Dealing with Guilt

[JA89]

Just in need of feedback from other experienced RNs on this one. I've been a nurse for about 4 years, working mostly ER. I've seen some bad things, but one case still haunts me. It was roughly three years ago. Had a pt who was 50s-60s in age, obese, diabetic, high blood pressure, and if I recall correctly some coronary disease as well. He was admitted to the floor at my small rural hospital. I worked nights, and our only staff was me, one other nurse, and a cna. This pt was admitted with a diagnosis of acute renal failure. I mean absolutely zero output. The docs were pushing fluids on him at the time, which I found odd since he was unable to diurese whatsoever. Because of the renal failure he was unable to rid himself of the metformin buildup that had acquired. Due to this, his blood sugar would tank anywhere from 25-50 every couple hours or so, and a shot of d50 would be required to normalize him. He would present with the usual hypoglycemic symptoms; confusion, slurred speech, or just grunts and moans. Over the shift I gave him d50 about three times, notifying my doc each time. Well about midway through the night, me and the other nurse were working on an ER pt. Our cna had made rounds and came back saying, "'mr. So and so isn't responding to me". I naturally assumed she meant he was displaying hypoglycemic symptoms again. I walked back to the floor, and went to my med room to chart the dose I was about to give and prepare the d50. It was at this point I became distracted by something on my cell phone(I know, huge mistake). I read something on my phone for probably 4 or 5 minutes, then proceeded into the pts room. When I arrived I knew something was wrong. The pt was cold to touch and had no chest rise. No pulse detected. I called a code, but we were unable to save him. For three years I've wrestled with guilt over that situation. I just feel I didn't move fast enough. I know he had other comorbidities that could have caused his death, and for all I know he coded well before we ever found him. My biggest fear is that the man coded due to severe hypoglycemia while I was wasting time reading something on a cell phone for those few minutes. I can't help but feel responsible for his death. Can anyone give me some advice here? All my coworkers and old administrator tell me it wasn't my fault, it was just his time, let it go and move on. I just can't seem to do that. I'm to the point of guilt that I want to call my board of nursing and report myself. I'm just desperate for advice here. Can anyone help me?

[Rose_Queen, BSN, MSN, RN]

Have you reached out to your EAP? They may be able to give you some guidance on how to deal with your situation.

[JA89]

I've had one visit with my EAP at my current hospital. The small hospital I worked at when this happened closed operations some time ago. To the honest the appointment was very unhelpful. His first advice was simply; well do you think the guilt would go away if you quit nursing? He totally missed the point. I enjoy helping people, would like to further my career to nurse practitioner school, but I have to find closure on this or it's going to ruin me

[dishes, BSN, RN]

What if closure is a myth? What if finding meaning and a deeper level of understanding about yourself and your nursing practice is the best you can hope for?

[Pangea Reunited, ASN, RN]

I think I would feel very guilty, too. I would probably try to reassure myself that I'd done more good than harm over time. I can't think of any other good "spin" to put on it.

[AutumnApple]

Write the patient a letter. Tell him everything you have to say about this situation.

Seal it.

Put it away.

Wait a month.

Open it, read it, see if you feel the same.

Keep repeating until you feel everything that can be said has been.

[Kitiger, RN]

I recommend regular counseling, because you sound so troubled. In the meantime, you need to forgive yourself. You know what you should have done. Can we say that you learned a hard lesson?

To make a mistake is human; to not learn from it is the bigger problem.

Please, take a deep breath and move on.

[BonnieSc]

While I agree with the others that more counseling would be the way to go (and I wonder, was the therapist not saying "you should quit nursing" but "even if you quit nursing, as you seem to be contemplating, would that really take the guilt away?") and I agree with what you clearly know about yourself, that checking your phone during that particular situation was wrong:

This man didn't die because you checked your phone for five minutes. It takes longer than that for a body to get cold. Full stop. He was not alive when the CNA found him and cold by the time you got there.

It sounds like he was being mismanaged by the medical team (and it sounds like you know this). I've given one dose of D50 plenty of times but if the problem continues a different management should be attempted.

You may be able to acknowledge that and still feel guilty, but what will help you come back from that varies person to person. A therapist can help you figure that out. It might be by developing some education for nurses and/or CNAs on some medical aspect of the case, by learning everything you can about renal failure yourself, by "punishing" yourself by grounding yourself from your cell phone for a while, by doing "penance" in the form of volunteer work... this is a very individual and sometimes cultural thing.

[HeySis, BSN, RN]

Considering how you feel about this, I cannot feel like you will do anyone any good by reporting this to your board. You reported your concerns to your immediate supervisor which is where your responsibility there ends.

We, every nurse, has a responsibility to learn from our experiences, both positive and negative. Guilt is a powerful emotion that helps us reflect on negative experiences, and while at times we may never know how much our actions impacted the outcome, we can make a conscious decision never to have to wonder about that particular action again. I'm going to bet that you don't check your phone at work at all anymore, and that anyone reading your story will think twice before doing that too. (please know it's not because I assign blame, but because no one wants to wonder)

So ask yourself... are you a better nurse today then you were three years ago? Do you enjoy being a nurse (other then this experience)? If yes to both, I think you should continue on with your career.

I really like this advice.

Write the patient a letter. Tell him everything you have to say about this situation.

Seal it.

Put it away.

Wait a month.

Open it, read it, see if you feel the same.

Keep repeating until you feel everything that can be said has been.

[JA89]

Thanks for the feedback. Every one of you have made valid points, and some encouragement. I feel sure I am not the only RN who has ever made a mistake, or felt guilt over a patient outcome. And I must admit the fact that the pt was cool to touch led me to believe some time had passed since his coding. It's simply a guilt issue. I am a Christian man, and integrity is important to me. I never reported my concerns to my administrator then(although I have now) and it seems clear she would not have even considered reporting my actions to the board. So I am not sure why I'm tempted to do so myself. Perhaps a way of soothing my conscience. But at the risk of sounding arrogant, I would say I am a much better RN now than 4 years ago. I think my best solution is to continue counseling, and continue my career. However, this is one mistake I will never forget. I hope possibly some younger new nurses read this, and learn from my mistake

[dishes, BSN, RN]

@JA89, you're right, you're not the only RN who has ever made a mistake or felt guilt over a patient outcome, I have, so have many others.

[Mia415]

Wow. What you're feeling is totally normal. I'm sure I would feel the same. You paged your doctor multiple times and you were understaffed. Agree wth all other advice to get some counseling and keep assuring yourself it was not your fault. We all have that one case!