New Nurse In Tears...

  1. I just had to get some kind of guidance or input...

    I am a new grad (5/06) and I work 7P-7A on a Medical/Oncology unit. I usually average from 5-7 patients per shift. I have had a "run" of VERY involved patients for the last month or so. Last night one of my elderly patients had lung CA with liver mets, confused, c/o abd pain for the last few days, no BM for 3-4 days, enemas with no result, distended abd... I'm thinking obstruction. The MD finally orders the patient NPO and and NGT. The tube returned 900cc's dark brown drainage. I constantly irrigated the tube because it would get clogged with particles.

    To make a very long story short, I checked on him at 0600 and he was resting comfortably with a respiration rate of about 16/min. I did not wake him. At 0700 when the morning tech was getting vitals, the pt had no BP or pulse, spontaneous respirations, and was totally unresponsive. We coded the pt (my very first code) and sent them to the CCU. He was coded again in the CCU...

    I have cried non-stop ever since with NO consoloation from the charge nurses. I got home and tried to sleep, but I keep going over the events of the night in my head.... what could I have done differently, did I document everything, was my charting accurate and up to par, etc.

    I am absolutely scared to death, doubting myself and my abilities, and I am an emotional wreck. I have been out of school for 5 months and I feel like I am drowning! I run all night long while others are doing crossword puzzles at the nurses station... and I go as hard as I can all night long and still can't keep my head above water. I don't feel like I can go on at this pace for much longer.

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    About RNNURSE23

    Joined: Oct '06; Posts: 3


  3. by   riceberry
    I feel your pain, I graduated in May and you have described my shift and doubts to a tee. I have been told that it will get better and I will find my pace. Thankfully I have great charge nurses who help and are there to lift me up. I try to watch the seasoned nurses and learn from them. Already I have improved in organization and charting. My greatest fear is making a rookie mistake and going to court. Hang in there. I am going to watch this thread for some good advice too.
  4. by   gr8rnpjt

    You did everything you could. Pt's status can change at any time. You were concerned and did everything required of his nurse, but things happen, and you can't stay in his room alone, you have a potential for any one or every one of your patients to crash at any given time. You do your best and you brush it off. Of course you will second guess yourself, we all have been there. Pt's in the acute setting are sick, and can get more sick at any time.
    Don't beat yourself up. One thing I can guarantee that as long as you work in an acute hospital, you will have more codes, and more patients will crash on you.
    Keep well, try to get some rest and have a hobby in your off time so you can enjoy that part of your life instead of dwelling on your work problems.
    take care.
  5. by   TazziRN
    The only way you could have done things differently is if you had camped out at the bedside all night long, thereby ignoring your other pts, and you still probably would not have prevented this. He was elderly, with met CA, and new problems on top of it. Sounds like it was just too much for his body.

    The first code is the roughest if it's your pt, because you start second-guessing yourself. From what you're describing, you did nothing wrong and left out nothing.

    :kiss :icon_hug:
  6. by   nursem2
    Give yourself a break. Sometimes patients will go bad, despite everything you do. If he was resting comfortably with normal vital signs, you had no indication that anything was wrong. Good job on the successful code! You said it was your first, and you also said he made it to the unit. At least you have that experience under your belt and obviously were able to function efficiently in a very stressful situation. Also, it takes a LONG time to feel comfortable as a nurse, especially with that many patients. Don't ever let anyone make you afraid to ask questions or ask for help when you need it. Shame on the other nurses for sitting around while you are running crazy. They have all been in your shoes, and they should help. Double shame on your charge nurse for not helping you come to terms with the situation you described. You sound like a very competent, caring nurse. Keep doing your best, learn from both the good and bad situations, and you will find your way. Hang in there!!
  7. by   mekkasoon2bRN
    I am so sorry for you terrible night. Don't be afraid to to ask those nurses who are doing crosswords for help, most won't mind and if they do most of the time they will still do what you ask. Confer with other nurses on what you should do if you have a situation you are unsure about and call the Dr if they don't have the answers you are comfotable with. You might feel inadequete at first but you are a new nurse use your honeymoon period to gather all the info you can. I can't see what you charted but you seem pretty dilligent and I'm sure you did ok. Don't expect consolation expect help, you'll be ok I promise. I've been an lpn for 5 years and will soon have my RN. I would not go back if it didn't get better.
  8. by   jojotoo
    OK, a couple of things here. No matter how hard you try or how good your nursing care is, patients are going to die. And only you can figure out how to give yourself some emotional insulation from this. That won't make you less of a nurse or a human being. But over your career, a lot of patients are going to die if you are in a hospital or LTC facility.

    As far as your charge nurse be supporting. Nursing is notorious for "eating their young" or your peers/ superiors hanging you out to dry. Fair? No. Reality? Yes. So you need to get a support system in place. Friends, family, clergy, therapist, hairdresser. Somebody!!

