I failed my patient

bsyrn, ASN, RN · Nov 2, 2011

While I truly do not feel like you did anything wrong, nurses get gut feelings for a reason, next time follow your instincts. Don't beat your self up....keep learning and improving. You sound like a caring nurse....:)

NurseLoveJoy88, ASN, RN · Nov 2, 2011

I'm sorry, I'm a little lost. It sounds like to me you DID use your best nursing judgement. You did an assessment, vitals and reported to the doc? Were there any thing else you could have included such as recent labs and etc.? Was having surgery and a colostomy a result of what happened on your shift?

llg, PhD, RN · Nov 2, 2011

Maybe you shouldn't let it go just yet -- because you are not quite done with it yet. You may be "hanging on to it" because you still have some issues to resolve and things to learn.

Uncomfortable feelings often exist for a reason -- and we can learn from them if we confront them fully, work through their causes, and learn from those situations. Too often, people try to simply "get rid of" those negative feelings as fast as they can. By hurrying to get rid of those feelings, they miss the opportunity for growth that comes with those experiences.

I suggest you find someone you can trust (like a mentor, educator, co-worker, etc.) -- preferably an expert pediatic nurse -- and talk through the events of that night. Be thorough. What could you have done differently? Were there actually things you could have done that would have improved the outcome? Or are you beating yourself up over a situation in which you did everything correctly? You probably won't (and shouldn't) be able to shove this situation aside until you get a REAL answer to that question.

What can you learn from this situation? What lessons will you take forward with you to help you be a better nurse? As you work through the answers to these questions, you will gradually resolve your intense feelings of guilt. But hopefully, you will never forget the case -- and you will use it in the future as an exemplar to remind you of the lessons learned.

There will always be times when we are not "super men and women" -- always times in which we question our actions and wonder if we could have done something better. Don't shy away from those questions and wondering. They are what makes us better and stronger. They are crucial to our growth. It's when we fail to face them head on that we get into the most trouble.

Go through the self-examination process -- review your work with an expert -- and learn from it, whatever the outcome of that honest review might be. Then (and only then) will you truly be ready to move on.

A&OxNone, MSN, RN · Nov 2, 2011

I'm sorry, I'm a little lost. It sounds like to me you DID use your best nursing judgement. You did an assessment, vitals and reported to the doc? Were there any thing else you could have included such as recent labs and etc.? Was having surgery and a colostomy a result of what happened on your shift?

Yes, on paper, I did what I was supposed to do. I called the doctor and told him about UOP and vitals, ect ect. That's not really the point. I felt like there was MORE than just what I could tell him by numbers. It's that feeling that I can't really explain. I felt like I should've told him to just come see her, because he had seen her during the day and I hadn't. I think maybe he could've seen how different she was from day shift, where I didnt have that perspective.

Without giving too much information (I work in a pretty narrow, specific field) she had a complication from a major abd surg. Not exactly a common one, but serious no less.

A&OxNone, MSN, RN · Nov 2, 2011

Maybe you shouldn't let it go just yet -- because you are not quite done with it yet. You may be "hanging on to it" because you still have some issues to resolve and things to learn.
Uncomfortable feelings often exist for a reason -- and we can learn from them if we confront them fully, work through their causes, and learn from those situations. Too often, people try to simply "get rid of" those negative feelings as fast as they can. By hurrying to get rid of those feelings, they miss the opportunity for growth that comes with those experiences.
I suggest you find someone you can trust (like a mentor, educator, co-worker, etc.) -- preferably an expert pediatic nurse -- and talk through the events of that night. Be thorough. What could you have done differently? Were there actually things you could have done that would have improved the outcome? Or are you beating yourself up over a situation in which you did everything correctly? You probably won't (and shouldn't) be able to shove this situation aside until you get a REAL answer to that question.
What can you learn from this situation? What lessons will you take forward with you to help you be a better nurse? As you work through the answers to these questions, you will gradually resolve your intense feelings of guilt. But hopefully, you will never forget the case -- and you will use it in the future as an exemplar to remind you of the lessons learned.
There will always be times when we are not "super men and women" -- always times in which we question our actions and wonder if we could have done something better. Don't shy away from those questions and wondering. They are what makes us better and stronger. They are crucial to our growth. It's when we fail to face them head on that we get into the most trouble.
Go through the self-examination process -- review your work with an expert -- and learn from it, whatever the outcome of that honest review might be. Then (and only then) will you truly be ready to move on.

I think this post has a whole lot of truth to it. Thank you for this wisdom - in a small way, it makes me feel better already. I feel like it's different when you have an adult screaming at you "I'M IN PAIN!!" verses a 20 month old that can't tell you anything, and you have to go by judgment and feelings and numbers. I do need to talk it out with somebody that wasn't there that night and see what I could've done different and at what point I did something, if anything, wrong. I just feel, like I said, I was her voice and let her down. *sigh*

Munch · Nov 2, 2011

I think most of us at one time or another had made a mistake or two when it comes to patient care. I personally don't think you failed your patient at all or made a mistake..but that's my opinion.

