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.

[thenursemandy]

You learned a valuable lesson.....new onset severe fear, restlessness or aggitation can occur shortly before death.

[julz68]

Thanks to everyone your encouraging words. I do feel better about it now.. all that you all have said, my coworkers and doctors have also said.

It took a lot of persistence to even get the sitter. I had to talk to the supervisor and the doctor because initially the CN said there was no one available. So at least he did have someone there the whole time keeping his mask on and holding his hand.

I did learn from this experience. It was just hard for me to go through as an RN since I was responsible for his care. But I guess we all go through this as nurses at some point.