Ever Killed Someone?

[Bug Out]

Weird topic I know but I think about this alot.

I always wonder out of the thousands of patients I have been assigned how many of them demised because of something I either did, did not do, did not do fast enough, did too fast, or just simply did not assess.

For example you give the Ativan that confuses the pt, pt crawls OOB, falls, breaks hip, eventually leads to demise of pt that would have otherwise went home safe and sound. OR you fail to see the s/s of some obscure syndrome and disease which leads to late treatment and eventual demise.

On the other hand, how many lives do you think you have saved?

Honest rough assessment, how many lives do you think you have directly saved through your actions/inactions and how many do you think (or know) demised because of your action/inaction.

P.S.

Pretty sure I killed 1 person, maybe 5-10 unknowingly?

Saved hundreds indirectly, I hope. I know I saved about 15 through direct action.

[sjoy]

I can't believe I even clicked this thread...

But here goes anyhow.

It is amazing at the amount of, various perspectives on, and excuses individuals make concerning what some say is an assisted death. Isn't that what they call it now? Not murder, but putting an end to their suffering. There is a reason death is unpleasant. So you have to ask yourself this: Is suffering worse than death itself? I really don't want to hear the answers to that...especially after reading the responses on this thread.

Now...any action you take that moves someone closer to death, brings death on, or harms a person....regardless of what your society says..the state..government..cases from decades ago...or whoever...just know that if it was in the heart of the person to expedite death, it is murder.

So now that the consciences have been pricked...

What audacity there must be, in the community of nurses ,to assume a patient is ready to go? Who has determined the are ready to meet the other side? Trust me it is not in our hands. True, some don't believe there is another side...some don't believe death is as bad as everyone is saying it is...some just don't care due to whatever their own circumstances are...Now of course I don't expect these workers to lay down their machete in a hurry. But I appeal to those who admitted to having a piece of a conscious and felt the guilt.

Guilt comes when there has been wrong doing. Point blank. That is the work of our creator.

Listen to the voice...the benefit outweighs the career..believe it.

BTW: Trust me I certainly won't be following any responses...good or bad.

Time tells all things..I just hope the right decisions are made hereafter.

[neutrophil]

It is interesting that you mention this and put it in those words. I think are erroneously chosen. I do how ever know that we do have an effect to those extremes. Some of the patience that I recall regularly are patients that I assisted in their dying days. One of which I knew that after giving her the dose of morphine, would breathe her last breaths. She was special to me because I was one of those that cared for her for a year. She was so nice and gentle. I was fortunate enough to be thanked by her children for the care that I gave. But although she was going to pass. I, in the name of comfort care, assisted her to pass from this life. Many, many nurses do this day after day. It is imperative that we as nurses know, and take very seriously the job that we do. All nurses are human, but not all humans are nurses. Kind of like Cognac. All Cognac is Brandy, but not all Brandy is Cognac. If you take your job seriously and believe that you are doing the best that you can. Then, be proud of what you do. And be thankful.

[nursel56]

My sister died about a year ago in Icu, she had diabetes since she was 12 was on dialysis, and had congestive heart failure. I had only been an Lpn for 6 months. My sis was short of breath and extremely anxious. Classic signs of blood clots, which was found a few days later. After not being able to dissolve the clots, she had open heart surgery. Few weeks after surgery became septic and died. I feel as if I should of suspected blood clots. So how's that far an answer. This is the first time I admitted that anywhere.

