Feeling like a horrible nurse

[chachh, BSN, RN]

Something bad happened on my floor a month or so ago and I am having a hard time letting go. My first patient died unexpectedly.

I feel like a failure because I did not catch it in time. I work on a high acuity floor w/ telemetry monitoring. This pt was on monitoring and in sinus all night. The pt alway complained of abd pain that the dr said was referred pain from bilaterel pleural effusions. I had medicated the pt with mild analgesic and a sleeping pill and a beta blocker that evening. Make a long story short, light on in pt room all night, pt breathing about 22-26 all night (very heavy size pt, norm for them). Pt had stated pain was keeping them from sleeping but when they fell asleep I refrained from waking to give stronger pain med. Found early in the morning with frothy sputum from nose. Could not awaken. Obtained orders and took awhile for abg collection (everyone was thinking pulmonary edema). No rhythm change except hr in 70's. (initial bp low when found, sys high 70's, but increased to 130's when trying to awaken pt) hgb in 6's and K in 7's. Pt went to unit and coded by the end of my shift and died.

I feel awful, like I should have caught that. I can't seem to let it go. I feel like I missed some vital piece of info that night. I checked on that pt every hour that night. Easy to do with light on. Would count resp in doorway. Pt never looked good the night before either (never got any sleep while in hospital). I feel paranoid!!

Is this normal to feel like this? I have only been a nurse for six months. Anybody else going through this?

[NurseLatteDNP, MSN, DNP, RN]

I am not a nurse yet, but it sounds to me like you have done everything you could. You seem to be a good and caring nurse.

[Adam D. RN2005]

Something bad happened on my floor a month or so ago and I am having a hard time letting go. My first patient died unexpectedly.

I feel like a failure because I did not catch it in time. I work on a high acuity floor w/ telemetry monitoring. This pt was on monitoring and in sinus all night. The pt alway complained of abd pain that the dr said was referred pain from bilaterel pleural effusions. I had medicated the pt with mild analgesic and a sleeping pill and a beta blocker that evening. Make a long story short, light on in pt room all night, pt breathing about 22-26 all night (very heavy size pt, norm for them). Pt had stated pain was keeping them from sleeping but when they fell asleep I refrained from waking to give stronger pain med. Found early in the morning with frothy sputum from nose. Could not awaken. Obtained orders and took awhile for abg collection (everyone was thinking pulmonary edema). No rhythm change except hr in 70's. (initial bp low when found, sys high 70's, but increased to 130's when trying to awaken pt) hgb in 6's and K in 7's. Pt went to unit and coded by the end of my shift and died.

I feel awful, like I should have caught that. I can't seem to let it go. I feel like I missed some vital piece of info that night. I checked on that pt every hour that night. Easy to do with light on. Would count resp in doorway. Pt never looked good the night before either (never got any sleep while in hospital). I feel paranoid!!

Is this normal to feel like this? I have only been a nurse for six months. Anybody else going through this?

I've been practicing 5 months now. Have only lost one patient as an RN and one as a student. But the biggest and most important thing that I have learned is to leave my work at work.

Next, you are human. You are sometimes going to miss things. But also, there are going to be times you will catch things that others did not see. I speak from this first hand.

Don't go beating yourself up, you will stress yourself and burn yourself out as a result. Also, losing your first patient, no matter how you lose them is haunting. I lost my first pt as a student. I took it very hard and it haunted me for several months.

Losing my first pt as an RN was different. I remember the pt's name, but it doesn't bother me. If your hospital has Mental health benifit, take advantage of it. That is what it is there for. And again, ther first one will always haunt you.

Adam, RN

[grannynurse FNP student]

I have been a nurse for more then thirty years and will always remember the first one I lost. What you need to do is review, in your mind, what you could have done differently. Then put it out of your mind. Remember we learn from our mistakes.

