Completely panicked and failed to react appropriately to an emergency situation

[calastro]

I feel like such a failure. This is my first post, the reason I'm posting was really what prompted me to join the forum. I'm hoping someone can give me some advice on where to go from here because I feel like I don't have anyone I can talk to about it at the moment and I'm so ashamed and disappointed in myself.

I've been qualified and practising for 5 months, the ward I am currently assigned to is a Cardiac/Diabetes ward and I have been working there for almost 3 months now. It was nearing the end of a dayshift and I was attending to a patient when I was alerted to the fact that an elderly patient behind me was having some sort of seizure episode. The patient had been returning from the bathroom and was mobilising when the episode occurred. When I turned my attention to the unwell patient I could see that she had become rigid and tremulous, an auxillary nurse had caught her before she fell and was struggling with her weight. I immediatley assisted her in getting the patient onto her bed and ensured that she was on her side, maintaining her airway.

That's when I completely lost it, I don't know what happened and I can't understand it but I completely panicked and froze. My mind went blank and I just felt helpless. This has never happened to me to that extend before, I am not a very confident person and I do have a tendency to panic in emergencies but despite this I have always acted appropriatley and maintained the safety of my patient. I have never been the most senior member of staff or the only registered nurse present at such an event and I think it could be possible that I felt added pressure to take control and was unable to do so. Immediatley prior to getting the patient on her side 2 other auxillaries arrived to help, they held the patient down to maintain her safety. I assisted in this, but it did not take 4 people. I do not remeber how long passed before one of the auxillaries shouted for medical staff who were present at the other side of the ward. At this point I became more in control of myself and was able to retrieve the equipment necessary to obtain the patient's vital signs. When I returned with the equipment, a more senior staff nurse was present and in the process of administering o2 therapy. Space around the bedside was limited and lessened further with the no. of people present - 1 Dr, 3 auxillary nurses, myself and a more senior staff nurse - I felt very much on the periphery and unable to fight my way through to my patient, as a result, I passed the equipment onto the other staff nurse for her to administer. As I was so far away from my patient I was unable to provide her with any verbal support or assertain her neurological status, this was also left to the other staff nurse. Thankfully the patient's observations were stable, including o2 levels, Cardiac monitor showed SR and patient stabilised quickly.

The most frustrating and disappointing thing is the fact that I knew what to to do. I knew that my patient's vital signs should have been taken ASAP and adequate oxygenation was priority. That is basic nursing care and I cannot understand what happened and why I was unable to act. I had 3 untrained but experienced members of staff who I should have delegated to, I should have stayed with my patient and requested that they retrieve all equipment needed and alerted medical staff. I put my patient at risk and this is not acceptable, I am so so thakful that my patient stabilised quickly but there was potential for arrest and this fact terrifies me.

Although I still consider myself to be a very junior nurse, I have been qualified for 5 months and cannot let that fact excuse me for my inability to act. I was unable to take control of myself let alone the situation or other members of staff. It was like I was frozen and could not physically move or think, I have been unable to sleep or eat since it happened and cannot stop thinking about it.

At the time and for the rest of the shift my coalleagues did not act any differently towards me and what happened was not mentioned. My method of dealing with it was to put on a brave face and try to get through the rest of the shift without allowing it to affect my confidence. I felt the best way to prevent myself from breaking down was to rationalise that my patient was stable, no harm had came to her and I would try to learn from the experience and ensure that it would never happen again. In reflection I feel that this may have conveyed that I was unaware of how badly I handled the situation or that I did not appreciate my colleagues for stepping in and taking control when I was unable to do so. I know that this was unfair on them, particularly the untrained staff, and maybe I should have taken them aside and apologised and thanked them immediatley afterwards but I was aware of how much attention I had to focus on 'keeping it together' and felt that any discussion of what happened would lead to me becoming even more distressed and therefore of no benefit to my patients. I was also so ashamed and knew I was deserving of anger from colleagues who were in every right to critisice and I did not feel emotionally able to deal with that.

Four days after the incident I was called into the sister's office to discuss what had happened, that is when I found out that I had been reported to her by my colleagues for my lack of action. I fully understand that my colleagues are required to do this but I wish they had spoken to me about it also. I want to bring up what happened and discuss it with those present at the time but I do not know if this is appropriate or would be beneficial?? I feel I should apologise and I believe that my relationship with my colleagues has been affected, it would be understandable to assume that confidence in my ability as a nurse and my practice has been lost among fellow staff and that they will no longer be able to trust me as they should. I know I have let my patient down but I have also let down my colleagues, my manager and my ward. I don't know if this damage is repairable.

Should I take aside the 3 auxs involved and apologise for my lack of action and thank them for taking control when I could not?

Should I try and discuss what happened with the other staff nurse present, and make attempts to salvage any confidence or trust that she may still have in me?

Should I arrange a meeting with the ward manager to discuss how I am feeling and inform her of my plan of action to ensure I respond to any future situations with confidence and conpetence?

Should I try and allow my actions to speak and focus all attention on maintaining good practice in attempt to slowly regain my colleagues' trust rather than make apologes or give excuses?

Does anyone have any advice on how to stay confident after this? I'm dreading my next shift and I really want to be a good nurse. Any advice on how to stay calm in emergencies like this, or how to take control effectivley?

I am sorry that this post is so long and I am very grateful to those who have read it. I hope that posting about it is not in breach of any confidentiality, I have been careful not to metion any locations, names or other details. I would be so grateful for any advice, input or opinions. Please help

[meluhn]

Dont beat yourself up about it just learn from it. Chalk it up to a bad judgement and move on. Everyone has felt like this at some point. Dont let it consume you.