This is such a common feeling-- there are a multitude of "what ifs" that come in the aftermath of the death of a beloved family member. But by mixing up the roles in our heads sometimess (ie a loving sister or an LPN with 6 months of experience) you burden yourself with a needless extra layer of guilt. Seeing your sis out of breath and anxious could have had a number of causes, but you absolutely should not beat yourself up because you didn't in essence "diagnose" her respiratory issues. You were the loving sister. That is the only standard you need to worry about. Honest. ((erikadawn)):redpinkhe

[paranrs66]

Just want to add: what's done, is done. Every nurse has an obligation to continue to learn and advocate on behalf of their patient and their patient's wishes to the end. While there are times that we can only "do the best we can", there are many times when we must "do what is necessary". Sometimes the "best we can do" is simply not good enough. We can sit around patting each other on the back and say " you did the best you could do", or "we did the best we could", or we can critically examine how we can improve to be better in a future situation. Always strive for a higher standard, always choose to learn and learn from mistakes seeking critical imput from those with more experience and knowlege. Sometimes we don't know what we don't know.:)

[traumaRUs, MSN, APRN]

In many ways, we must just move on from this thinking. As above poster mentioned: we go into our shifts with the expectation that we will do our best. Sometimes our best isn't good enough and sometimes no one's best is good enough. Sometimes the pt outcome is just out of our hands.

In my mind, I can't keep rehashing things that have happened. Learn from your experience but we all have to move on.

[netglow, ASN, RN]

Sjoy, I appreciate and understand what you have posted.

Another line of thought would be to say that any intervention to thwart the disease process can be construed as getting in the way of God's intentions for someone. I feel that when nurses mention that "it might be time" for a person to leave our world, it is based out of knowledge of pathology, experience, and also allowing ourselves to know the presence of a higher power. This doesn't mean that as nurses we've decided the patient's demise. I don't think that there are too many nurses who are in a bad place, simply because they become aware. Our senses help physicians, families, and most of all the patient communicate. I don't think you can be more caring and close to people than at this time. Having said that, not everybody feels comfortable in this role. To allow yourself to be in the right place takes a lot. In learning from hospice nurses here who post, I can see that it takes a special person, as you have to give so much of yourself in order to do right by your patient. It is a serious business.

[NurseLoveJoy88, ASN, RN]

I have to admit I always feel a sense of helping someone to die when ever I give morphine rtc to a dying pt. I know they are pain free and I also know the morphine sped up the dying process. I had a pt. That had an order for morphine every hour, I still can't believe he lasted for a few days and didn't go sooner.

[epinephRN]

My sister died about a year ago in Icu, she had diabetes since she was 12 was on dialysis, and had congestive heart failure. I had only been an Lpn for 6 months. My sis was short of breath and extremely anxious. Classic signs of blood clots, which was found a few days later. After not being able to dissolve the clots, she had open heart surgery. Few weeks after surgery became septic and died. I feel as if I should of suspected blood clots. So how's that far an answer. This is the first time I admitted that anywhere.

I am so sorry for your loss.

For me, responding to what I believe to be the intentions of the OP, I think we have all been in a place where we believe we failed to the detriment of the patient. At times, we bear responsibility, at others, we have only vague guilt.

We all have so many stories, either those we have witnessed or those we have taken part in. I call them nursing ghosts. All you can do is do your best every day, and learn from every opportunity.

I believe we also have systems issues. I also consider how much we have to overcome; not enough staff, resources, or time. Assessment is such an important part of our role, yet so many times we don't have a chance to pee, more or less accomplish everything that needs to be done, especially in the first year after graduation, which I remember clearly. This is when I wish we had more time for true mentoring. I believe there are many nurses who quit the profession when they feel they are the only one to ever miss something or not be able to do all they need to do. It is the dissonance between the perfect nurse I think we all want to be and the time we have in which to accomplish many things.

Prioritization is necessary, but I feel the casualty is often the time spent with patients. I have noticed that subtle changes are easiest to spot when you really, truly have time to assess and interact with your patient. Last info I read said that around 80% of those who code had some change in vital signs or assessment within the 8 hours prior to code. This is not always easy to detect when you are running around "putting out fires" all day. I think it IS important to reflect on these things to improve our performance, but not to the extent that we continue to "beat ourselves up" over it. The key is to do the best we can with the knowledge we have at the time. I do wish more facilities offered incident debriefings, not for punitive purposes, but so others could talk through and look for opportunities to change and improve and to heal.

I do them informally during and after a code (ex- "does anyone have ANY other suggestions?" and "Is there anything we could have done differently?") but the hospital does not offer formal debriefing.

