Am I a failure

[Rncaligirl88]

I have been a nurse on a med-Surg floor for two years and had several critical patients whose conditions were critical but always had an expected outcome. Last week I had a patient go septic on me. He had multiple other chronic and severe comorbidities and is vent dependent but came in with abdominal pain the night before and then was diagnosed with cecal vulvulus. I put an NG tube down him and got him fluids, they did another exam that was inconclusive because of positioning, etc. Anyway I had notified the physician when his heart rate got into the 130s and he ordered a fluid bolus and antibiotics and to call the surgeon if HR did not improve. Then his heart rate went up, and up, and up. It got to 160. I had the doc in there two more times but there were no further orders and the surgeon didn't order anything new except for monitoring overnight. In the midst of all my phone calls and rechecking him I did not alert my charge nurse except to tell her when we placed him on telemetry at which point she also did nothing. I know in retrospect I should've called a rapid response the moment his heart rate went above 130, but I didn't. He went to surgery and looked great the next day in ICU but now he is in renal failure because of the severe sepsis. My nurse manager knows about the situation and reassures me that he would've gone bad on anyone, but I can't help fearing more dire consequences such as a lawsuit. The patients family and I had a great relationship and knew I was in contact with the doc many times. But I still feel like I failed the patient. I'm so scared I can't sleep. Even if it doesn't go to court, if he doesn't pull through I can't help wondering if he would've been ok had we gotten him to surgery sooner and I feel like it's all my fault. Should I get out of nursing and start looking for a new job?

[TheCommuter, BSN, RN]

Based on your post, you appear to have gotten the physician(s) involved, intervened appropriately and provided adequate care. I wouldn't feel bad or beat yourself up over this situation because poor outcomes happen.

Then again, I must not be normal because I have a difficult time feeling bad or guilty over issues surrounding patient care.

[green34]

You should request a stress debriefing even if it is one on one with your manager. Your company also have a hotline that may be able to help you too. This is a stressful event for you and it needs to be addressed. Address it before you decide to quit or let your job performance suffer.

[CheesePotato, BSN, RN]

Take a breath, my friend, you did just fine.

I'm going to be really honest with you, this horse was well out of the barn at word go. Really.

Look, a rapid response is going to get more eyes on the situation, but unless you have orders and something that is actually correctable by external intervention, like labs, tube placement, etc, you would still be in the same situation. At least in my facility, an RR call does not = a surgeon at the bedside. Just sayin'.

And for pity's sake, you were in constant contact with the doc and followed his orders. So long as you documented same, you are all good.

From the surgical standpoint, often times in some of these belly cases, when we open, we find that there has been something a brewin' for some time. Ceacal Volvulus and many things bowel can be one of them. But like so many things (::cough:: sepsis ::cough:: , it can take a bit to marinate, if you will, but when it goes bad, it goes ugly.

Sometimes !@#% happens. In great quantity. All over our shoes. And try as we might, we can't fix everyone but we can sure as shoot give it our best shot.

Sounds to me like you gave it your all. Make peace with that. Get a sandwich (May I recommend turkey on rye with bacon, lettuce, tomato and onion? Perhaps some dijon mayo?), snuggle your favorite critter (whether four or two legged), and keep on keepin' on.

Cheers,

~~CP~~

[brithoover]

Try to learn some stress management..it will be a very long career if you fret over every patient. Sometimes no matter how hard you try they get very sick. You did a great job!

[Morainey, BSN, RN]

No, you are not a failure. From your post it sounds like you did everything you were supposed to do.

[Orca, ADN, ASN, RN]

Sometimes things go wrong even when everything is done right. As nurses we often believe that we should be able to fix everything, but that isn't reality. Some things are beyond our control. You kept the physician advised, and the physician gave you appropriate orders, which you carried out. Even if the outcome is negative, your actions weren't.

[HouTx, BSN, MSN, EdD]

OP - With such a large membership here on AN, chances are good that some of your colleagues are AN members also. PLEASE do not divulge such specific information on a patient - this opens the door for a HIPAA complaint against you.

As for the situation you have described, I agree that it appears you were actively advocating for your patient. Depending on your own internal 'learning' from this experience, I wouldn't be surprised if you act much more strongly and decisively in the future... initiating RRT, escalating requests if attending does not respond adequately, etc. Experiences like this can turn us into Ninja Nurses... going to the mat for our patients and refusing to accept anything less from others.