Feel responsible for deteriorating patients

[Ele_phant]

Recently at my work (medical ward) we've been experiencing many complex patients, post covid patients seem to be extremely complex, more frail, and youngish cancer patients with multiple metastases. Plus opening visiting back up to very anxious and mistrustful relatives. 

The past month we've had a lot of palliative patients, end of life. We've also had patients that are palliative, awaiting hospice, but also undergoing medical intervention, drains, scans, IVs, blood tests.

Which is difficult to manage when you are trying to prioritise these patient's comfort and QOL as they will likely be dead in a month.

2 of the palliative cancer patients developed infections, one had SBP after ascitic drain inserted, the other developed e.coli. 

Another frail elderly lady that had seemed she might pull through also developed sepsis and died on the ward quite quickly after being made EOL.

All of this very distressing for the anxious relatives.

I just feel worried that I am contributing to them developing infection. I feel that it is in some way my fault but I can't logically say how.

I have very strict hand hygiene between patients /thoroughly clean equipment between patients. I use ANTT on dressings/IVs, I don't cut corners in these areas.

But I just feel responsible and fearful that I am somehow responsible for the deterioration.

Do you ever feel this way with patients? What are some ways that a nurse may contribute to a patients deterioration without realising it? Of course not the obvious hygiene, positioning, escalation of obs, but other more obscure ways?

[K. Everly, BSN, RN]

First, I am so sorry you are experiencing so many sad and distressing situations as of late. I've heard difficult seasons like this can come in waves for nurses, and as a new RN myself, I can only take their word for it. 

I definitely struggle to feel that I am providing enough competent nursing care to my pts. I never feel my assessments are thorough enough no matter how long I take on them, and I usually feel like I am missing some part of the clinical picture even if the experienced nurses around me are telling me I'm doing a great job. 

I might ask you this, as I simultaneously ask myself: what would you say if it was a colleague in your situation, a colleague with whom you had a strong enough rapport to be honest? Do you see the fault in their actions in this situation? Can you pinpoint something they should be doing or knowing more about that would ultimately have saved these pt's lives? 

[Music in My Heart]

Old patients die

Sick patients die

Frail patients die

Infections happen; sepsis happens.

I'm glad that you're meticulous in your care and introspective/self-critiquing, but take a look at the mortality statistics of those kinds of patients... and work to avoid responsibility for non-specific reasons.

[heron, ASN, RN]

Your sense of responsibility has led you to be meticulous in your hygiene and safety habits, and that’s a good thing. But it also helps to look at the underlying assumption that we can perfectly control whether bad things happen to our patients. In a way, it’s supremely arrogant to assume that we have that much power over the reality of human mortality. Balance is the key.

Control the things that you can, let go of the things you can’t control, and pray for the wisdom to know the difference.