[EmmyBee]

for me, responding to what i believe to be the intentions of the op, i think we have all been in a place where we believe we failed to the detriment of the patient. at times, we bear responsibility, at others, we have only vague guilt.

this was my understanding of the thread, as well.

what audacity there must be, in the community of nurses ,to assume a patient is ready to go? who has determined the are ready to meet the other side? trust me it is not in our hands. true, some don't believe there is another side...some don't believe death is as bad as everyone is saying it is...some just don't care due to whatever their own circumstances are...now of course i don't expect these workers to lay down their machete in a hurry. but i appeal to those who admitted to having a piece of a conscious and felt the guilt.

guilt comes when there has been wrong doing. point blank. that is the work of our creator.

listen to the voice...the benefit outweighs the career..believe it.

btw: trust me i certainly won't be following any responses...good or bad.

time tells all things..i just hope the right decisions are made hereafter.

i can’t remember what every single post on this thread discussed. but i do know that the majority of replies didn’t even answer the op’s question. so after reading the above response, i’m wondering where the idea came from, that so many people are making “excuses”, and taking it upon themselves, to end a patient’s life?

and for those of us who did share our story, most of us were doing routine care on our patients, when death came about. i doubt the op of this thread decided that day, “gee, i think i’ll put my patient out of his misery now. this pudding should do it.” that doesn’t even make sense. and i certainly wasn’t expecting my patient to die, a mere ten minutes after i changed her soiled diaper that night.

even the morphine examples…many of us were taught that the terminally ill patient should be kept comfortable. not everyone understands or agrees with that. and that's their right. but the order is there and it’s expected to be followed. perhaps some people do give it with the intent to speed things along. i can only speak for myself. but whenever i administer morphine to a hospice patient, the last thing on my mind is that i’m trying to hasten their death.

i don’t recall anyone saying that they intentionally brought about their patient’s demise, simply because they felt like it was time for them to go. sure, there are people out there who have engaged in such behavior. so maybe this is directed at them. but they obviously didn’t post here. most of the examples given here were far from heartless, gross negligence, or taking things into one’s own hands (except maybe the anesthesia situation).

and yes, of course guilt comes when there has been wrong-doing. that's understood. but can it not also rear its ugly head, when we are unsure if our actions led to a negative outcome? can it also not manifest itself in hindsight, once we have had the time to absorb and analyze the events that led to that negative outcome? absolutely, it can and it does.

no one makes all the right decisions, each and every time. like others have stated, we can only try to do our best. at times we will not succeed in doing so, but it doesn't make us bad people because of it.

[rn/writer, RN]

There is a big difference between recognizing that it's the patient's time to go and making that decision for them.

There is also a difference between giving an opiate to end life and giving an opiate to decrease pain with the understanding that depressed respiration (and even death) may be a result. Only the person administering the med knows what their goal is, and it can be a challenge, at times, to discern your own true motivation, especially if the patient is in dire condition and death would not be an unwelcome outcome.

One way to evaluate your motive is to ask yourself if you gave 10mg morphine and it relieved the patient's pain, would you give the same or a higher dose the next time? If you gave the same dose and the person died, you would pretty much be able to say that you had pain relief as your goal.

Similarly, if that dose didn't relieve the pain and you gave a larger dose or gave it at a closer interval (assuming you are administering the med within prescribed parameters), you'd be able to point to a reason (other than hastening death) for doing so.

An overlap in desires doesn't necessarily mean you did wrong. It may only mean that you wanted to relieve your patient's pain and that death was a real possibility of giving the med as ordered.

[zofran]

I work on a med-surg/onc floor....I have not been in the position to directly "save" someones life nor have I ever "killed" anyone by accident or on purpose. What comes in between...well i am not even in a position to comment.

I believe God has a plan for our patients and I'm not sure that I even have a role in it. I see my self as an RN and do my job to the best of my ability on my shift. God knows whats going to happen that shift. I don't.