when you cant let it go (long vent after a crappy day)

Nurses General Nursing

Published

Specializes in Trauma/Tele/Surgery/SICU.

Why is it that whenever a pt. goes bad I automatically think what did i do wrong? Why is it that I feel guilty when a pt. has a complication that I clearly had nothing to do with. Why do I keep going over and disecting every little thing I did for and with said pt, developing insane hypothesis that could never have happened?

Today I had an extremely pleasant, a&o 4, perfectly stable pt. admitted for observation following a fall with a arm fx. Pt. was fine ALL DAY. Vitals stable,a little brady (mid to high 50's) but taking several cardiac meds and a hx of MI. Only med received from me was Pepcid. Handed off pt. at 1530 and on my way out stopped to chat for a minute with pt. about what they were going to order for lunch. Again perfectly stable pt.

Apparently within minutes of my leaving the unit this pt. crashed. (I know this because a coworker called to inform me) So here I am blaming myself, wondering what I did wrong, thinking I am going to walk in tomorrow and be fired immeditely, lashed with a wet noodle, license revoked and perhaps a small blurb written up about me into the latest editions of all the nursing textbooks as an example of poor nursing. I envision myself walking the hall of my unit as my coworkers slowly turn their backs to me as I pass (I think I saw that in a movie once).

Is it because I am a mother and used to the fact that everything is my fault? Is it because I am mentally ill? I seriously concocted the following scenario in my head: The vial of pepcid could have been something else......nope I always check my vial. Maybe I grabbed a vial of something else mistakenly....the only other iv push med I gave today was dilaudid and I ALWAYS check my vials when I draw up meds.....Maybe we have a rogue pharmacist secretly switching pepcid vials with some other insidious conconction or perhaps someone at the pharmaceutical company accidentally substituted a batch of Pepcid with some other drug......Do you get where I am going here?

Why can't I just let it go????????

While this is a tad bit exaggerated, I really am having a hard time letting go of my pts. I automatically think it is my fault when things go wrong even if I had that pt. a week ago, (maybe I did something, what did I miss, etc.). It doesn't help that certain coworkers can be a tad bit accusatory and love to sit around disecting the nursing care of others (and apparently have time during crisis situations to call the offgoing RN to ask them for information easily accessible in the pt. chart).

Can anyone share some coping skills? Mine aren't working!

:hug:

Specializes in ER.

I can't believe that nurse called you at home! Insane! Sounds like you did all that you were to do, did all that was ordered, and sounds like a relatively standard day. You did all that you could do, and if something was evolving (like an MI) and there were no tell-tell signs, then what else could you have done? Nothing. That is why we have shift hand off and the next nurse comes in! Continuing care. Patients get worse sometimes, and not always on our shift. I don't blame you for feeling guilty, though. You're a good nurse, as well as a responsible professional who wants to know if there was anything that you did that might have contributed. Unless you have a way to test that Pepcid, you're going to drive yourself crazy. Not knowing what else that patient had going on, my first thought is cardiac....

Let those other nurses run their mouths. Good, solid coworkers know better not to talk about their coworkers and a patient change - because it happens to all of us at some point. I would ignore those who are critiquing. It helps me to vent to someone I don't work with - usually my mom who lives in another state, but is also a nurse. It helps to get that feedback from someone who has walked a mile in your shoes... but otherwise, humor, lots of humor helps.

Specializes in pediatrics.

I can't believe they called you either. What do they want you to do? Just worry? That's one of my pet peeves. It's like they don't want you to sleep tonight. Sheesh. Too bad for them, 'cause you're gonna have a nice evening!!! :D

I think a lot of this is in the co-workers. If you don't feel supported and like they're going to talk about you of course it makes you anxious about every little thing.

And, like others have said, that is kind've mean to call you. What did they think you were going to do? Was it to be snarky by worrying you for no reason?

It's the hospital. People are sick and sometimes they die. This reality is still reality no matter how those nurses interpret it. Everyone is going to have their turn (pts who crash and die) and they are stupid not to realize that. Let them run their mouths, it'll blow over and then who cares. Enjoy your evening!