I usually work in the neurology/neurosurgery unit(occasionally I work in oncology) but this day I was working on the neuro floor. I was caring for a patient that recently had brain surgery. The patient rang the call button and the PCA(Patient care associate) came to see the patient and took vitals because the patient was complaining of having a rapid heart rate. The vitals the PCA took reveiled the patient was tacky, had high blood pressure, and a slight fever. The patient was on was on 5mgs of morphine IV push every 2 hours for pain, decadron for swelling and a muscle relaxant for neck spasms. I went in and listened to the patients heart manually and the patient indeed was very tacky. I just figured the patient was anxious or in pain. I called the house doctor and he order 1mg of IV ativan, and changed the morphine to 2mgs of dilaudid thinking the patients pain wasn't being managed enough. The patient was due for pain meds anyway. So I pushed the ativan and dilaudid thinking the patient would feel better and the blood pressure and heart rate would decrease. The house doctor was going to come see the patient because of the fever, but the patient wasn't on his urgent list. After a while the patient was STILL tacky with high blood pressure and the fever went up a little. So an EKG was done(in hindsight it should have been done when the patient complained in the first place). The EKG was abnormal so we put the patient on a heart monitor(which kept going off) and called for a cardio consult.

Long story short the patient needed heart surgery and had to have a valve replaced for endocarditis. I thought the patient was in pain since the patient was a few days post op. I never thought a cardiac problem was the cause. I blamed myself for a while, eventhough the cardiac problem would have happened anyway. But maybe if I thought it was a heart problem sooner the patient could have been treated medically with antibiotics instead of having surgery. I later found out the patient was heavy into street drugs(which can cause endocarditis) but never told ANYONE. All the tests(EKG included) were normal during pre-op testing. I guess the infection came on so quickly because of the surgery and decreased immune system due to the steroids? That's the only thing I could think of.

vinsonmm · Nov 2, 2011

Most of us at one time or another have felt the same way you do now. Just remind yourself that colostomies can be reversed and children rebound better than adults.

CrunchRN, ADN, RN · Nov 2, 2011

You are holding yourself to an impossible standard.

I so agree with the poster that said find someone else to look in on your patient next time and get some input from them, but other than thant you did a fine job and you cannot be psychic.

Sometimes instincts are right and sometimes not. Chances are the doc would not have come in anyway, but either way you did a fine job and now you have a plan if the situations should arise again. So time to let it go.

llg, PhD, RN · Nov 2, 2011

I do need to talk it out with somebody that wasn't there that night and see what I could've done different and at what point I did something, if anything, wrong.

Exactly. You need the honest answer to the question, "Was there anything I should have done differently?" Until you get that answer, it will eat away at you. The best way to get that answer is to review the details of the case with an expert. That's why physicians have sessions like "Morbidity and Mortality" conferences in which they review cases and look for ways to improve the care they provide. It should be a normal part of our practice that happens regularly -- and without a punative culture. Unfortunately, the punative culture in nursing has discouraged the development of such regular case reviews. Be brave and have such a session with an expert yourself. Resolve your questions and issues ... so that you can move on.

FloridaMurse · Nov 2, 2011

In my strong opinion, never stop feeling the way you feel. That's the sign of a caring, loving, good nurse. You can learn from the patients you win, and the ones you lose. The moment you stop caring, is the moment you will become a bad health care provider.

And please remember, it's better to be safe than sorry - you'll always walk away saying "I did the best I could." If you're questioning anything at all, call for backup.

Jenni811, RN · Nov 2, 2011

you did nothing wrong. You had a gut feeling something was wrong and you acted correctly. You did an assessment, and everything was wrong. If there was nothing else wrong except respirations and fever you have nothing else to go off, and that is by no fault of your own.

I once had a patient that kept saying "i cant breathe. i just can't catch my breathe" i paged respiratory and there wasn't much they could do cause we had no orders for PRN inhaler. I turned off her fluids and paged the doctor. There was nothing i could tell the doctor except she states she cant breathe. No Chest pain, vitals stable, respirations were actually normal, oxygen sats were just fine (97-98). He gave me an order for a PRN albuterol nebulizer. something in my gut was telling me, there is something else wrong here. I listend to lung sounds, she was admitted for pneumonia, so crackles didn't surprise me.

Albuterol did nothing for her breathlessness. i paged doctor back, there was nothing else i could tell him. i told him i discontinued the fluids. he said he was fine with that and will come check on her when he has time.

an hour went by, im like on the edge of my seat with this patient, because i can't do anything except what iv'e already done. By the time the doctor came she was coughing up frothy blood and clearly in respiratory distress. She ended up being in full blown pulmonary edema. He got Pi$$ed at me. What more do you want??? i called you 3 times and actually paged you when i saw it getting worse!!!! It was NOT my fault, i did everything i could and everything i was supposed to do.

The fluids i was given were probably what caused it, but i didn't order the fluids, there was nothing she had that made me question her getting fluids at 100cc/hr. It is just something that happened. i felt awful about it.

Patients are unstable, and that is why they are in the hospital. Things are going to happen to patients that we can't explain, and thats why we are there.

guess what im getting at is NOTHING you did was wrong. Like my patient, i did nothing wrong with her. I did everything i was able to do in my scope of practice. i had a gut feeling she was going into pulmonary edema, so the 4th time i paged the doctor (when she started getting worse and my hint to say get here now) i pretty much asked for an order for an XRay and he wasn't here soon i'll be calling an MRT. Even after that call it took him 20 minutes. thats when he got mad for me not paging him AGAIN or calling an MRT. Um....you told me not to call an MRT and just get an xray and you would be here in a few minutes.

sometimes, i tell ya!