Nursing Mistake. How to move on? HELP!

[nursing_problem]

I've been staying with the hospital where im working for almost 2 years. I had my training in different areas in that hospital for 1 year and 4 months until last April of this year I was hired as an ER nurse. in other words, I am an er nurse for 5- 6 months. I admit I had minor medication errors like opening Ceftriaxone instead of Cefuroxime, i got a Flagyl instead of Metrogen for Metronidazole... but didn't caused any fatal to our patient..

But I made a mistake few weeks ago. A patient was brought to ER with difficulty of breathing and hypertension.. SHe was a patient with CKD and undergoes dialysis. It was my senior nurse and our resident doctor who first saw the patient because I was starting an IV line to another patient that time. The initial BP was 220/11mmHg ans I can see that patient has dyspneic presentation. She was hooked to O2 inhalation 5-6 lpm. The doctor ordered for nebulization. I was the one who asked he relatives to buy the needed meds and started it. But before starting, I checked here BP it was 230/110 and informed our ROD, yet he didn't gave any order of anti-HPN. Maybe because the relatives gave the patient Catapres before goingt o our hospital. The relatives also asked me its ok since patient has history of cardiomegaly. I told the query to our doctor. he said its ok so I proceeded. When I asked the patient to hold the neb kit, she wasn't able to do so I asked the relative to hold it for her and left to attend other patients.

After contacting the attending physician of the patient, he ordered an emergency dialysis for the patient. I secured a consent from the relative. She told me that the patient still has difficulty breathing, I saw that her neb kit has still the med in it (actually its as if she didn't nebulized yet). I asked why isn't she nebulizing, the relative told me she was just resting but will continue later. I asked the patient to nebulize it may help her breathe easily. Then I checked here BP its 220/110. The relative asked me if there is no anti HPN meds. I told her I cannot just any anti HPN drug especiall she will undergo emergency dialysis. She asked me two times, and told her the same.

After more than an hour our dialysis nurse called that machine is already ready. I checked her BP few minutes, it was 220/110 still and informed our ROD but no meds was ordered. I asked the client to move a little so our male attendant can assist here to the wheelchair with oxygen. I was about to go with the patient when I was asked by other patients regarding confinement,etc. Suddenly, our dialysis nurse called and asked our ROD to assess our patient. The doctor found the patient gasping and intubated and perform CPR. UNfortunately, the patient died.

2 days later, the relative voiced out her complaints and according to our chief nurse, the doctor is out of the picture and completely complaining of the nurse which is me. I submitted an incident report. The relative said that what I told her regarding the anti HPN meds and I was not able to accompany the patient to dialysis. My superior and I are aware that our ROD is informed regarding the BP of the patient. Worst is the patient is a also a relative of our lab technician. The doctor expressed that it was the congestion/ difficullty of breathing he was concerned first he must overlooked the BP. He thinks that if patient undergo dialysis she will relieved. Unfortunately, she wasn't able to be hooked in dialysis machine.

OUr chief nurse had an emergency meeting with us. She eventually asked me if I can fo it in Er. I just tell her if I cant then I'll be back being a trainee. I told her I can. She told me I will be supervised by my seniors for the time being.

I read forums here and it helped me a lot move on. or i was trying to move on. I prayed night and day. I heard the relatives just voiced out their complaints and our resident doctor was able to explain his course of action. I must say, whenever I encounter such patients, I stay with them once Im done with other work and I regularly asked their condition. I even try to establish rapport by talking to patient and their relatives. I know that I might get suspended for some days because of the incident and I'm ready.

However, this morning the resident doctor called me that he was about to write a letter to our legal department because the relatives wrote one. The doctor told me he will be the one to explain regarding the BP however, there are other complaints which is not for him. I told him that I know the mistake I've done and wrote an incident report already. Which bothers me right now is, I heard the relatives told that I just left the patient to nebulize by herself without telling who will hold the neb kit (which I told you guys earlier, I did asked that relative to hold..). Im really back to being desperate, nervous that I might lose my job and standing on a witness stand. Even my picture was taken out from the organizational chart to present to the board because I;m new and board members dont know me yet.

Sorry for this kind of post but an advice will really help me alot... thanks.

