Haunted by incidents at work/Part II UPDATE

[IloveSnoopy]

HI everyone...long time no see....

Anywho..I'm a nurse on a med/surg unit in a fairly rural area. I have gained a lot of confidence and the house supervisors actually refer to me as "the best nurse on med/surg"...which boosts my confidence even more...BUT...I am still finding though...(after 6 years now..eeek)...that I tend to let isolated incidents stick with me.

Without giving too much info....I had a patient that never should have been admitted to med/surg in the first place. She was a trauma patient...elderly..enough said. Anyways...I walked into her room and she did not look good..I called the on call doctor..got a few orders..and monitored...by am...still wasn't feeling right about her...called her regular doc(he was to take over in the am)..he came to see her and immediately had her copter'd out.

I felt soooo bad after this whole thing...like I should have called again, been more aggressive, called again sooner,etc. I guess everything turned out ok but I still think about the whole thing everyday. Her doc..(who is also my family doc)..didn't appear mad at me or anything...but i'm just wondering if he thinks I'm a big dummy or something. I haven't even been in to see him because I feel like he thinks I'm a horrible nurse. I did call two physicians, monitored the patient closely, and she didn't ever change the whole night..it was just that she was down the tubes from the get go. I think my doc was more upset over the fact that she was admitted to med/surg to begin with.

I feel so stupid that I let things like that stick with me. I guess I just want to be super nurse or something and when things don't go right or if I kick myself for the "should have done that' thing...I get anxious, depressed...even to the point of wanting to quit nursing. I'm seriously starting to wonder if I need Xanax or something? Anyone feel like this every...or am i the only one?

I guess maybe I don't have as much confidence in myself as I thought.....I know stuff happens and we need to just go on...but for some reason..I can't..I think about this night all the time and sometimes it makes me not even want to be a nurse anymore....does anyone know what I'm talking about? Of course..I was super worried about the patient...but now...two months out..I'm worrying about what others...i.e. my doctor thinks of me...is that crazy or what? Ok..I guess I'm done rambling...I think I needed to vent more than anything....any comments or similar feelings anyone could share might make me feel better.......??? Ok..thanks everyone....

UPDATE:

Ok..here's a little update on this whole situation. Ok...apparently..I wasn't feeling bad enough about this patient....SO...I come to work last Wed., check my e-mail and find an e-mail and powerpoint regarding the new SBAR and rapid response team our facility is implementing...well..guess what the case study on the first part of the power point is...??????? This lady that I had...errrrrrrrrrrrrrrrrrr. The only problem is that they only picked out the bad things about the story....they didnt mention that two seperate physicians were called, that house supervision was involved, that the patient was monitored..basically one on one all night...I was soooo peeved!!!! There's a lot of people that know that whole story with that lady and it was easy to pick out the fact that it was her by the case study. I was so irrate that I went to our DON and she whole-heartingly apologized saying "that she never thought to ask me my opinion before letting one of our internal med doc's use the case study in his power point for all the facility to see. I talked with the DON for a long time and she knows that I am very upset about the whole thing.

Then she decides to tell me that our quality control lady and others have been meeting and are doing a "cause and effect analysis" on this case. She said don't think it is just you they are zeroing out....they are looking at the whole case from ER til the time she was flown out. I told her..."how can I not think about it"...I told her that I was just now finally mentally forgetting about it and going on with things and then I find the whole episode in a case study and find out they are studying it for some darn cause and analysis". I'm all like "so when am I going to be a part of this"...since thus far..they've been doing everything behind my back. She was like: "oh..they will be contacting you for an interview shortly"....I'm like oh great...now I can think about it some more...uggggggghhhhhh. She said they are really looking at the doctors too....cause' i guess a lot of people are really wondering why the lady was admitted to med/surg in the first place....so..she's right...it's not just me they are looking at...it's the whole process. But someone like me...that stresses big time anyway....can't help but think they are looking at me. But I guess...if you think about it.....I actually did follow the rapid response...I contacted md's, contacted house supervisor, monitored closely,etc....but I still can't help think that I should have called back more when the doc wasn't really listening to me. I'm wishing I would have called back and said "this lady is too critical, may I move her to CCU" or "come in and see her"....etc.

Good news is...the lady did turn out ok an is at a local nursing home now...still recovering from her fractures. I told my DON that I was going to start ultrasound school...lol..cause I was so upset. (actually I have been thinking about it). I told her that I get stressed out easily and that this whole thing is making my life hell. She apologized again and said that she thinks I am an excellent nurse...one of the best we have..she goes. She says she's heard numerous times from house supervision that I should transfer to CCU or supervision. My nurse manager on med/surg also sent me a little poem and wrote that "there is no other nurse I'd want caring for patients on nights"......I know they are just trying to be nice because they know I'm feeling so bad....but I do think there's some truth to it...I am a good nurse. I just have to start believing it more....i'ts just so hard for me when this case where things didn't go exactly right....comes back to bite me in the butt. Why me???? There's been other cases...some with worse outcomes than mine...my lady survived. Why can't they do cause and effect carp' on some of these cases....uggggggggggggggghhhh.

Ok..I just wanted to update. Sorry it got so long. I'm just feeling really bad about it all and needed to vent and look to you guys for some help. Thanks...