Fx..hx of MI..fat emboli? it is NOT your fault..just let it go!

Specializes in Critical Care/Coronary Care Unit,.

Not to sound mean...but here is the reality. People die...especially elderly people. They go to nursing homes and hospitals b/c they're not healthy....at some point...they're going to go downhill. They usually come with 1.5 feet in the grave already. Leave work at work. Don't take it home with you. Do the best you can everyday and be done with it. Make sure you have a life outside of work...b/c it'll eat you up inside if you don't. As far as people calling you at home, completely inappropriate...they need to look at the chart...they don't know how to handle emergencies...perhaps they need to take some refresher courses or BLS and ACLS.

Specializes in Critical Care.

May I suggest you meet with a counselor? Sounds like there are some issues here that are more than learning to set boundaries regarding patient care. If you're taking this much home, you need to speak to someone. Ideally, someone who deals with healthcare providers. Speaking to someone about what YOU can do to change how you deal with things can really help. You can't change coworkers or their behavior, you can only change yourself. I speak from experience. Don't make work your life and there's nothing wrong with speaking with someone. Good luck to you.

Specializes in Community, OB, Nursery.

Some times patients crash. I sent a baby to NICU this morning that looked stable, but had a couple subtle signs of something serious going on. I've been a nurse for nine years. I picked up on it this time, but a few years ago, I might not have. And sometimes patients code with no warning whatsoever. It happens. Especially with something like an embolus, like another poster mentioned....people can go from walkie-talkie to dead very very quickly. So please, cut yourself some slack regarding this particular patient. I'm not sure what your coworkers' motivation was in calling you at home to tell you about him. It's not like you could change a thing about it at that point.

Having said that...

I struggled with this similar thing as a new grad, and it became so bad that I couldn't even think of going to work (very afraid of something happening like what you described) without crying and trembling uncontrollably. Not a fun place to be at all. I too worried about pharmacy switching stuff out just for fun, about losing my license for the smallest change in a pt condition, for getting written up about things that happen to all of us.

You deserve better. I second highlandlass' suggestion to seek counseling. Most hospitals have a contract with an outside EAP program. That is what I did as a new grad and had all the aforementioned issues. They helped tremendously; everything is confidential and for a certain number of visits they are free (I think this varies depending on the place/contract) and afterward some insurances will pay. Please do investigate this.

Hugs. I know this is not fun.

Specializes in ICU, Telemetry.

There are 2 rules of nursing. Rule 1: Everybody eventually dies. Rule 2: You can't change rule 1.

It used to tear me up -- what did I miss? I had a patient who was A/O, walkie talkie, came in for a UTI that caused confusion, had CTs and all kinds of testing to rule out a CVA/MI. Nothing, just a bad UTI that made her confused. We got her on antibiotics, she came out of the confused state, and was the doll baby of the floor. We didn't want to send her back, we wanted to keep her as the floor pet.

The morning she died, she wasn't my patient, but she was stable, CNA's getting her ready to go back to her nursing home, doc's already been in and signed the DC orders, every nurse on the outgoing and incoming shift had seen this lady that morning, either because she was their patient or because they wanted to stop by and say "good bye." There were a lot of experienced nurses who laid eyes on this woman within 30 minutes of the code, and none of us saw a thing. CNA's getting her dressed, the patient says, "I'm going to sit down for a minute," sits down on the bed and falls back dead. We coded her for almost an hour. Half the nurses were in tears, we were all in shock. Turned out she'd thrown a massive MI -- we never got any kind of a shockable rhythm, and hit her with everything in the crash cart, all to no avail. I can still picture that woman's face to this day.

Having said that...it was better for her to pass with us, where she'd been spoiled and treated like a queen her last days on earth, instead of the pit of a nursing home she'd come from. The last hands that touched her in this life were people that cared about her. I have to think she knew that. And sometimes, that's where we have to leave it. I couldn't change the fact that it was simply her time, but she wasn't alone at the time, and she was mourned when she left. And isn't that the most any of us can hope for?

