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Feeling Guilty with Patient Outcomes

I have been a nurse for two years. I started off on a medical/surgical/tele floor and then moved to the emergency department 6 months ago. I still consider myself a new nurse, although I have much more confidence in my nursing judgement and skills than I did throughout my first year of nursing. I know I am a good nurse. I receive patient letters thanking me for my care a lot and my manager tells me she's impressed with me for being new to the emergency department. However, I sometimes have a hard time coping when I have a patient with a bad outcome. I know this is part of nursing and the medical field. I know we can not save everyone and I am okay with that as long as we did everything we could. I see deaths and critically sick people all the time in the emergency department, and I am fine with that. I guess what bothers me though is when I take care of a patient who I transfer to a med/surg floor or tele floor thinking they are stable and then later find out they crashed. I feel when this happens I should have seen something sooner and acted upon it. I spend lots of time looking through my charting seeing what I could have picked up on sooner. I talk about it with coworkers who tell me I did noting wrong, but I still feel guilty. Most recently what triggered me to write this post is that I had a patient who was being admitted for an infection to a med/surg floor; I had asked the attending if the MD wanted her on tele due to a low potassium which he denied. After she was transferred to the floor, I heard a rapid response an hour and a half later, and it appears the patient was transferred to the unit due to low blood pressure. I read the floor nurse's receiving note in which the patient was received with a stable blood pressure (she also had a stable blood pressure when I was taking care of her). I guess I feel guilty because she crashed so soon after being transferred from my care, and I felt like I should have seen it sooner. I've talked to experienced nurses who I work with who ensured me I did everything right and that septic shock can happen suddenly, which I know, but I still can't get over thinking about this patient. Does anyone else ever feel like this with patients at times?

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

There are going to be times like that throughout your career. And it doesn't mean that you missed something, or that the outcome would have been different if this or that had happened (or hadn't happened). You can't beat yourself up about it when nothing you did or didn't do would have changed the outcome. People go into shock and die every day. You can't anticipate every case.

You will make mistakes, and hopefully none of them will harm anyone. It's a chance we take every day that we go to work. It sounds to me that you are a good, safe, smart nurse who understands her own limitations and realizes she has a lot to learn yet. I've always believed that if I didn't start a shift feeling just a wee bit nervous, I wasn't on my toes and needed to get myself together. So don't get too comfortable, but also don't be too critical of yourself. ((((HUGS))))