A good friend of mine from nursing school was recently on Facebook talking about teaching a lab on Foleys to brand new nursing students. Upon reading her entry, my PTSD kicked in, and I started having flashbacks. You see, I almost failed nursing school because of the dreaded Foley cath.
How to place a Foley catheter is one of the first skills we were taught after the basic vital signs. It is probably the most intricate (in my opinion) skill we had to check off on in order to graduate because it is supposed to be a sterile procedure. On day one of nursing school we were all given a "Skills Booklet" detailing the skills we had to master and get checked off on before graduating. You had 3 tries to do the skill properly on an actual patient if you were unsuccessful, you were out. No big deal, you have 2 years to master and check off each skill. RIIIIGHT.
My first semester of clinicals came and went with no opportunity to try a Foley. My second semester of clinicals came and went with no opportunity to try a Foley. My third semester of clinicals came and went with no opportunity to try a Foley. (Do you see where I'm going with this?) My fourth and final semester, again no opportunity to do a Foley until the very last clinical rotation--OB. Did I just hear every nurse on the planet groan? For those of you not in the nursing profession, the 2 hardest types of patients to do a Foley on are pregnant women and little old ladies (LOLs) for many of the same reasons. Things don't look like they are supposed to on either and a lot of the time things are no longer in the right place.
So, my teacher, knowing I still needed to do a Foley calls me into a room with a VERY pregnant woman who is going to give birth in the next few minutes and the baby is in severe distress. There is the doctor, a nurse and my teacher all watching me and they are all saying "HURRY!" No pressure. Nope, none at all. So, I got her cathed and my teacher and I walked out of the room.
"Do you know what you did wrong?"
The next day I get the chance to do another cath. Maybe now is when I should tell you some of the other reasons pregnant women are difficult to cath.
1) they are not in the best of moods
2) the labia is swollen and heavy
3) everything is VERY slippery
I walk into the room trying to look more confident than I felt. I opened my Foley tray, put on my sterile gloves. Got my tray arranged to suit me. Opened the woman's labia to begin to clean the area. And my fingers slipped. Contaminated the sterile field.
Defeated, knowing I had one final chance and knowing I had only two more days before the end of the semester to do the perfect cath, I went into an empty room and sobbed.
"I guess I really shouldn't count that first cath, that might have been a little unfair. You have 2 more chances."
Reprieve. I went into an empty room with another student and practiced over and over. I felt confident the next time would be the charm.
The next day, I go into my patient's room, take a deep breath and begin the procedure. When I finish, I proudly give my teacher my skills booklet for her to sign me off.
"You contaminated the sterile field."
"When you put on your gloves, your thumb grazed your arm."
Holy hell, I'm screwed. I have one day left and one more chance left. In a daze, I barely heard her say, "You will have to check off with another teacher, I can only fail you twice." I knew I would never be relaxed enough with her to pass. Maybe there was hope.
My very last day of clinicals I went to the hospital knowing today was do or die for me.
"I'm sending you down to the ER so Mrs. A can check you off."
Mrs. A was only about the coolest, funniest and smartest nursing instructor ever. She was in her 70's and had been an ER and neuro nurse for at least 50 years. Her hands shook like a Parkinson's patient, but she NEVER missed an IV. Maybe there is a chance.....
I go to the ER and find Mrs. A. We wait for someone to need a Foley. I'm praying we find a man who needs one (they are soooo easy.) Nope, not with my luck. Eighty plus year old LOL.
We walk in the room. She in not responsive. We spread her knees and OMG! I look at Mrs. A and we agree that we have to clean her up first. We gathered towels and lots of soap (I looked for a Brillo pad) and proceeded to clean her up. Next I took my pen light to find to the meatus. Remember what I said about things not being where they are supposed to be?
"I don't see it."
"Neither do I"
"So what am I going to do?" I say with panic in my voice.
"Just try where you think it should be."
Poke. Not there. And now I've contaminated the Foley. I hear the umpire whisper, "You're out, you're out."
"What do I do now? Can I go get another tray and try again?" I know my voice is a shaky whisper.
"Don't worry with a new tray, there is no way we are going to be able to do this sterile. Let's just do it. I'm going to stick my finger in her vagina so you know that isn't the right spot. You just poke around until you find it."
When we finished, she asked for my skills booklet and checked me off with her shaky signature.
Coolest nursing instructor EVER. She knew I knew HOW to do a Foley. She also knew sometimes you can't go by the book. More importantly she knew sometimes you need some help. That is the most important skill to master in nursing. Knowing when you need help and asking for it.
That was 3 years ago. I'm happy to say that she is still working in the ER and she is still teaching.