feeling so scared, paranoid and worried !!

[socalchinesenurse]

Hi everyone!

Just want to vent my feelings of being an RN for almost 4 years now. Recently, I am feeling so scared and worried that I will be sued. Especially, recently I transferred 2 patients to ICU, they deteoriated conditions were nothing to do with my care. One of them had SVT after EGD in day shift and she gave him like 5 different types of IV cardiac drugs by midnight his hr as low as 39 still AXOX3 then finally got the order to transfer to ICU. He was coded 4 hours after transfer. The only thing about him was day shift and me gave him 40meq kcl PO as order because we all (included MD) awared his K was 4.8 he had GI BLEED, have BM quite often. So I did not question the order. After the code ICU checked his K was 7.2!!!! and he died the next day. The 2nd patient was POD # 4 s/p CABG. 1st night in step down unit was doing okay. I came back next day, day shift told me pt has no urine output all day, then day RN bolus him 500cc NS ,put Foley in, patient has 200cc urine output. I check him first because he was the most critical, his b/p was 71/49,hr 110, No urine output in the Foley, Pt’s bladder was slightly distended,painful when palpated. pt stated “ feeling weak but no dizziness and palpitation. Then I notified the cardiologist Ns bolus 500CC, pt b/p up to 97/59 hr 108 after bolus, about 1 hour later pt stated “feeling dizzy” I checked his b/p 64/40, no urine output. I was try to figure with the charge nurse.distended bladder? Foley was in, we tried to irrigate it, NS return but no urine, we changed the foley while I was waiting for call back. I phoned the cardiologist again and He told me “ just watch the patient” then I called the primary MD (even this pt was seen by NP but NP was not on call, only MD oncall) immediate after the useless cardiologist. I got the order to transfer ICU and start gtt. I called the surgeon after I transferred patient to ICU. Then there were series of things happen in that patient. The surgeon was angry and blamed the nurses. I cared for that patient total of 3.5 hours. How can he say that to the ICU charge nurse? Anyway that patient was in acute renal, he is in HD and also intubated . So far nobody come to talk to me about it.

I am feeling so scared, worried and paranoid in the past 2 weeks. Thank you to let me vent here. I love to be a nurse. I am sick of working non teaching hospital even it was very close to my home. MD do not like to be phone at night time. I have thick skin, I do not afraid to call them at all. Anyway, I already applied the Large University hospital even it was 30 miles away from my home. Wish me luck!! My interview will be on 4/7.

Also anybody can give me some advice to alter my scared, paranoid and worried feeling??? PLS ADVICE!!

[dRkazN]

sounds like you did everything you could for each pt that you cared for i mean the K WAS 4.8, but the thing about that is WHEN the K was 4.8, how long the K was 4.8 and how long in between the 4.8 and the K you infused. also, it all depends on how he is, granted that hipaa wont let you discuss his history, so, if no one is talking to you about this, YOU have to step it up talk to the manager or charge or someone in HR to know your options. And the 2nd pt you cant really ask to be judged because again, you'd have to discuss history and blah blah...

But I think you just needed to vent this one out, instead of having strangers asking for advice lol. Ask any of your colleagues who were there, if they're not talking to you talk TO THEM. ASK ASK ASK!

[SFRN]

I am sorry that you are feeling so scared, etc. As for the first pt. I don't think 40meq PO is a lot of K. I have given way more via IV. However, having said that....what was the pt.'c creatine, was the pt. receiving blood. With a K of 7.2 I am just wondering if this pt. was in RF and also if the pt. received PRBC's this can bump up the K. As for the 2nd pt. well I think this sounds like a system that failed......it sounds like you notified the docs which is good, but I can't stress the importance of good documentation. Anyways, good luck and I hope everything works out.

[morte, LPN, LVN]

hmm the first one, i would wonder about a transfusion as well, and could the act of "coding" actually cause hemolysis (sp) that would also up the K+? or was their spec hemolyed? the second one falls to the shift before you and the surgeon.....in my opinion.....I think you are making a good move in getting out of there.

[helpnhands]

Situations like these are exactly why I carry malpractice insurance. I don't think you did anything wrong, but there's no way I'm going to court alone, if it should come to that!

[socalchinesenurse]

K:4.8 was in that am lab.Day shift give one dose of 20meq and me one dose of 20meq PO not IV. He did have transfusion the day before not on my shift. I agree with everyone EVERY RN need mal insurance. Of course! I have one since I was a nursing student. The first one pt was happened one year ago, and i knew that one for sure was suring the hospital because my charge nurse told me after the pt died in ICU. the 2 nd patient was just happened 2 weeks ago. So far no manager or lawyer talk to me about anything.

[meluhn]

When a pt has a bad outcome or dies I always question weather I could have/should have done things differently. But the bottom line is, you are not the only one caring for this pt, there are other nurses and mds. As long as you do your part and pick up everything in your assessment and report it, I think you are OK. I dont think you need to worry because I have seen cases where there was a complication or bad outcome and the family remains clueless.

I had one pt husband say to me, "She just happened to have a stroke while she was having a balloon angioplasty done. We really were lucky that we were right in the hospital when it happened". All I could say was "Oh".

That is why every pt should have an advocate that knows something whenever they are in the hospital. Otherwise your at the mercy of an imperfect system.