I feel like I caused a patient's death and I can't get over it

[jane82]

I am a new nurse working in a sub acute rehab facility/LTC. I am typically assigned to care for 28 to 40 patients on midnights. I have been trying to get into a hospital but not having prior experiance or a BSN forced me to accept this job for experience. I have been concerned from the being with patient safety and the patient load I have.

Awhile back I had a patient whom I was not familiar with. She had a trach site, on O2, with continuous tube feed, and a mental illness condition. Later the CNA said she told her she was having difficulty breathing. So I checked her spo2 I raised the HOB from 30 to 45 degrees and increased her o2 and the sp02 increased. I notified the doctor on call.

When I later entered the room I noticed the patient looked really pale and asked if she was ok, the nurse replied "no she isn't, get a suction machine". I was in a panic, I thought "should I have suctioned her ?!?" I ran out to the find someone who knew where suction machine one and was told that there was one on the crash chart so I grabbed the crash chart and ran toward the room. When I came closer to the room someone said it was a code and to announce it on the overhead.

I feel like I did not do all I could for her and I have been crying almost daily because of it. I even started smoking again after quitting 6 years ago. I can't sleep without sleeping pills and I see her pale face in my head over and over. I would love some honest opinions from more seasoned nurses on this event because I feel so horrible about what happened.

[Cliff-RN]

I'm not religious but I will say a prayer for you. To be honest, under those circumstances I don't think most nurses without trach experience would have been able to respond to that situation appropriately. And to all those nurses that try to insinuate that this was all your fault - that is just cruel. That facility was just an accident waiting to happen with or without you.

[Cliff-RN]

Okay, this is just killing me.....As a former level 1 trauma SICU (surgical intensive care unit) nurse and a university college of nursing instructor, something needs to be said. Now from what was described, I picture the patient who had a CABG and a trach to be a failure/difficult to wean patient. Meaning that the patient was already high risk because the hospital could not wean her off the mechanical ventilator and had to insert a trach - those patients remain high risk beyond the SICU/MICU all the way to recovery. Further, I don't think some nurses are helping jane82 with this personal crisis. As a SICU nurse, I know nurses make mistakes and/or miss certain details with patient care under far less stressful conditions. So regarding the circumstances, I don't think sharp criticisms are appropriate, but rather helpful, useful, supportive advice on how to proceed from here.

[Esme12, ASN, BSN, RN]

@doppelganger The acuity level on this unit actually very high and many patients get dumped at this facility that are not ready for rehab and we send them back out quite frequently. There is a LTC unit in the facility also. This was not on the LTC unit this was on the rehab sub acute care unit. I and other staff have spoken up about the ratio with but management doesn't care. When I was first hired they said it was a patient max of 14. A turn out that only applies to day shift. I did offer the patient nectar thick liquids and they were provided to her. The HOB was elevated 30 degree to start with, if you read my post you would see I only elevated it higher. I never saw the family I am only stating what other staff members told me. Believe me I am not trying to justify anything here. My heart truly breaks for what happened and unless you have been in my shoes you have no idea what I do for these patients. I know I have helped some maybe a lot. I have patient thank me for my care I give them because many people there ignore call lights and treat them poorly. I wish I was better that night and this is something I will have to try and live with. Before this happened I thought seriously about quitting. I wanted to stick it out and I don't want a lap in my employment but I know it is my license on the line. You can't tell me that your critical thinking skills will be sharp when you are caring for 28-40 acutely ill patients per night with a staff that has a low moral for helping others. I will not forget about looking for a hospital job and you saying that is really just hurtful. I know none of you know me but during all of my clinical rotations I had nothing but praise from my clinical instructors on my critical thinking skills and my interaction with patients. I am just too overwhelmed with what I am assigned to do and after these posts I know now that I should defiantly quit.

I think you need to talk to someone....patients die. I don't think any one thing contributed to this patients death and certainly not you. Sub acute/LTC is a tough place to work. try finding an acute job.....it i easier to find a position when you have one.

A majority of these posts are positive. To me she was working on something...you need to forgive yourself....Don't let a stranger on a social media site upset you...((HUGS))

[RyanCarolinaBoy, ADN, BSN, MSN]

Oh my, there are so many things I want to say on this matter......

You contributed to this patients death. Allowing the family believe that it was the hospitals fault for discharging this patient too soon, when in actuality it was you and your facilities negligence for not providing proper equipment and training to its staff.

You stated the pt was sob so you raised hob to 30-45 degrees and increased 02.if this pt was on a continuous feed, their head should have already been elevated to those degrees.

When the pt asked for water but you refused because they are nectar thick liquids only. You should have nectar thick water provided for you and if not there should be the thickening packets so you can make your own nectar thick liquids.

If you didn't think it was a "safe" patient load you should have spoken up.

None of what I'm saying here is going to make you feel any better and it's not intended to. There are serious things that you, other staff and your facility did that contributed to this pts death.