Grannynurse

[Daytonite, BSN, RN]

I know you are feeling awful, but you are stuck in a rut over this and you have to get out of it. First of all, what would you have done differently? You did everything I would have done. I've been a nurse for many, many years and had this scenario happen to me a number of times. There's nothing you can do sometimes. When it's the patient's time to go, it's time for them to go. It sometimes happens when they are sleeping. Feel good that the patient wasn't awake when everything was going down. All the medicines and treatments in the world can only do so much. We are not immortal. Eventually, the heart fails or the lungs fail, or the patient strokes anyway (which is probably what happened to this patient). You can't stop these things. People are going to die. You will see it especially more on stepdown units. That is part of life. All the drugs and treatments only delay the inevitable.

[chachh, BSN, RN]

Thanks you guys for your thoughts and support. I am feeling better now. I still think of that patient often but realize I did nothing wrong and I did learn from that situation and it is making me hopefully a better and stronger nurse.

I think it is just when you are new you so much want to do your best and be the best for your patients. And then when something like this happens it is a blow to your, not ego, but your belief in yourself to catch everything in time and ability to provide pt and family with a feeling of safety? I don't know, am I making sense?

I guess I am unrealistic in some of the expectations of myself, but I will keep trying to be the best I can. And thanks for the advice and input!!!!

[DidiRN]

Sounds like you are doing much better. As I'm sure you have heard before, the first year is so hard. Just by the fact that you reviewed what happened and are willing to learn from it if you can, that is a making of a great experienced nurse. You already sound like a great first year one :)

Hang in there, we need ya in this profession! :)

Thanks you guys for your thoughts and support. I am feeling better now. I still think of that patient often but realize I did nothing wrong and I did learn from that situation and it is making me hopefully a better and stronger nurse.

I think it is just when you are new you so much want to do your best and be the best for your patients. And then when something like this happens it is a blow to your, not ego, but your belief in yourself to catch everything in time and ability to provide pt and family with a feeling of safety? I don't know, am I making sense?

I guess I am unrealistic in some of the expectations of myself, but I will keep trying to be the best I can. And thanks for the advice and input!!!!

[doodle-hambone]

My instructor in nursing told me about me a study that was done comparing new nurses to those in the field for a while. The study showed that you are considered a novice nurse for the first FIVE years. It sounds like you did everything you knew you could do. I also had a patient die, but I missed many of the warning signs, failed to do followup on ones that I did recognize, and my patient died. I did not do everything I should have done. It sounds like you will be a great nurse.

[Lorie P.]

it does sound like you did everything that you could do.......please go easy on yourself, don't think any of us will ever forget our first pt passing on us.

keep up the great work and know that in your heart you did do everything!!

[chachh, BSN, RN]

You bet I am going to go with that novice nurse thing for as long as I can!! Thanks for cheering me up! Unfortunately, there is always something else I can obsess about doing wrong each shift!! But you know, you do learn something everyday from those experiences!

Like the other night I had a pt who was normally confused half the time. The Dr (who has a reputation of being the biggest %*#, who you do not call unless the pt is DYING!!!) got really ticked off at me because I did not call to get bld cultures done when the pt got a temp of 39. The pt was in for septicemia and UTI, was on antibiotics. I had sat on the fence about calling for that because cultures had been done on adm, but that was 6 days ago.

I should have had them drawn on retrospect, because there had not been a fever in a few days (there was no standing order for it, but I got them drawn that next night when the fever came back). But the day nurses tell me he was yelling at everyone because I had called for a sleeping pill for her. (he had wrote in the orders NOT to call for a sleeper, but the family insisted because they wanted her to have one) I did not call just for the sleeper, but for restraints since she tried to tear out her central line, and the dtr works at the hospital and told me to ask the dr when I calll for restraints (she knew I was going to tick off that other doc). There were orders already in the chart to treat htn over 180, which arrived with the fever, and the tylenol supp. order.

Live and learn huh? But they also tell me he was ticked because her heart rate increased at that time but I didn't call. Yeah, she had a fever? Sinus tach to 109? Isn't that a normal effect of fever? Oh well, these are our hospital dr's and the next time a hospitalist pt gets a fever at 3am and he is on call I am going to call his butt, and when he chews me out for calling about a fever I am going to remind him of this!

[chachh, BSN, RN]

Oh, and when I called for restraints, she did not have the fever, that was later that shift.