    Was it your fault this patient coded? Doesn't sound like it. In fact, it doesn't sound like he could have been down more than a minute or two, or you would never have been able to get him back. He even coded in the unit when he was most likely a 1:1. Does that make you feel better? Probably not. We nurses have a lot of guilt and a "if only I had..." attitude.
    You have to get past this.

    Now as far as the other nurses doing crossword puzzles. We both know that they are not giving the level of care that they should be giving. There were always be those who do the minimum required - just enough to get by. Don't let their example guide your practice.

    Stop beating yourself up over this. I know that is easier said than done.

  9. by   Tweety
    Welcome to Allnurses. I hope you find the support you need here, and stick around.

    It will get better, I promise. Almost every new nurse worth a hoot experiences the same feelings of being overworked and overwhelmed.

    You did fine by your patient. The patient was going to code no matter what you did. On busy med surg floors you can't been with the patient 100% of the time and a last check at 0600 is the best you could have done. People code, and people die. Stop beating yourself up.

    You're doing fine. Hang in there.
  10. by   SmilingBluEyes
    OH dear, I feel for you. We all have those heartbreaking moments, when no matter what we could have done, patients die, or they just get worse/sicker. From your account, it sounds as if you were "on it" in every way that matters. You should not be so hard on yourself. You must not let this stymie and paralyze you. You will have to get back on that "horse and ride" again...and you will.

    Take with you that you cared and were there for this poor soul. Your heart is good. And you have integrity. Just the sort of person we NEED to STAY with us in nursing.

    Take the time you need to grieve and feel the pain and then pick up, dust off, and go back in there again. We really do need you. So do those patients and their loved ones.
  11. by   Flutemom
    I've been a nurse for 10 years, and I remember being a new nurse like it was yesterday. I spent many days questioning myself and thinking everyone's life was in my quite uncapable hands. Then one day a friend told me to stop thinking so much of myself. I thought it was a rather odd comment. But, then she explained that it wasn't up to me to play God and to think that everyone's life was up to me. You may or may not have been able to save that patient had you found them earlier. You can only do the best you can and apply the knowledge and skills that you are building on daily. Including the skills of coping when you think things should've gone differently.

    I'm teaching my 10 year old when she is overwhelmed with emotions to run or walk to get them out so she can think clearly. Find something that will allow you to "expend" those overwhelming emotions so that you can reassure yourself, logically, that you are doing the best you can, with God's help.

    Good luck and keep putting one foot in front of the other. Because you care, you're going to be just fine.
  12. by   cinderella6251
    Dear nurse,
    Please accept this huge hug from me ((((((((()))))))))) as you read this. That patient will not be that last you will see die during your nursing career. We help patients live. We help them die. It sounds as if this patient with the liver mets already had a very serious prognosis. I mean, I'm not writing him off or anything. It's just the facts you stated speak for themselves. Would have been different if it were a 20 y/o s/p appy patient with a negative health history, right? Still, it is normal to have these thoughts after a patient dies. You are a nurse and you are human. I've been through this same thing with my patients. Find something fun to do when you are not at work. I know that sounds bad because you just lost a patient but as time goes on, you will find ways of coping with nursing grief. Also talk to your hospital chaplin or counselor or someone who can help you sort things out a bit. As long as you know you did your best within the scope of your training to help him and support the patient. Of course when you are a new nurse, you lack the confidence and experience but trust yourself and in the training and education you recieved! I'm sure you did an excellent job caring for this man. You sound very consciencious or you wouldn't have written to this message board. How lucky that man was to have a nurse like you who cared in his last hours! Hang in there, sweetie.
    I'm sorry you have such a lack of support by the staff on your unit! How sad to be working in oncology and not stick together and support eachother! Please feel free to email me any time. I am here to listen.
  13. by   NaomieRN
    Although I am not a nurse, but from reading your post it seemed you did all you could. I think one thing for you to remember, is that you are not the Savior for every patient. There are doing to be some patients that you wont be able to save. Like someone mentioned, patient status do change. I hope you can understand that. Good luck to you.
  14. by   RNNURSE23
    I cannot begin to say how much your words of wisdom, advice, and consolation mean to me. I am so thankful I decided to post on this site... you all are wonderful. After about 3 to 4 hours of sleep, I feel some better. I know that this is all a part of nursing, but I really had no idea it would be this hard! I have had hospice patients die before, but this was a totally different situation. I think the stress and frustration of the entire night just sent me over the edge! I am going to "get back on the horse and ride" Wednesday night... I hope it goes much better than the last few nights!

    Thank you, thank you, thank you. It's wonderful to know that I am able to share with such a wonderful group of caring people!