Oh my..)judgmental much here? I am not attacking you. But when someone ones err needing a shoulder to lean on, it is NOT appropriate to say cruel hurtful things. We ALL make mistakes. To err is human. Please don't be a holierthanthou nurse we have enuff of those in real life! To the op:I am sorry for your experience. I too have questioned myself after difficult outcomes. Just be the best nurse u can be today. Nothin more nothin less! With time and experience comes wisdom.

[cardiacfreak, ADN]

Jane82 I promise you, you will never make this mistake again. The next time you have a trach patient you will automatically run for suction equipment if it is not in the room. One thing I always tell the new nurses I train is the mistakes I have made along the way. Some mistakes were minor and some were biggies. WE ALL make mistakes.

I once received a patient from the ER who had no medical history he was an elderly man and hadn't been to the doctor in years, I don't remember what he was admitted for but around midnight he started to desat I turned the oxygen up but he wouldn't come above 85% so I put him on a NRB and got his sats up to 94% called the doctor and he said okay just watch him. He was fine at 0100, talking to me at 0200, arousable at 0300, when I went in to take 0400 vitals he was not responsive. The man ended up in ICU and later died. I'm sure my decision to place him on a NRB aided in this mans demise and every time I have a pt on a NRB or even see one I think of this man and why I didn't get ABG's. So I have been there and done that and I won't ever do it again.

I agree with the statement "show me a nurse who claims that they've never been responsible for sub-optimal care and I will show you someone who's either delusional or a liar."

[doppelganger2]

@ OP Wow you really polished up/edited your post since I read it last.

Here's the thing: yes people die regardless of nursing intervention. Yes everyone make mistakes. Yes you are new and overwhelmed by your current position. Yes the facility you work for doesn't care about its employees or support them.

Do I think you contributed in some way to this pt death, yes. Your facility and other co workers take part of that blame as well.

Hopefully you learned something from this experience. Obviously you see where things went wrong on your part and will be able to act differently next time.

I don't think that you should quit your job until you have another one lined up. If nursing is what you want to do with your life then keep doing it. Just learn as you go and know that mistakes(big or small) can have serious consequences when your dealing with people's lives.

[gardenfan]

was there an order for suction on file? or you have to make a critical judgement at that moment to think of suction rather than just raise the head of the bed?

[imintrouble, BSN, RN]

You already know the answer to your question.

There are pts who haunt me for one reason or another.

You've just acquired your first.

I'm sorry for you, for her, and for her family.

I'm sorry there wasn't another more experienced nurse to help you. To help your patient. I'm not one to lay blame, but if I were, you would be the last one on the list.

[CapeCodMermaid, RN]

Nurses make mistakes. The good ones take the mistake seriously and learn from it so they never make it again.

As for the posters who are critical of the people who gave their honest opinions, if you don't want an honest opinion no matter how tough it might be to read, don't post a question asking for an opinion on a public forum.

[Biffbradford]

It's not like you're working in the ICU where you can simply reach over and grab the suction tubing that's already running. Even after suctioning, the patient may have still coded. We sent numerous patients to LTAC from lengthy ICU stays after heart surgery and sometimes they do die within a week! They are very sick, have little reserve left after such a traumatic life event, and sometimes they do die. The body can only tolerate so much. If it didn't happen on your watch, then it probably would have happened on someone else's. Maybe not that day, but another time.

[Debra,RN]

I feel your anguish. When I was a newly licensed LPN (I am now an RN) I worked on a "sub-acute" floor of a LTC I had 20 patients on the day shift. Everyday I thought I was going to lose my license. It sounds like you were set up to fail by the management. I now work at an acute rehab facility on the night shift and have a patient load of up to 15 max, which sometimes is difficult. The mentality that goes into overnight staffing is that the patients are sleeping. We have had nights where we are all running all night long. People don't sleep when they are sick and in the hospital. Then you have to add in the brain injured and dementia patients that need 1:1 supervision. The policies at your facility definitely need to be looked at and adjusted. In our facility if a patient has a trach, they automatically get suction equipment in their room whether they need it or not. We don't have wall suction or central o2 at my place. Use this as a learning experience. As a new nurse you will constantly second guess yourself and wonder if you did enough or the right thing. I hope you can get past this experience and like I said use this as a learning experience, you will never make the same mistake twice.

[wingding]

jane82 - from one new nurse who is overwhelmed to another ---- DON"T YOU QUIT --- Don't you dare quit on this note --- you have experienced ALL of our worst fear - a pt. death that you may have contributed to. You worked hard in school, you busted buns in clinicals --- only to get a job that has dumped an unsafe acuity on you. I often repeat an (old as the hills) instructors words to myself & now to you ---"You do your level best - it may not be good enough, but it is your best at that moment..... And then you go on - because you are human & you will make mistakes - do not let a mistake cause you to quit - let it help you learn for the next time & grow". I have been having my own type of growing pains as a new nurse --- my heart goes out to you. As for doppelganger - well - there are some that are just mean & don't allow for humanity - EVERY nurse makes mistakes! Find someone to talk to - counselor - therapist - EAP assistance. You are going to be heavy hearted regardless of whether you are a nurse or flipping burgers at McDonalds --- might as well stay & save as many as you can!!!