked us of course and went home as any good patient does.

So what’s the take away why am I writing about this? A nurse knows nothing about what’s going to happen in the course of their shift except planned medications and procedures. Many cases like this one we have to improvise and sometimes it’s less-than-perfect from what we learned in school. I’m quite sure, since I know my instructors very well, that those nursing instructors would’ve done the same thing playing it by ear as I did. Of course, I was mortified as a new nurse because I didn’t do anything like we did in the skills lab. Well maybe except being sterile as possible.

For the patient, every patient presents differently. What works with patient A may not work with patient B. I see this in medication prescribing all the time. That’s why they call medicine and art and practice and not an exact science. This does not mean that medicine does not use science as its base that just means folks are a little different and no matter what you still have to get your fucking kid vaccinated.