How do I trust my judgement after this? First Patient Death

Updated:   Published

Hello everyone. I have been a nurse for one year and last night I had my first patient death. I should have recognized the symptoms they were textbook for hypovolemic shock, but I didn't. Her death is my fault and I should have recognized her deteriorating status sooner. I could go into the specifics, do a full SBAR, but at the end of the day it boils down to my inability to respond quickly and page the MD and do a further workup to see what's going on.

The purpose of this post is to ask how do you continue to be a nurse after this? How do I trust my own judgment and have faith that I will recognize other symptoms again? I consulted my charge nurse and talked to him about the patient's deteriorating condition, I even paged the night before detailing the patient's symptoms but those test were negative. Long story short I was thinking SBO when in reality she probably had a GI bleed and went into shock. I haven't been able to stop crying since my last shift and I feel like I failed my sweet patient who was just there for an elective surgery.  

Anyways, I am questioning my abilities as a nurse and even though I love nursing and my patients I am terrified I will hurt someone again.  Maybe I am not smart enough to be a nurse 

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Specializes in Private Duty Pediatrics.

I remember my first death when I was floating to ICU. It happened so fast, and I didn't have a clue what went wrong. I was distraught. Several of the other nurses talked to me after the shift. They told me that deaths happen. That we do our best. And they wouldn't let me go until I said, "I did good." ("Repeat after me", they said, "I did good.")

I left, knowing that they had my back.

Who has your back? You need to talk this through with a nurse who has been through this or with a counselor. 

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Specializes in ER, Pre-Op, PACU.

I had so many patient deaths in the ED with it being a critical care environment. Some were not hard at all. Others were crushing. I think all of us remember our “first” patient death as nurses and look back to wonder what we could have done differently. In reality, 9 times out of 10 we couldn’t have done anything more. We did the best we could. I know my coworkers helped me out - hopefully yours are helpful to you too. You can and need to talk about it.....totally normal.

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Specializes in Critical care.

We can’t save everyone, despite our best efforts. GI bleeds are particular beasts that can rear their ugly heads hard and fast. Some times we know a patient is decompensating but we don’t know why or we can’t stop it. 

Please look into using your EAP. You did the best you could and it is not all on you.

Sending hugs. 

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Specializes in PICU.

First off, you  were not the only single person in the past 24 hours that had contact with the patient. The physician had access to this patient's chart, labs, as did the nurse on the previous shift. Obviously I was not with you while you were caring for this patient, but the only way you would be 100% at fault would be if you purposefully injected a medication to kill them, with intent walk away and tell someone it is their problem, smother the patient, etc.

What was the differential the Medical team was using to treat this patient? If you were following the plan of care.. You are also now looking at it with hindsight. Sometimes some things come out of nowhere and catch everyone off guard.  

Take care of yourself, you were not alone in this nor will you be in the future

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Specializes in Oncology, ID, Hepatology, Occy Health.
13 hours ago, nurse54361 said:

I consulted my charge nurse and talked to him about the patient's deteriorating condition

You did good.

Sometimes patients go off quickly and there's nothing we can do to save them. 

It's good to question yourself and learn from what you might have done differently, but really, I don't think this patient's death is your fault. 

You come accross as a conscientious nurse who tries to do their best. No patient can ask for more, frankly.  

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Specializes in NICU, ICU, PICU, Academia.

In answer to your original question- how you trust your judgement is to learn from this experience- and take the lessons learned into future situations. 

You've done that. You've reflected. You've thought critically about the situation. You've consulted more experienced nurses both on the job and here. 

Those are all the marks of a GREAT nurse- and that is you! 

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18 hours ago, RNNPICU said:

First off, you  were not the only single person in the past 24 hours that had contact with the patient. The physician had access to this patient's chart, labs, as did the nurse on the previous shift.

I can't like this advice enough.  OP, you were not working in a vacuum there were plenty of other providers involved here.  I can tell you each and every one of them is now second guessing themselves on some level.  You did what you could.

Reflect on what happened, and use what you have learned in your future practice.  ((hugs))

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Thank you everyone so much for your kind words and support. I can’t tell you how many times I’ve read and reread each of your responses. I have an appointment with my therapist and asked my manger if we do a postmortem review, still feeling like I need to talk through the case medically. 

I truly appreciate each and everyone of you who took the time to respond. I really needed some guidance from more experienced nurses. Thank you for all that you do

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On 10/23/2020 at 6:26 PM, nurse54361 said:

Hello everyone. I have been a nurse for one year and last night I had my first patient death. I should have recognized the symptoms they were textbook for hypovolemic shock, but I didn't. Her death is my fault and I should have recognized her deteriorating status sooner. I could go into the specifics, do a full SBAR, but at the end of the day it boils down to my inability to respond quickly and page the MD and do a further workup to see what's going on.

The purpose of this post is to ask how do you continue to be a nurse after this? How do I trust my own judgment and have faith that I will recognize other symptoms again? I consulted my charge nurse and talked to him about the patient's deteriorating condition, I even paged the night before detailing the patient's symptoms but those test were negative. Long story short I was thinking SBO when in reality she probably had a GI bleed and went into shock. I haven't been able to stop crying since my last shift and I feel like I failed my sweet patient who was just there for an elective surgery.  

Anyways, I am questioning my abilities as a nurse and even though I love nursing and my patients I am terrified I will hurt someone again.  Maybe I am not smart enough to be a nurse 

How do you definitively know it was hypovolemic shock? Wait for the autopsy if you are that curious. Until then, prepare well and be more attentive to detail and communicate your findings/concerns/assessment to your colleagues. I highly suggest that you develop some proper coping mechanisms especially relative to grief. I quickly learned to have amnesia about my patients once my shift was over. It is easy to overanalyze scenarios and Monday-quarterback yourself into preventable misery and unwarranted depression. 

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You do not need to be hard on yourself. And think of negative thoughts .  Charge it all to experience. As your exposure to the clinical area runs by, you'll be able to develop a what they so called "clinical eye." It all starts with Assessment, from ABC, LOC, vital signs etc..

Even those who have years of experience may sometimes missed or ignore the basic assessments . Clinical judgment supported with facts on your assessment to the patient will surely give you more confidence to refer the patient when needed. Nursing is a life long learning. 

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Specializes in Mental Health.
On 10/23/2020 at 7:26 PM, nurse54361 said:

Hello everyone. I have been a nurse for one year and last night I had my first patient death. I should have recognized the symptoms they were textbook for hypovolemic shock, but I didn't. Her death is my fault and I should have recognized her deteriorating status sooner. I could go into the specifics, do a full SBAR, but at the end of the day it boils down to my inability to respond quickly and page the MD and do a further workup to see what's going on.

The purpose of this post is to ask how do you continue to be a nurse after this? How do I trust my own judgment and have faith that I will recognize other symptoms again? I consulted my charge nurse and talked to him about the patient's deteriorating condition, I even paged the night before detailing the patient's symptoms but those test were negative. Long story short I was thinking SBO when in reality she probably had a GI bleed and went into shock. I haven't been able to stop crying since my last shift and I feel like I failed my sweet patient who was just there for an elective surgery.  

Anyways, I am questioning my abilities as a nurse and even though I love nursing and my patients I am terrified I will hurt someone again.  Maybe I am not smart enough to be a nurse 

If you did something wrong, believe me, the facility would be after you.  You didn't say what the patients overall condition was.  If she were on her way out, they may not wanted heroics.

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