Struggling with what goes on around me.

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Hi! I've been a nurse in a neurotrauma ICU for about four years now. The last little while I've been witness to numerous life altering or ending mistakes or decisions. Mostly this is due to physician decision or error. After my last set, it is just weighing down on me like a ton of bricks. I don't want to be a part of it. I get sad. It keeps me up. I'll give you a few examples of events the last few months.

-I came on. My patient had been given TPa post stroke on a surgical unit and then transferred to us. It was 12+ hours later from the TPA dose and no recovery was noted in her hemiparalysis. I was looking at her IV pole. The TPa was still hanging as a secondary vial. No vented tubing used. The medication was never given. It would have said it was running but just drew out of the main line if there was no vent. The vial was full. I did an incident report. Never heard back. Patient died later on ward.

-Patient took a purposeful OD on cardiac meds that had no antidote. Came in talking, very regretful, wanted to live. Severe hypotension that minimally responded to pressors. It was dire. Physician on days opted not to dialyZe him for his kidney failure (due to hypotension). Physician on days also opted not to transfer him for ECMO even though it could have saved his life. Physician on nights came on and was upset. Tried to do some of this but his pH was now 6.8. Tried to put in a hemoline but it was too late. Too late for ecmo.

-patient CTd as outpatient months before coming to us. Reported as normal. In hindsight, had pons swelling. Brain dead when we got her. Too late.

- patient Ctd as outpatient. Reported as normal. Missed the tumour. Now doing terrible in our unit post op.

- young kid. due to fear of anyone recognizing the story, ended up a quad.

I know I work in a high-stakes environment where things like this will happen. But man the latest influx is killing me. I don't know how to feel okay about it. As you can see, a lot of these incidents are happening outside of ICU but it makes me doubt the system. I so badly want to say to these families "ask for an investigation" but I know how inappropriate that is. It's just weighing on me. Any advice? Does anyone else feel like this? Sorry if there are typos - on my cell.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Moved to our Critical Care Nursing forum for more replies.

I have similar situations at my institution. I work at a small level 2 trauma hospital in the ED and now SICU. the amount of medical mistakes is ridiculous by both medicine and to the lesser extent the surgical dept, but it happens too. It's even a running joke in the surgical dept that when they downgrade a patient to medicine they'll die shortly after. I've seen multiple residents not know how to run a code, not come to evaluate patients even if we call them and insist on it. Order treatments, diagnostic tests too late. The residents complain that their attending don't care about them and etc... very sloppy institution. Even the nursing dept is a mess (whole other thread) I came from a bigger institution to work here thinking it was a less hectic ED and boy was I shocked. In hindsight should have stayed where I was which was a reputable, well run institution.

The only thing keeping me here is the fact that my coworkers are gems and this is my last bedside merry go round before advanced practice nursing as that I'm in school. By the time I'm done I would have done 14 years of bedside.

I like you have no idea what course of action to bring up especially since I've only been here about 3 years and other RNS have 10 tines that time vested. They just tell me it's always been that way and they've raised concerns before. But let's be honest will administration take nursing seriously when they question the facilities medical quality? That would be a first. Our new CEO likes to have biannual townhall meetings with the CMO/CNO present but how in the world do you eloquently say that the doctors need to practice better medicine without becoming a target?

I just believe some issues have to work themselves out/things have to be exposed before the right thing is done. I'm ashamed as a healthcare professional especially as a nurse to admit that there is no guarantee to the public that everything goes right and that negligent and sloppy medicine does happen. I would not recommend my institution to anyone and that's a horrible reality.

Specializes in Critical Care, Rapid Response.

I've seen mistakes everywhere I've ever worked.

And there is always that fear of becoming a target. So I was looking for a way to delete my post, as the info about me at the end might be recognizable. I don't see a way to do that, so I basically gutted the body of the post.

Specializes in Family Nurse Practitioner.

Medical errors are the 3rd leading cause of death. Medical error—the third leading cause of death in the US | The BMJ

There are good hospitals and bad ones out there. Find a good one to work at. Sometimes you don't realize how bad a hospital is until you start working for a better one.

Medical errors are the 3rd leading cause of death. Medical error—the third leading cause of death in the US | The BMJ

There are good hospitals and bad ones out there. Find a good one to work at. Sometimes you don't realize how bad a hospital is until you start working for a better one.

and the other way also, sometimes you don't realize how good a hospital is till you work for a worse one...

Pt 1 - What did they die from? Complication of the stroke? tPA is like what, 30% effective at reducing deficits? Seems I had read a study that ~17% of stroke patients die regardless if tPA was given or not. Did not receiving the tPA kill them? You can't really say.

Yes it was a mistake with it not being given, but blaming that on their death is not accurate.

Pt 2 - Well, was the pt too unstable for dialysis? The fact that the pt came in talking, regretful and not wanting to die has no relevance. The pt took a fatal dose of a medication. That is what killed them, not the Dr decision. The second Dr coming in questioning the first Dr, well, that is their right, but would it have made a difference?

Pt 3 and 4- imaging is easy in hindsight. you can't go over every mm of film with a microscope and then run more tests on every little thing found. It is not a perfect technology. Some things don't show up or look normal in imaging.

Pt 5 - no idea since no story, but age does not matter that they became a quad. Lots of young males become quads because of stupid things they do.

Medicine is not perfect. We can't fix everything. People die. Lots of people die. Everyone dies eventually. Of all you posted, the only mistake I see is the tPA not being started when it was charted that it was. No way to know if it made a difference in outcome. the rest is just how it is.

Specializes in Cardiac/Transplant ICU, Critical Care.

I don't mean to sound insensitive or disrespectful, but we are NURSES, not MDs. Our job is to advocate for our patients, give them the best care possible, and to notify the MDs if we see a change in condition or throw up a red flag for an alarming trend. If you are more experienced ,then you can add guiding the MD's decision with your input and insight to the list as well.

If you don't like what the resident says then page the fellow, if you don't like what the fellow says then page the attending, if you don't like what the attending says, page another attending. If you still do not like the answers you are getting then you are out of luck and all that you can do is chart that you notified everybody. If the patient ends up passing because of the actions of the MDs or the lack thereof, you did everything that you were supposed to and you shouldn't feel bad or guilty.

My philosophy is that I will follow any order, no matter how weird or even if it is a 4th quarter 3 seconds left on the clock long shot hail mary, as long as it IS NOT criminally negligent. It sucks to have so many losses in such short succession but you also have to remember that you have a lot of wins as well. But like you said, many of those things happened outside of your control and you are unfortunately left to clean and salvage the mess. This happens to all of us at one point or another when the losses start to bother you.

Through some pretty emotionally taxing work related events early on in my career, I made the decision to forge myself into the best nurse that I can be. I did this because I want to be the best, I want to give my patients the best possible care, and if there is a weak link in a team that is caring for a patient, it is NOT going to come from the nursing aspect of it. Through hard work and determination I have made sure that is the case for every single patient that I am tasked to manage. As long as you did everything in your power to advocate for the patient, you made all of the right moves, there were no better interventions, then you can still leave your shift with your head held high.

This is something that we all go through as Critical Care Nurses and you will get through it in one way or another. Whether you stay on The Units and make yourself into a Beast Mode member of it, continue to be an All-Star, or if you decide to do something else, you will make it out alive on the other side. But only you can decide what is right for you. Good luck and stay strong!

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