I am seriously consumed with guilt and just need to vent.
I work in peds, but I'm new to peds.
Without giving specifics, I went in my patient's room at 2000 (work night shift) to do my assessment, and did not like how the kid looked. I did my assessment, and just had that gut feeling that I didn't like how she looked. Resp were about 48. She had a fever, so I thought maybe it was that, treated the fever. I was on the phone with the doc several times through the night and felt like I really didn't have much assessment to go on besides,"this kid just doesn't look good, she's worrying me..." Other vitals, besides resp and temp, were WNL.
She ended up in surgery yesterday and now has has a colostomy.
I just feel like I didn't trust my judgment the way I should have and should have told him to come see her. I knew she didnt' look right. What was I supposed to say? I was her voice and I failed. I'm not sure the outcome would have been different, but I feel like it's my fault.
"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."
ding-ding-ding! we have a winnah!
6-8 weeks of iv antibiotics might have helped, but if he was a junkie he'd just keep using anyway, and it will be even easier because he'll have that handy picc or quinton line in. i've seen it a zillion times. he'd have had the surgery anyway; you don't see endocarditis on the ekg unless there's major problems like an eroding perivalvular abscess; no harm, no foul.
(and junkies with endocarditis end up having their tricuspid valves out anyway... they live fine without'em, really)
Specializes in Gen peds,ER,Retail medicine, peds heme.
I am a NP and one of many midlevels that manage inpatients overnight at our facility(with attendings/PICU always available). I think, from what you have posted, that you did great. When my coworkers comes to me with such concerns I am there to assess that patient immediately(as any of our PA's/NP's would be). I have no idea if you were reporting to a resident or attending, but either way, what you did was appropriate and I think you shouldn't be so hard in yourself. Keep up the good work!
You did the right thing. You were concerned about the patient, you called the doc, explained the situation. You really can't help their lack of concern for the patient; the only thing you can do...is if you really feel they need to come assess the patient, then say it. (and document it, too lol) Say that they need to come assess the patient. You're new, and you are caring. Don't beat yourself up too much....you've learned now that you need to be more assertive (which is harder if you lack confidence being new; just trust yourself and your instincts, have confidence in yourself and your knowledge, and don't let them intimidate you) However, you really don't know that the outcome would be any different; I don't know the situation, but the kiddo may have needed the colostomy anyway.
I reflect on my days, too, and I think it will make us better nurses. Sounds like you're doing a good job. Just use other more experienced peds nurses as your buffer. If you know something is not right, and the doc doesn't seem to care even after you've asked them to come assess (which they should come assess when you ask, and if the doc doesn't do anything after he assesses)...well, you ask for a 2nd opinion...just call their attending if you have to or speak to your nursing supervisor. Hopefully that won't be an issue, though.
Nursing is a big responsibility. You learn, you do your best while you're there, but you need to leave work at work. You've learned from what you could do differently now, so incorporate it into practice and move on. (I used to take work home and put all the weight on my shoulders when I was brand new, and it's natural when you're new, but you'll burn out if you continue to worry about work when you leave work).
I am seriously consumed with guilt and just need to vent.
I work in peds, but I'm new to peds.
Without giving specifics, I went in my patient's room at 2000 (work night shift) to do my assessment, and did not like how the kid looked. I did my assessment, and just had that gut feeling that I didn't like how she looked. Resp were about 48. She had a fever, so I thought maybe it was that, treated the fever. I was on the phone with the doc several times through the night and felt like I really didn't have much assessment to go on besides,"this kid just doesn't look good, she's worrying me..." Other vitals, besides resp and temp, were WNL.
She ended up in surgery yesterday and now has has a colostomy.
I just feel like I didn't trust my judgment the way I should have and should have told him to come see her. I knew she didnt' look right. What was I supposed to say? I was her voice and I failed. I'm not sure the outcome would have been different, but I feel like it's my fault.
Help me let this go! Please?
Should have, Would have, Could have, these are the things that eat at all of us. If you keep going over it you will end up in nice soft room, wearing a sport jacket with silver buckles in the back. Just use your sixth sense always even if your wrong.
It can't hurt. There was nothing you could have done. Now on to the next patient who has been lucky enough to get such a caring nurse---You.
i had a patient in nursing school (lpn) she had crackles you could hear from the door, and i was taking over for my fellow classmate who had her the day before and never reported anything about crackles the day before. Well, when i get in, her canula is out of her nose so of course her sats are low and she is gasping for air she looks frightened and pale. I put the canula back in make sure her flow is correct assess her resp, report to her primary that her canula was out and sats low and she is crackling so loud i can hear it outside of her door, i say she seems to have the sx of pulmonary edema, but no pink frothy just regular frothy. The primary says okay, I'll check her. I tell my instructor, who comes in and says patient shouldn't even be on this floor, she is in pe. So she goes and tells the primary and the primary comes in and calls, dialysis to come up cuz pt can't go down and we need to get fluid off of her. well she gets a mask for her oxygen, dialysis. Instructor is asking when she is going to get transferred off this floor because she is probably gonna have to be vented and there was no such equipment on the floor we were on. Long story short she was transferred off the floor, had to be vented, it was a crazy day all day long, they didn't get her off the floor till we left. The primary apologized for ignoring my warning, and was very upset to find that the canula had been out and she didn't know it. I told her things happen, that's why we are a team. I told her i am sure students make a big deal out of a lot of little stuff because we are learning and that's why we are taught to tell the priamary and the instructor, because when you see the instructor coming to get you you know something is probably really wrong.But still she felt bad. Well i am a 2 year old nurse now, and i will never forget that day.
I think you did what you were suppose to do, but like the other very experienced nurse said, when bad things happen, use them as learning experiences, grow from them and be honest with yourself, use the experienced experts who supposed to be there to help us and get yourself some guidance if needed and some closure. I think i know how you felt, i wanted to tell that primary "i think you should get in here and look at her now!" but i didn't, i didn't feel as though i had the experience to tell her that, but my gut knew the patient was in bad shape and not just because of her canula being out.
My dad used to come home looking grey and drawn. We all knew it was a case that hadn't gone well. The physician who answered your calls is also having a bad day. Introspection and review with others like you are doing here is part of the process of moving on. THe next time, you'll know just a little bit more. Chances are, the outcome would have been the same, but I know it bothers you. God bless you are in my prayers.
nurseprnRN, BSN, RN
1 Article; 5,116 Posts
"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."
ding-ding-ding! we have a winnah!
6-8 weeks of iv antibiotics might have helped, but if he was a junkie he'd just keep using anyway, and it will be even easier because he'll have that handy picc or quinton line in. i've seen it a zillion times. he'd have had the surgery anyway; you don't see endocarditis on the ekg unless there's major problems like an eroding perivalvular abscess; no harm, no foul.
(and junkies with endocarditis end up having their tricuspid valves out anyway... they live fine without'em, really)