Dealing with Guilt and Coping

[clouds_creamy]

Hello all,

I've been a Med-Surg nurse for about a year and a half. Several months ago, I had a patient who was talking to me and seemed very normal. Nothing clued me that she would end up passing away that night. She did have some serious issues, with her heart (EF was very low), she was Oxygen dependent, etc. Later on in the night, after I came out of my other patient's room I heard the intercom for Code Blue. Took me a second to realize it was my patient. I rushed in there, and I see my Charge Nurse doing compressions on her. I couldn't believe this was happening. Before I could get more hands-on and help, I decided to grab my WOW while my Charge and another coworker were doing compressions and breaths. I decided to do this to get more accurate information on the patient because at this point, I didn't want to rely on my notes or memory for more info about the patient.

RRT arrived with the MD, and they asked me about her previous medical history, which I told them according to my papers. I just felt so useless at the time. I was even asked at one point what her K+ was, which I didn't write down (b/c it was normal)... Later on, I was asked if the pt had a pacemaker, which I remembered reading somewhere, but I couldn't remember exactly. I did find it in the notes though and let the team know.

To sum it all up, I thought I was able to move past this situation because even my Charge was telling me that she was quite sick, and there was nothing else I could have done that could have prevented that... And I tried to make peace with that, but at times, I would think about all the little things that I could have/should have done... Like today during my BLS, they were talking about using the CPR board, and I don't even remember if we did this during the Code... and how I could have offered more info when the doctor asked, and how I should have known right away that she had a pacemaker... Have been contemplating talking to this Charge about it, but I actually switched jobs, and I think bringing this up again to her might be a bit much...

I realize that death is something that we will encounter as nurses and that it is inevitable, but how do you guys cope with it when it happens to your patient? How do you deal with the guilt?

Thank you to all offering any insight.

[Cat365]

It sounds like you did a good job. You provided accurate information and you looked up what you didn't know. A CPR board wouldn't have changed the outcome.

It's hard as a nurse to accept that people will die. Everyone dies sometime. It feels like a failure, but you are not a god and don't get to decide when it's time.

Relax, accept you are human, and acknowledge that as hard as we try we can't save everyone.

[Davey Do]

I realize that death is something that we will encounter as nurses and that it is inevitable, but how do you guys cope with it when it happens to your patient? How do you deal with the guilt?

When it is your time, it is your time.

I've known of people and patients in pieces who survived and others who were perfectly well and keeled over.

As professionals, we can only be there and, as you did clouds_creamy, do the best we can.

And welcome to AN.com, clouds_creamy!

[Crush]

It sounds like you did a good job. You provided accurate information and you looked up what you didn't know. A CPR board wouldn't have changed the outcome.

It's hard as a nurse to accept that people will die. Everyone dies sometime. It feels like a failure, but you are not a god and don't get to decide when it's time.

Relax, accept you are human, and acknowledge that as hard as we try we can't save everyone.

This. If you have to, tell yourself out loud you did a good job. Your co-worker even said you did fine. Did you guys have a debreifing afterwards?

Ok, so things you can do to move on. Talk to employee support (or whatever your facility calls it), talk to your floor chaplain or even a private counselor.

Please be gentle with yourself though. It really does sound like you did all that your could. It sounds like you did the best you could with what you knew and what was available to you at that time.

[Nurse SMS, MSN, RN]

You did great. Seriously.

The longer you are a nurse, the more you realize that when it is time to die, nothing done will save and if it is not time, nothing done will kill. Everybody dies. The only fault to be found is in the imperfection of the human body. The more I learn about it, the more shocked I am that it ever works the way it is supposed to in the first place.

Its okay to be sorrowful that the patient died. Don't take the responsibility of it on yourself though. Your patient was obviously extremely sick. The rest of your code team didn't save her either. Would you call all of them failures too?

[ruby_jane, BSN, RN]

A good nurse will run some "what if" scenarios immediately after an incident. You want to make sure you did what you could have. I'm impressed that you grabbed the computer - not sure I'd have had the presence of mind to do that.

You can stop running the "what ifs" now. All is well. Hang in there.

[brownbook]

I am many years experienced, many years of working ICU and taking ACLS, my trick to code blues is to hide in the linen closet . They are stressful.

I think you did an amazing job.

I am feeling good about myself if I can remember 30 / 2, or 15 / 1, if that's even right it changes tooo frequently!

[nursej22, MSN, RN]

Do give yourself permission to grieve, and talk to someone, such as EAP or if you have a chaplain. Debriefing should be standard after codes, to see what went well, and what could have been done differently.

Review your code blue protocol, if you have one. When I was in the hospital the patient's primary nurse was assigned to give report on the patient, which you did and access the chart (which you did with your WOW, I think). Nobody can have all the pertinent info at the tip of their tongue, but with experience, that will come more easily.

Worrying about the backboard? Who ever was doing compressions would have noticed that. That is usually the first thing to come off the crash cart in order to access the drugs and equipment.

It does sound like she was very ill and people with low EFs are at risk for sudden cardiac death.

You did fine.

[CharleeFoxtrot, BSN, RN]

Do give yourself permission to grieve, and talk to someone, such as EAP or if you have a chaplain. Debriefing should be standard after codes, to see what went well, and what could have been done differently.

You did fine.

All of the above. Avail yourself of the support available at the hospital to help you to debrief and cope. I had a similar incident happen to me early on in my career and I wish I had not been so quick to dismiss the help the facility offered to me.

[clouds_creamy]

Wow, thank you all for your comments. I'm so touched by your words of kindness.

Sadly, we did not have a debriefing after the code, but now I'm realizing that we should have had one. Not only to discuss what we could have done better but for our own closure.

I'm hoping that this will get better with time, but I've been learning how hard it is for myself when I make a mistake (referring to other incidents), and dealing with the fear of potentially really hurting a patient. I wish I could just let it go, but it's been something really difficult for me to do and I'm really trying to cope with it in a healthy way.

Thank you guys for your responses because it honestly has offered me some comfort. :)

[OldDude]

clouds_creamy...there isn't anything I can add to the above peer support, understanding, and outright love as has been expressed. With the exception of the fringe lunatics, which don't last long, I've come to realize this site, allnurses, is likely the best therapeutic intervention money can buy...and you don't have to pay for it. for the best advice and support for our brother and sister nurses. These guys will lift you up when you need it and they'll kick your ass when you need it too! I'm damn proud to be a part of allnurses. Nobody knows what nurses do except other nurses.

[canoehead, BSN, RN]

My first code, I called for the code team, but then when they asked me things, I couldn't comprehend enough to answer. Someone said "get a bag!" and it flummoxed me for the rest of the event. I knew we had them, but couldn't remember what they were. Totally useless. But my coworkers all had their own first code experiences, and understood.

You did amazing, compared to most. And every code you will review in your head, and come up with a way you could have done better. That's the sign of a good nurse, not a bad one. My second code, I damn sure knew where the bag was, and how to use it. Your next code, when they ask about the pacemaker, you'll just feel his chest, (like anyone else could have done, BTW) and say "yep!" One of our ER docs regularly asks if the patient is on oxygen while he's looking at someone with a NRB on their face, and it tickles me every time.