Did I cause my patient to die faster?

[lou_tango]

I am a CNA on a medical/surgical floor and am in dire need of clarification (from a nurse please) of what just happened at work last night. I work nights, came on the floor and got to work right away. I got a walking report from the 2nd shift CNA. One pt was an unresponsive very elderly woman who had suffered an acute MI several days earlier and wasn't expected to make it through the night. I was told in report by the CNA that the pt was being turned side to side every 2 hours (with oral care, checking for incontinence, etc.) and she was due again at 11:30, so I had him help me change her and turn her before he left. She passed less than an hour later. Here's where I need some help...

One of the nurses told me (not even the patient's nurse) that it was our fault the patient passed when she did. She didn't do it in an accusatory or mean way...just in a very matter-of-fact (and a little condescending) way. Like: "by the way, you shouldn't have turned her, that's why she passed so soon." I've been at this hospital for 9 months and somehow I have managed to skate by without any patient deaths...so this was my first. Needless to say I was speechless and felt terrible, as if I had taken her away from her family sooner than she was supposed to go.

She then gave me some explanation that I didn't understand. Something about when turning the patient, the blood floods the heart and the patient will pass soon after. First of all, we had to turn her to get her cleaned up. Second, I was told she was being turned every 2 hours all through 2nd shift. So did I really do something wrong? Is there truth to what she said? And if so, can someone give me a better explanation of what happened?

Thanks in advance...feeling confused and guilty here.

[lou_tango]

Wow, thank you ALL so much for the kind words and reassurance. After reading a few replies yesterday after I posted, I finally broke down and cried because I felt like I never had a chance to deal with my emotions about my first pt death until then. Knowing that I didn't accidentally cause her death was a huge weight off my shoulders and I am feeling much better about everything now. I have been working at the hospital for almost a year and have seen and experienced a lot, but I am only just starting my nursing pre-reqs (career change...so excited!). So honestly, when she told me that, I really didn't know any better and actually believed her.

Although now I feel I should probably always take her comments with a grain of salt. This was coming from a nurse who last week told me (and btw I am a type 1 diabetic) that I needed to take a diet soda away from a new onset type 2 diabetic pt who was still running high numbers because it will raise his sugar even more. Even when I tried to correct her and explain that there are no sugar or carbs in diet soda (which is one of the very few 'freebies' in life for diabetics), she insisted that I still take it away because it "must be something in the coloring or how its made, but don't let it fool you, it will still raise your glucose, I see it all the time." True, the nurses that I work with have waaaaay more experience and knowledge than me in the nursing field. But when it comes to diabetes, I'm the expert. So what kind of nonsense was that?

Anyway, per several of your suggestions, I will be talking to my supervisor about this. Not so much because I am personally upset...I can let that go. But because it seems she continually tells CNAs and patients things that simply aren't true, and that can't be good for anyone's physical or emotional health. Whether she's on a power trip or just that ignorant (my guess is it's a combination of both), I need to speak up so she doesn't subject anyone to further false information.

Thanks again for all of your support, it is truly appreciated.

[nursebethat]

It was time...thank you for being such a good caregiver.

[makingitright]

Working as a CNA and I have noticed that sometimes when a pt is dying and you turn them, some not all do tend to go faster. I have had nurses ask me to be very gentle when turning the patients in this case, or sometimes not to turn them at all if the turn is almost at the end of the shift. This has been my own personal experience.

My perspective is this, we are here to provide good care for our patients. We are here to help them through one of the most difficult transitions in life and so we do turn them, and we make them as comfortable as possible, that is what we do.

It seems to me by what you have written here that the pt was not a critical pt or else there would have been special instructions for you to have followed. That nurse whoever he or she is was very unprofessional to have guilt tripped you that way, I would even go as far as to say mean spirited.

Know this, realize that you did the best that you could do, and you have given your patient the care and attention that she deserved to then be able to continue her journey to the other side. You did nothing wrong here.

[silmas RN]

when the nurse said that, you should have replied, "can i turn you too?"

seriously, you did nothing wrong. that nurse is just passing flatus (ie. she's talking out her... )

lmao!!!!! i totally agree. turning the patient did not cause her demise. that nurse needs to get a grip.

[Fort Worth]

I hope you are there to care for me when my time is near!

