Staff cutbacks? Nursing shortage? Incompetence?

 

So I came out of my mastectomy with a huge horizontal incision where my right breast once was, and a Jackson-Pratt drain http://en.wikipedia.org/wiki/Jackson-Pratt_drain installed. On the left side, I had an infusion port for upcoming chemotherapy.

Although I’d expected to go home after the surgery, I was admitted to spend one night in the hospital because my surgeon expected me to have significant pain.  I even had a morphine pump.

The nursing staff got me all connected and then checked on me every couple of hours for the rest of the afternoon.  They checked my drain and emptied the collection bulb once.  By that time it was clear that I was having NO pain and my biggest problem seemed to be frustration with the lack of anything worth watching on TV.

When anyone looked at the drain again, it was empty. Knowing nothing about what to expect, I assumed that was good  - that no fluid was collecting at the surgery site.  The nurses, in retrospect, should have known better.

What really kept me from a good night’s sleep was not the occasional visit by a nurse, but by the incessant dinging of other patients calling for a nurse.  I have no idea how many RNs and LPNs were on duty, but there were certainly not enough to handle patient demand. 

I don’t know what is an acceptable nurse/patient ratio, but I’m sure it wasn’t the case here.  Why?  Pencil pushers setting standards for care?  Shortage of nurses??? 

If you read the previous post, you know that I was not discharged until mid afternoon on the day after surgery.

I was given oral instructions to empty my drain’s collection bulb twice a day.  

I was given 13 pages of discharge instructions and educational info.  12.75 pages of which were general information and thus utterly useless. 

WHAT I DID NOT GET

Someone who might have thought that it was unusual that no fluid was draining out; and who might have at least asked someone more knowledgeable if it should be looked at further.

Any discharge instructions specific to my situation – mastectomy, drain, port implant.   (After my earlier lumpectomy, the outpatient surgery center gave me very clear and specific instructions.)

WHAT HAPPENED NEXT

The surgeon had arranged for Home Health Care so on Sunday a visiting nurse came to see me.  My drain still wasn’t draining and I still had no pain.  I declined to continue with Home Health Care.

Monday morning, my favorite nurse “S” called to ask why I’d declined the nursing service.  After I’d explained, she commented that perhaps the drain was clogged. (That thought should have occurred to me, but it never did.)  She asked if the area around the drain was swollen.  It was. But I still didn’t catch a clue.

As we were getting ready to go out later that morning, I inadvertently pressed on the swollen area and released a deluge of fluid – not through the drain tube, but from where the tube was inserted. What a mess!  I called S and she called the nursing service.

Another nurse came to see me and did what should have been done before I left the hospital.

She flushed the drain which freed the clog.  Much draining ensued.

She explained that not only should I empty it twice a day, but I should measure the volume of fluid and keep a log so that the surgeon can have some information about how things are progressing. The hospital gave me a vial for emptying the fluid but said nothing about measuring and logging.

ALL’S WELL THAT ENDS WELL

The drain is working.  I know what to do.

It was a very frustrating couple of days.

At first I was upset with the hospital nursing staff because no one thought my lack of draining was unusual.  Then, considering the constant ding of nurse call bells, I came to fault the hospital for inadequate staffing.  Nurses are run ragged with too many patients to look after.  How can there not be lapses in attention and care?  It’s a very unhealthy situation for everyone.