Luv,

Snoop

[SFCardiacRN]

Case studies and root cause analysis are how facilities improve patient care. Don't feel singled out. Take pride that your facility is "dissecting" a case that was bothering you in the first place.

[IloveSnoopy]

Thanks Cardiac....

I know deep down that yeah....they are just trying to improve patient care...and that's a good thing...but man...I'm just the type of person that automatically thinks it's all me...u know? I suppose if they thought I was being incompetant or something...they would have let me know about it right away. I don't know why it all bothers me so much....but it does. I am questioning myself as a nurse..and I feeling like that.

[IloveSnoopy]

"hate" feeling like that. Sorry :)

[RMBONANNO]

Wow - I am not a nurse (nurse wannabe - if I can find a way to pay for it and take care of my family!)......but to me it sounds like you did a great job. You didn't just let it rest and you stuck with your gut!

I manage staff....and I totally identify with your feelings when I think (or know) I did not handle something well. I impact other's lives daily, I know how I feel if I have a crappy boss and have to go home after a bad day at work - it impacts my whole family!!! But fact is, I am human. I analyze what I did, what I could have done differently and what I will do next time and take it as a learning exercise.

I totally get that nurses and doctors have a MUCH bigger impact with their actions/decision - someone's life. It sounds like you handled it well, that you are well respected and the problem lied more in the initial placement decision by the doctor(s).

I am sure it will work out fine for your part - stick in there! It was a nurse with your caring that made me decide I want to be a nurse!!!

[steelcityrn, RN]

Our homecare company is part of the medicare quality insights study and have been under review of any re-hospitalizations. Even though we were picked because we fall inhe top 10% of quality homecare companies in our state, there is always room for improvement. Thats a good thing for all!

[wooh, BSN, RN]

Don't feel singled out. You were handed a bad situation and handled it best you could with the resources you had. Like you said, shouldn't have come to you anyway, so steps could have been taken before she got to you. I got called into a chart review not long after graduating on a woman that died of sepsis. I had this woman for one shift. I stated my part, and surprisingly didn't have to defend myself on anything, just clarify some things from that day.

Hindsight is always 20/20. Just take cases like this that you did good on, and with that clearer vision of what "could have been", see if you can learn something to do GREAT next time. The fact that you're concerned shows you are a good nurse, you've got the "gives a darn" that we all need to do our jobs well.

[snowfreeze, BSN, RN]

You did good, the facility is making good of what you did.

[traumaRUs, MSN, APRN]

I think you did the best you could with limited resources. You advocated for your patient by contacting two MDs, closely monitored her. Yes, in retrospect maybe you could have insisted that she be transferred. However, hindsight is ALWAYS 20/20 and you seem like a very conscientious nurse who truly cares for her patients. You did just fine.

As to the root cause and analysis - this is just a change process - not a way to point fingers.

[jax]

It sounds like you did everything right, but need some help leaving work at work. Playing the "what if " game, and seconding guessing ourselves leads quickly down the road to burn out.

I have had to learn not to bring "work" home, sometimes something sneaks in, but I need to have a home life and a seperate work life.

[IloveSnoopy]

Gosh...thanks again everyone!!!! You guys have a way of always making me feel better about things!!!!! I guess I need to unload things here more often...lol...j/k. Yeah...in the 6 years I've worked on this floor....this has really been the only thing that has "really stuck with me". I am seriously starting to wonder if I have other problems like depression and anxiety...that are hindering my ability to cope with things. I looked up symptoms of depression and anxiety and I matched every one of them....eeeeek. The "taking blame or feeling guilty much of the time" is me to a tee. I have also noticed myself losing interest in things, sleeping all the time,etc. I am also battling some other problems like trying to work with chronic pain from endometriosis and we're dealing with infertility as well. Oh yeah..then I passed out at work the other week and hit my head and needed nine stitches to sew my ear back together..lol. Overall...I'm just feeling sad and worn out...but I don't really think it is work that is wearing me out....it's just a combination of everything. We have very decent nurse to patient staffing ratios..which is great. I may talk to my doctor about getting some treatment for depression and anxiety issues...what do you guys think? I just want to be the healthiest and best nurse I can be...and when things don't go exactly right....somehow i need to learn to let it go....and just go on. Anyways..thanks again everyone...I really appreciate everything..

luv,

snoop'

[heron, ASN, RN]

Thanks Cardiac....

I know deep down that yeah....they are just trying to improve patient care...and that's a good thing...but man...I'm just the type of person that automatically thinks it's all me...u know? I suppose if they thought I was being incompetant or something...they would have let me know about it right away. I don't know why it all bothers me so much....but it does. I am questioning myself as a nurse..and I feeling like that.

Dear Snoop ... don't let this come as a shock, but ... it's not about you!:chair:

I want to second what other posters have pointed out: that the retrospectroscope is useful only long enough to pinpoint mistakes that we can avoid in the future ... and from your post, I can't see that you made any. I often tell folks that ask me about nursing that we are moms who went to school (yep, even the guys). We are conditioned to take responsibility for everything that happens to anyone, anytime, anywhere. I am not G-d ... I have minimal control over others' bad decisions. The way I see it ... you were a big part of why this lady survived to be coptered out. What is interesting to me is that, as the main caregiver you were never involved in the process ... could it be that someone wants to downplay the non-response from the docs ... perhaps for risk-management reasons?

Anyway ... you did good!:flowersfo