[Diploma'82]

You did nothing wrong...you took good care of your pt and it was her time to go.

[Ihoplover]

Dear Lou - Bless you for caring for your patients and being tender hearted enough to be concerned about this issue. I'm sorry as are all the nurses posting here that you were demeaned by a NON tender hearted nurse. A better statement to you from the nurse would have been "thank you for helping me take care of this patient tonight - I know it's emotional caring for a dying patient - are you doing alright?". I'm amazed at the hardness of nurses caring for dying patients and the aids too for that matter. You did nothing wrong and try to forgive the nurse that did do something wrong - we're all human and make mistakes. Maybe she'll even apologize to you the next time you see her - not that it makes it right by any means but sometimes people reflect and then realize the error of their actions/words. I've seen this happen on my unit - an apology a day or more later and unfortunately the person receiving the apology had already been stressed in the meantime and hurt for no reason. Try to let it roll off you - God Bless.

Merry Christmas :redbeathe

[mystic33]

Having someone die is painful enough. Most disturbing is having a pt die that you were taking care of, even if you provided the best possible care. Worst yet, I cannot imagine how you must feel having someone insinuate that you contributed to someone's death. That is SO insensitive. Of course the pt's death is not your fault.

I hope you are able to convince yourself of the facts and start feeling good about the wonderful care you provided to your pt at such a critical point in time, and not allow some else's opinion to cloud the truth.

[Gabriel13]

You didn't do anything to hasten this patient's death. Maybe that nurse was was joking or just messing with you. If she really was being serious, then she is really full of it. The main purpose of turnping bed ridden patients (aside from cleaning them) is to prevent or slow the formation of pressure ulcers. You didn't do anything wrong. Patients, especially the very elderly and in poor health, are going to die even in the best of conditions. If anything, I get concerned that the health care we deliver does more to prolong death and dying than extend life. While we may be extending life further and further, how many of these added years are good ones? I see so many patients in conditions that you describe and I hope that I die before I have the need to be changed and turned and all. I know of people who have seen their patients code right upon transfer from an ambulance stretcher to an hospital bed. These things just happen.

[ionatan]

I think this nurse is the kind of person who likes to talk others down to make herself feel better about her own inadequacies. From my own personal experience, it does seem true that when you turn dying patients, they go faster. However, you have to keep the patient comfortable and as clean as possible. That being said, you did nothing wrong. You followed the nursing orders given to you, so don't worry about it. The nurse who told you that you should NOT have followed nursing orders should keep her mouth shut and stop picking on the nursing assistants.

[CountyRat]

with all due respect for my esteemed colleague (the nurse who made the statement that upset you) that is the dumbest, most irresponsible pile of ignorance i have heard in years! does turning have an effect on hemodynamics in the bed-ridden patient? yes. so does breathing. so does digesting food. so does having a heart attack (as in your patient's case).

no, you did not shorten your patient's life; period! in your op you wrote, "one of the nurses told me (not even the patient's nurse) that it was our fault the patient passed when she did" (emphasis added). this has happened to me, to other nurses that i have worked with, and it will happen to you again if you stay in healthcare (which i hope you will). some, ahem, "colleague" (i am trying to be polite) who was not present at the event, knows nothing about the patient's condition or treatment, and has not even asked a single intelligent question about the circumstances of a patient's death starts pontificating about the mistakes a coworker made. the fact that he or she was not there and knows nothing about what actually happened does not inhibit him or her at all. such people are not insightful enough, smart enough, or professional enough to deserve to be listened to.

you gave your patient good care. this nurse gave you a guilt trip based on his or her stupidity. you deserve to be proud of the care you gave. that nurse deserves to be ignored.

[sharab]

:loveya::loveya:Merry Christmas & Happy New Year

Some elderly patients do die upon turning but usually within minutes, not an hour later. At least in my experience that has been the case. And I did stay with my Grandmother, 88 years, during her passing. She expired shortly after turning but it was a clean and dignified passing, in the manner that she would have wanted. "Just what the doctor ordered"!! and after watching the whole process with my Grandmother I am a firm believer in "going when your time comes, or when your number rolls around. You did you job to the best of your ability and that is all can be expected. Any judgements that are passed are just that and should not interfere with the kindness and compassion you show your patient.