First patient death as an RN

[julz68]

I've been in health care for many years and have seen a lot of deaths. I was a CNA/Med Aide in LTC for 6 years and a PCA at the hospital for 10. Every death affected me, but I was unprepared as to how the death last night would affect me as an RN.

I had an elderly pt in with COPD exacerbation. During SBAR, at the beginning of my shift, the family was in the room and getting ready to leave. The pt started getting restless and saying he wanted to go home too. He was confused and trying to get out of bed. I went to the CN and asked for a sitter. She said I could have one for 2 hours to see if he'd calm down and go to sleep.

The family was reluctant to leave, but I assured them the pt would be safe, as he would have the sitter, an LPN, in the room with him. The family went home.

The pt was getting increadingly agitated, wouldn't keep his O2 mask on, was combative and was too much for the sitter to handle. I got an order for 0.5mg Ativan IV to help calm him. It took 3 of us to get it administered.

I went about my assessments and get a call from central telemetry saying he had a couple pauses and was dipping down in the 30s and then 20s. I raced in his room and he was unresponsive. I called a rapid response, but by the time everyone got there, about 3 minutes, he was gone. He was a DNAR.

What bothers me the most is that I told the family it was ok to go home since we had a sitter to keep him safe. I just feel awful.

The Dr said it was most likely end of life agitation and the ativan calmed him enough to let go. But I just feel so bad... like it was my fault... ugh.

[Esme12, ASN, BSN, RN]

It wasn't your fault....patients will do this. As I was reading your post..... I was shaking my head knowing what was next. I try very hard not to tell families it is OK to go home....most of the time. I will tell them that he will be watched he will be cared for..that I will call with any changes but the decision to leave is theirs. This patient was DNR it was his time. That restlessness is that sense of impending changes.

It's hard when you have that responsibility.....take a bubble bath...a bowl of ice cream...a glass of wine....know that you did your best and that is all you can do....((HUGS))

[Been there,done that, ASN, RN]

What was the patient's oxygen saturation levels during this time?

[Blue Roses]

I hardly ever tell patients or family members that everything will be ok. I have this irrational fear that I'll jinx myself. I think you did the right thing. He was scared and he might not have been able to go peacefully if the family had stayed around, worrying and agitating him.

I remember my first patient death. I remember hugging the family members when they arrived. It did effect me, but it effected my badly because I was so stressed about the entire process of paperwork and procedures that go along with a patient death that I blocked my emotions out and I never got a chance to really feel them. I wouldn't block your emotions out. Let yourself remember the patient as someone who was loved, and allow yourself to cry. And the wine, bubble bath, and ice cream suggestions is a good idea too.

[SwansonRN]

Not your fault, my friend! It seems like it may have been his time to go. Could he have gotten a blood gas and maybe been intubated when he first got agitated? Sure, but that's not what he, nor the family wanted. COPD is not a reversible disease. You did your best to keep him comfortable and safe and that's a good thing. It's okay to be sad, but don't blame yourself.

[cardiacfreak, ADN]

I also was thinking about o2 sats and maybe his abg's. Patients who have elevated co2 levels will also act "crazy", it is very common with end stage copd. The first person to expire on

your watch is the hardest, however we must know that death is also a part of nursing (just not one we like to talk about)

[applewhitern, BSN, RN]

Don't beat yourself up about the family going home; sometimes a patient will "wait" until they are gone to die.

[Londo48]

Not your fault. You can only do what you feel is best at the time and under those circumstances. Its always terrible to lose a pt but it will happen. I remember my first and it reduces me to tears even now, 9 years later. But i dont cry because i couldnt help (to be honest she was genetically cursed at birth) but i cry because her husband loved her so much that it filled the room with warmth. I cry for her lost opportunities and the things she would never get to do. But i dont cry because i failed or didnt try to give her everything i was capable of doing. Having read your post, i cant see that you could have done anything differently. Chin up, learn, stay human and always be sad at a passing. They will never leave you.

[caffinatednurse]

You are not alone. I am a new nurse and I have been struggling with thinking things are all my fault too. It is not. As long as you did your best and did what you thought was right for the patient that is all you can do. It took me an entire day yesterday to get over my patient declining. They did not pass or anything, but just declined and I keep thinking its my fault. It is not. I did do my best and that is what matters.

It changes after being a CNA because now there is much more responsibility involved and more decisions are yours. yet-

We cant control everything that happens in the human body, although we try.

[cadawasp]

Do not beat yourself up about this. You did your best and learned for the next time. I agree to allow the family to decide if they want to leave or not that is one of the lessons to take from this. I a a hospice nurse and would have done the same before working in hospice. What I have learned since then is listen to the patient he was saying that he wanted to go home, that can be saying that they want to go to the next place whatever that is to them. Giving the Ativan was what we in hospice do but would also add morphine to decrease the feeling of breathlessness. Many times the patient does not want the family to be their because they are afraid it would hurt the family members too much, and that may have happened here. You did a good job and you need to have the ice cream, wine and bubble bath and keep on learning.

[NurseOnAMotorcycle, ASN, RN]

*HUGS*

[kerrynurse]

Of course its not your fault. Eat some ice cream and try to move on.