[sissiesmama, ASN, RN]

Calastro - PLEASE don't think you are the first nurse to feel like this, and you for sure won't be the last. It's important to learn from mistakes you make, and learn from it so at least you don't make the same one again.

It is hard not to panic in a critical or code situation, but it will get easier. I speak from experience - believe me it does get easier!

Anne, RNC

[calastro]

Thank you for replying, I feel a bit better knowing I am not the only one to feel this way or to have panicked. Whenever I read other nurses' reflections regarding first emergency situations they are always positive where the nurse did really well and was praised for reacting appropriatley. It makes me feel better that this is not always the case. I will try to move on and learn from this. Still nervous about returning to work but am much more positive about it.

[Penelope_Pitstop, BSN, RN]

I think in emergency situations, it's much easier to "know what to do" when it's not your patient.

My first code was my patient. I was so stressed out, felt responsible, was terrified. I freaked out and ended up having to be pulled from the room by my charge nurse. I didn't know what to do at all.

Fast forward to my most recent code. It wasn't my patient. I ran in and started chest compressions without a second thought.

That first code years later still haunts me. Should it? No, but it does.

Take a deep breath.

You're okay.

[mama_d, BSN, RN]

I can recall very very few emergent situations which I've been involved in where lack of experience or "freezing up" momentarily resulted in the rest of us involved feeling like the nurse handled things poorly.

On my floor, those of us with the most experience tend to take over with the patient and let the less experienced nurses participate as they are comfortable. If you feel up to jumping right in and and doing compressions during a code, great. If you're more comfortable standing back and limiting yourself to communicating with the doc, that's fine too, as long as everything else is being covered. It's just the way we do it, and no one ever thinks twice about it. Everyone takes their own amount of time to get comfortable with rapid response type of situations.

Most likely no one even thought twice about it from how you described it. I'd think at most all you'd need to do, if it makes you feel better about it, is thank those involved for the great support you had; no need to even bring up feeling inadequate regarding how you handled it.

[azhiker96, BSN, RN]

Here's some advice I received once. When the unexpected happens, take a deep breath. If you don't know what to do next then just take another deep breath. This way, even if you never do anything else you're still breathing. :wink2:

One thing that helps is to step through your ABCs. Airway is first, make sure the pt. is breathing. Then check for circulation; pulse and BP. Protect from harm and then treat other symptoms as needed. I think the shock of being presented with the unknown/unexpected can freeze us. By doing something you start moving and then it seems more natural to continue with assessments and interventions.

Review this incident in your mind. Review the symptoms the patient presented and the interventions. Next time a patient has a seizure it won't be quite as unnerving. It's just a learning process. You'll be fine.

[Freedom42]

You don't have to apologize for being a beginner. All of your co-workers were beginners once, too. I found myself in a similar situation a few weeks ago with a patient who developed flash pulmonary edema. She was literally foaming at the mouth. Did I handle it perfectly? No. Did I panic? No. Victory. I called for help, did as much as I could figure out, and got the patient emergency treatment. I vowed to do better next time. That was the best I could do at that point. When the time came for my next shift, I came in early and asked the supervisor for what I call "a debrief." I told her I needed to talk about what happened, what went right and what went wrong so that I would improve my game plan. No apology necessary: I made it clear that I knew I needed to improve and that I wanted to. That's part of being a beginner.

"Next time" came this morning, when an aide came to tell me the same patient was "having trouble breathing." I'll say. Cyanotic, diaphoretic, RR 32, HR 114, O2 sat 41 percent on 2 litres! This time I was able to take charge of the situation. Perfect? Heck no. Better? Yes. As my supervisor reminded me on the way out, it takes time and practice. I'm already going over the finer points to bring up at tonight's debrief. (NB: It helps to have supportive management. When I called the doctor at 3 this morning, he was patient: He knows I'm a beginner, and he took a moment to talk me through what I was seeing. I don't feel I owe him an apology; in fact, I got the impression that he enjoyed helping me advance my experience. These folks make me want to come back tonight!)

I think your colleagues will respect your status as a beginner if you demonstrate that you know what you don't know, and you're confident enough in yourself to ask for help. Take action now to do better next time. I put together an index card of basic steps that I taped to my clipboard, for example; when this morning's emergency came, I glanced at it and had my instant game plan. Maybe next time I won't need notes.

Don't apologize to the people who jumped into help you. Thank them. If you learned something specific from them, tell them what it was. That sends a signal that you're learning and growing and want to improve. And remember why you became a nurse. It surely wasn't because you wanted an easy way to make a living, was it?

[calastro]

Just wanted to say thank you for all replies and everyone's support :)

Was really appreciated

[AllieRat]

I do the same thing.. If it's not my patient I can think when it's mine I go into shut down mode..

[Freedom42]

I have found it helpful to review Benner's Stages of Clinical Competence. Looking at her principles reminds me that I have made progress. It also puts into perspective how our experienced colleagues think, why they think that way, and what it took for them to reach that point. Benner has clearly established what the learning curve is for the new nurse.

[Spatialized]

I second the others thoughts above, don't beat yourself up, we've all been there before. One of the first codes I responded to I walked (well, ran) in with the code cart and went completely blank. I "woke up" as a second nurse pushed past me into the room! Now it's better.

Don't apologize, thank them for their help.

Tom