[traumaRUs, MSN, APRN]

Dialysis is probably what the pt needed but it would have been fine to give a short acting anti-HTN med like labetelol IV if it was going to be two hours before dialysis could be arranged.

I'm gathering you are not in the US? This doesn't sound like care here (not that we do much better, just that your wording "I had the relatives buy the medication" isn't what we do here.)

Sounds like you handled the situation okay - you charted that you notified the doctor of the HTN right?

Is two hours the standard time for dialysis to be set up?

[nursing_problem]

its ok. Since the patient is in an OPD basis, their relatives where the one to get the meds from our pharmacy. But if they are admitted, we''re the one who'll get it.

anyway, the patient arrived 2:45 am.. since our dialysis dept is not 24 hours, we call dialysis nurse to go to the hospital for emergency dialysis. just imagine how many times we have to call them and wake them up to go to the hospital. Out of 4, only 1 responded. i called her at around 3:19 am (as registered in my phone).. the patient was transferred to the dialysis room at around 4:15-4:20..

i admit i didn't know that we can give her an anti HPN meds before dialysis. So I just rely to what our resident doctor will order us to give.

[traumaRUs, MSN, APRN]

Moving to the General Nursing forum.

[TriciaJ, RN]

What a horrible experience. Sounds like a lot of people dropped the ball, but everything was dumped on you. Was there an autopsy or any kind of investigation? What were the findings? Anything that was your responsibility? Do you have a union? If you do, contact them for further advice. Do you have your own Liability Insurance? If you do, contact them now. If you don't, look into getting your own liability policy. Especially if you work in a place where they put you in an impossible situation and don't support you.

Good luck to you.

[nursing_problem]

i believe there was an investigation. however, the result of it was not yet known for the doctor just submitted his report. Our chief nurse told me that the major problem i will face is why i wasn't able to join the patient in going to our dialysis dept.. Because the patient's condition may have been aggravated during those time and i wasn't there. Regarding the blood pressure, our doctor will be the one who will explain why he didn't ordered us to give any anti hpn drugs despite informing him..

the chief nurse also told me that all the blame was put on me by the relatives because i was the one always in their cubicle, im the one who they talked to them more than our doctor who attends other patients.

Do u think i may face any liability and loss my license?

[carolmaccas66, BSN, RN]

I found your post a bit rambly & difficult to read.

Sorry, I have to be the voice of reality here and you won't like it, but why were you asking a relative to hold the nebuliser for the patient? This is what annoys me as a RN - you are responsible for the patient, not the relatives. That patient is under your care at that particular time. And I don't see that you did anything else wrong. I also hope to God that you documented telling the Dr and your ROD (sorry don't know what that is short for), re the HTN & everything else that was going on.

Do not take the rap for this - fight, fight, fight. But in future I would really urge you not to ask relatives to do nursing duties - that is YOUR job, and you have to take responsibility for it.

[nursing_problem]

i know ideally if care shoud be given to them, it should include the relatives as well-- it should have been me holding that nebulizer, stayed with her until she was in the dialysis, get meds for the patient and not the relatives,etc. and that is how things are being done in your country. But unfortunately, here in our country, we were not able to do those things always.

Here, if you're on out patient basis, relatives will get the meds for them because they have to buy it unless they have health insurance with them. If you're an in patient, the nurse will get the meds for you provided that you have health insurance, you are in a private room even without health insurance or you have a letter from your doctor.

We have 4 patients in the emergency room an only 2 nurses are on duty. we have nurses in the intensive care unit. If they dont have any pt. They should be staying at er. Unfortunately, they will go to icu once they see that there are no patients in the ER. In case we become toxic, we attend to patient's needs before we can call them to go down and help.

[najpop]

I am nursing student and very interested in Emergency nursing but I have to say that your story is very upsetting and sounds like you were put in a position of no support from your team. It is unfortunate that no one thanks the nurse if everything goes well but if anything does not work then it is all on nurses since Pts only see nurses taking care of them and think nurses can do everything.

For the part where you asked the relative to hold the nebulizer, we are learning at school about the so called client centred care, where nurses allow patients or the patient's family to take part in the treatment/care. I do not see anything wrong with asking a family member to help with nebulizer or help with repositioning lets so avoid pressure ulcers,