Beating myself up

[chachh, BSN, RN]

Again, I think I dropped the ball. I had been watching a patient all shift, thinking something wasn't right. Had even told my charge an hour before that something wasn't right with the patient. A fib, hr increased to 100-130's (had perameters if hr maintained > 130. last bp 110/60. agitated, trying to poop constantly, non-english speaking. (had called family earlier for interpretation when agitation began). when i went in at 6am son was there, i took one look at the patient and knew, uh-oh. Ashy color, diaphoretic, states she felt okay though. me and the aide went in there together. I had her get bp while I ran and got pulse ox and more help. Now WHY WHY WHY did I go get pulse ox and help and not just call or send the aide??????? These are things that make me really question my judgement sometimes??? Pt did not code or anything at the moment, but called rapid response and sent to unit. pt septic and not expected to make it.

Am I scared? Am I just not getting it? Patient was sitting up conversing with son, I think if she was lethargic or seeming to really dump I would not have left the room at all. But I think I can really be stupid sometimes.

Hind sight is 20/20 and I guess I will just have to learn another lesson. Anybody else feel this way?

[Beary-nice]

Sounds like you had a pretty sick pt there but I think you did the right thing. I doubt it took you an hour to go get the pulse ox and okay, maybe you could have sent the aide. Sepsis can be very scary and sometimes people don't catch it at all and then you have a code on the floor. You knew by instinct that the pts condition was deteriorating and you were persisent in doing something about it from what I can tell. I don't think that the outcome would have changed if you would have stood there at the bedside. You are not stupid by any means. You told the charge that something was not right...you did what you needed to do. It is scary when pts go sour on you like that, so if you were a little scared...that is to be understandable. Good job...and you used the RRT...hang in there and take care!

[chachh, BSN, RN]

Thank you for the confidence booster Beary. And next time I will remember my lesson from this one!! It just makes me upset with my self that I couldn't have brought it all together sooner and got her to the unit quicker. When something like this happens at the end of the shift I feel like I have been missing something from the beginning. I take everything so personally I guess, but what else can you do sometimes. I need to develop healthy seperation from my job!!! It also seems like I get some bad patients!! My charge says they can give me nice healthy ones but I just seem to make them go bad! (Don't see how I can MAKE someone go septic, but hey.....)

Thanks again for the support.

[LoriAlabamaRN]

I had a very similar situation as a brand-new RN... I learned from it and it has never happened again. You'll learn from this as well- it doesn't make you a bad nurse, just a human one.

[beautifulb]

Chachh everything is a learning process. When you had said that you knew there was something not right, well that there, is instinct. I follow my instinct when it comes to a pt. and I feel that, although the numbers look good, something is not "quite right". I will do further assessment and call the MD. Sometimes they won't want to see the pt. I report what I have gathered on the pt. and will usually say to the Dr. "I really think you should see pt. x , something isn't right with him"

Example: I was taking care of pt. who to me, something wasn't right. His vital signs were good, pulse ox mid 90s. But something about him. So I called the Dr. on call and told him that I thought he should see this pt. With much reluctance on the MD's part, the Dr. came out to see the pt. Well, both of us are in this pt's room and not 2 minutes after we got in the room, the pt. coded.

[Tweety, BSN, RN]

So you left the bedside for a minute while the tech was getting vital signs? Is that it? So went to get a pulse ox and more help, you were gone all of 60 seconds? Are you thinking if you hadn't left the patient wouldn't have gone sour?

It's always good to review the shift when a patient goes sour. Most of the time the patient is going to go sour regardless of what you do and you can't own that.

Sounds like you were on top of things most of the night, monitoring the patient frequently, listening to your voice that something wasn't quite right, etc. You did a good job. You did not cause this crash, she was going to crash regardless - which is what your gut instinct was telling you all along. If you hadn't of listened to that inner voice you might not have called the family, the family wouldn't have come in, you might have missed something and the patient could have coded and died on your watch.

Instead of beating yourself up over this little thing. Pat yourself on the job for doing a good job.

[grinnurse, RN]

Bravo for listening to your "gut". Alot of us newer nurses find that hard to do b/c we don't want to be a "bother" to any of the other nurses or we don't want to feel like we are "over reacting". Sounds like you did what you thought was best, the patient wasn't left alone, and though the aide could have done some of those things you will know for the next time how you want to handle it.

The good thing about situations like these is that it teaches us how to handle things better. Been there done that too with a pt going into DKA.........these are the best learning lessons.