Dealing with first loss of patient

[broosevader]

Last night I had my first patient go bad, GI bleed it appears at this point, having a hard time dealing with it, keep thinking back to what I should have done or noticed earlier, does it get any easier, I've been a RN for just one year now, celebrated my one year anniversary just a few days ago. Hoping to learn from this and be better able to deal with this in the future.

[lkwashington]

I'm not going to say it will be easy everytime because I will be lying. We are human and we are allowed to be emotional for and with our patients and their families. I believe each time you may deal with a dying patient or a patient death better than the last, especially when it expected. The reason is you can prepare for it by waiting and knowing. Unexpected death are the ones that hurts and you know you have done all you can do in your scope of practice. Me personally I just dont believe a should patient dying alone. I have held my patient in my arms while they are dying. I learned this from my preceptor. I am getting emotional now. You may want to talk to nurses on your unit and/or facility who are more experience with this situation. They can share some light and you can become more comfortable with death. Please dont blame yourself. Im sure you practice within your scope. Keep us posted.

[Flying ICU RN]

keep thinking back to what I should have done or noticed earlier, does it get any easier,

The short answer is that is gets much easier, it's called "clinical detachment." The trick is to not allow that clinical detachment to evolve into complacency.

Your moral and legal responsibility in an acute care scenario, is timeliness of appropriate interventions. So long as you initiate interventions (call MD, rapid response team,..etc) at the earliest deviation from baseline, you have fulfilled that obligation. It is not your responsibility to diagnose and fix the underlying problem.

[Jech]

LKWashington is right. In my opinion, no matter what the situation is, you will always think of things you should have done, or would have done, or could have done differently... Talking to fellow coworkers will help you, and will show you that you are not alone. Sometimes, avoidance is my first choice of coping. I (TRY) to always find the positive in things. For instance, there was a very young girl who committed suicide. She was brought into the hospital, but was found to be brain-dead. The whole family was here. Even though I didn't have actual interaction with the patient, I felt very emotionally overwhelmed about them and their situation. She was pronounced dead, (get ready for the POSITIVE) almost ALL of her organs were harvested and donated to those in need of them! That helps with coping... for me anyway.

[Fribblet]

There is no doubt that as you gain more experience, your ability to pick up subtle changes in a patient's condition will improve. That nursing "instinct" will develop. I'm sure in just one year you can detect a great change in yourself compared to when you first started.

I don't doubt that what we say here will not do a whole lot to assuage your concerns, but you'll feel this way for a while. As your clinical skill grow stronger, so will your confidence. You may still wonder years later, if there was "anything else I could have done" when a patient goes south, but you'll be confident in your assessment that , no, you did everything correctly and that the situation at hand could not have been avoided.

Sometimes conditions, like GI bleeds, are obvious, sometimes they are a bit more insidious, and go from bad to worse VERY quickly. It's the MDs job to diagnose.

[Zookeeper3]

I can only say, that I applaud you. Only a nurse that cares would question these things later, and that will be the defining factor of what type of nurse you will be. Keep that, and never change.

Not knowing the details, and it really doesn't matter if you could have, should have... you already are doing that. just know that I still do that 15 years in. My mistakes, things I overlooked are so hard to swallow.....

But I look in the mirror, accept my faults, learn from them and NEVER EVER repeat them. If you can do that and forgive yourself and learn and move on... you'll be the best nurse. Thats all I can say. We all learn from our failures, no matter how big or small. Just NEVER repeat them. Hugs, you'll do well next time... and I certainly do NOT assume anything way in anyway of your fault, we unfortunately learn in hindsight. And we have to live with that sometimes.

[Mike A. Fungin RN]

Not to sound callous but, we work with sick people in the hospital. Sick people die sometimes. Period.

All you can do is your job. As long as you did your job there's not point in second guessing yourself or taking it home.

[ChristineN, BSN, RN]

Not to sound callous but, we work with sick people in the hospital. Sick people die sometimes. Period.

All you can do is your job. As long as you did your job there's not point in second guessing yourself or taking it home.

I have taken care of several chronic pts that have died, some of them I knew for years. When a pt spends more time in the hospital than at home with their family, it's next to impossible for the nursing staff not to feel a bit of a loss.

[EbonyBorn2Succeed]

I don't think anyone should ever get comfortable with death.

[gentlegiver, ASN, LPN, RN]

A bit of advise I heard years ago; When God places His hand on the patient's right shoulder, we must remove our's from the left one. We have no say in who lives or dies, second guessing our actions is very human and as old as time. Look back on what you did, forgive yourself for what you didn't do, and pray that your hand always be guided by His desires.

Last night, I had a patient pass away. We all knew she was going, she had told us her time would end soon. My CNA's went in to care for her during thier rounds, she seemed fine, no reason to alert me. I checked on her and saw no respiration problems, no signs of discomfort, just the gentle breaths of a sleeping person. Two hours later they went back in and found her passed. I thank God she went peacefully, but as I believe that no-one should be alone when they pass, it's difficult to accept that maybe I should have checked on her more often.

See, everyone questions thier actions, whether it be during an emergency, with a pt in distress, or, with the ones lucky enough to slip peacefully into that final sleep. Just don't allow your questioning to overwhelm you. Your going to be a great Nurse!

[OCNRN63, RN]

Does your employer have an EAP? I would suggest utilizing those services if they're available. Maybe talk to a more experienced nurse about how he/she handles losing a pt.

I will say a GI bleed is a pretty traumatic death to witness; I'm sorry your first patient death was a rough one.