Sugarcoma, we must be twins because I feel this way after nearly EVERY shift, but the kicker is.....I've been an LPN for 2 1/2yrs, worked a short time in a few LTC facilities and in a hospital, and I've not had a pt pass away on my shift...(knock on wood). I haven't done post-mortem care, not even during clinicals! Now, that being said, I'm not scared of HOW/WHAT to do when a pt passes, but will I know what to do if I'm there for the code?? It was pointed about by my units asst ncm on nights that since I have poor time-management skills and she feels that I lack in quality care, "who would want me to help in a code?" Her words. I think its safe to say even Florence Nightingale went through some rough times, but this "person" and her "observations" (I've worked with her only a handful of sifts) has given me such a complex, I feel defined by all the negative things that she points out. That being said, I own the things I know I could've/should've done differently. Its a surgical maximum (postop) unit and I had only worked a hodge-podge med/surg unit at one of our companies smaller hospitals. Now it's been said they "thought I had more experience than I did." What are reference checks for?? I worked for the same company, all of my reviews,etc were available. I said to begin with, my negative/positive qualities tend to be the same; I'm a people-person so I talk too much, I'm detail oriented, I'm organizationally disorganized and consistently inconsistent! I have even been told by a nurse that I can be too accountable for things, taking crap for something that wasn't my fault!! My exact words during my interview.

Now I've had 2 bad reviews (in 6 months!)and its this same person writing the reviews. And I was told they think I'm ocd (becaseu I use post-it notes??) and I was told to go to our EAP counselor before "it was made a condition of my next review and any information would NOT be confidential"....yes, my appt dates/times/progress among other things would be available to my unit manager. No pt has been hurt, only 1pt complained the pca pump wasn't available soon enough (as an LPN, I can't initiate those, RN's have to, but guess who the RN was that finally hooked up the pca for that pt???) When I mentioned going back to school in January for my RN, this was the response..."you shouldn't even think about that..." WOW, I was a hairstylist for years and I thought they were a bunch of mean girls......they don't even hold a candle!!

I am beyond second-guessing during and after my shifts, I'm now into the quadruple possibilities....and they can be preposterous, but with co-workers who will throw anyone under a bus, I can't help it. This unit is not my niche, I knew that going in. I just wanted to get back in with this company in hopes of 6 months--1 year on this unit and then transfer to another area of interest. Unfortunately, I have "1 month to show huge improvement" or I may not have a job. It really sucks that there is a 1year review from the other facility in my file that was EXCELLENT! No issues (except a few absences). And we get thank you cards when a pt mentions our name and I had 3 different pts in my last thank you card. It's like that part means nothing. I don't know what patients and coworkers are allegedly making complaints about me and I still find myself trying to figure it out constantly. I soooo feel your pain. Its mentally and emotionally a rewarding career, yet I am mentally and emotionally BANKRUPT at this point. I feel like I am being set up to fail.

I WILL be going to our EAP counselor (I used them last year during my divorce) and my advice is for you to do the same. And if I don't get canned, I'm going to keep going until I can transfer to another unit or find another job altogether :0(

Wish you the best!

Specializes in ER/Ortho.

I am a new nurse, and just recently left my preceptor to strike out on my own. One day while still with her (and she had been a nurse for many years) we went in together to assess the patient at the beginning of the shift. This was our third consecutive shift caring for this patient so we knew him pretty well. He was stable, plans were to DC him that morning, he had a good night, his family was all there etc etc. We walked out the door, and into the next room to see another patient.

Before we could even get across the room the emergency light went off in that patients room. We ran out, and back in to see what was happening. He was having a seizure, and his family pulled the emergency cord. He had NEVER had a seizure before. We saw no signs of this 30 seconds prior, and his family did not see it coming.

Come to find out he was having cardiac issues that were affecting his cardiac output, and his body couldn't compensate so he had a seizure. He was sent to ICU for meds, and cardioversion. The Dr had seen him an hour earlier, and he didn't pick up on it, and the prior nurse didn't see it either. We are not a tele floor so he wasn't on a monitor, and his vitals were stable at last check.

It really opened my eyes to how fast the situation could change. I mean we just literally walked out, and he was fine.

Don't beat yourself up ....We can just do what we can do, and have to let God do the rest.

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