I feel like I caused a patient's death and I can't get over it

[jane82]

I am a new nurse working in a sub acute rehab facility/LTC. I am typically assigned to care for 28 to 40 patients on midnights. I have been trying to get into a hospital but not having prior experiance or a BSN forced me to accept this job for experience. I have been concerned from the being with patient safety and the patient load I have.

Awhile back I had a patient whom I was not familiar with. She had a trach site, on O2, with continuous tube feed, and a mental illness condition. Later the CNA said she told her she was having difficulty breathing. So I checked her spo2 I raised the HOB from 30 to 45 degrees and increased her o2 and the sp02 increased. I notified the doctor on call.

When I later entered the room I noticed the patient looked really pale and asked if she was ok, the nurse replied "no she isn't, get a suction machine". I was in a panic, I thought "should I have suctioned her ?!?" I ran out to the find someone who knew where suction machine one and was told that there was one on the crash chart so I grabbed the crash chart and ran toward the room. When I came closer to the room someone said it was a code and to announce it on the overhead.

I feel like I did not do all I could for her and I have been crying almost daily because of it. I even started smoking again after quitting 6 years ago. I can't sleep without sleeping pills and I see her pale face in my head over and over. I would love some honest opinions from more seasoned nurses on this event because I feel so horrible about what happened.

[LadyFree28, BSN, LPN, RN]

((((HUGS))))

How unfortunate!

FIRST thing you need to realize is that this person may have been headed towards this destination; in hindsight there was something acute occurring; when in doubt, you always get someone to help; ask questions; it NEVER hurst to say "I'm concerned..." especially when you haven't had the experience.

The next thing to do is discuss your concerns with someone, even a licensed health professional. Every nurse has thought with hindsight in very stressful situations; for me, it has made me a better nurse.

Sending post iv vibes on getting back on your horse and do this nursing business...it will be up to YOU.

[thenursemandy]

If someone with a trach starts desating....and is becoming more anxious .....why do you think that was? Maybe because her airway was partially blocked....and needed suctioned. She couldn't adequately breath. I believe it is likely that you contributed to her early demise, but you may never know.

This isn't what you want to hear, but its what you likely feel in your gut. I'm so sorry for what you must be feeling.

Please:

1. Try to accept what happened. You are trying your best in a new role with tons of responsibility and little support...and sometimes horrible things happen...even to good people. 2. Seek further education on trachostomies and end of life care. 3. Do it ASAP. 4. Know that your skills/intuition will get better with experience and education.

[Pepper The Cat, BSN, RN]

Please talk to someone about this.

I think you did the best you could, given your experience.

You are not the only one who missed things. You said she had been there for 2 days, but her Xanax was not available, and no one else had set up suction. She had anxiety issues, which can make things difficult to assess, esp SOB.

Do you have an MD on call, or an on call person you can reach out to in situations like this?

I don't think I would have done much different than you did.

[Amistad, RN]

I'm so sorry this happened to you. ::hug:: I think you did a good job considering you care for 28 to 30 patients at night (how?!).

Perhaps this is a good opportunity to suggest to management that a trach inservice/class take place since it sounds like your staff doesn't take care of trached patients very often.

Don't beat yourself up. You did what you could and with good intentions.

[jane82]

thank you everyone for your input and thoughts...

I really do believe if I didn't have such a high patient load I would have thought about her condition more critically. I try my best daily do give good patient care but when I do decent care I fall behind and I get questioned by the DON's on why I am over. I say decent care because I know I am not doing all I know I can. I have always wanted to be in healthcare since I was little, but I am so discouraged where I am at now. We have an on call doctor and the regular doctors do not show up until around 9am on average and some patients have been there for weeks before they even see a doctor. I have called the on call doctor before and he always has an attitude like "why are you calling me with this?" I had to tell him one night that we need to send a patient out for respiratory distress so I know my assessment skills are not horrible. That patient was gone for a month before she came back, so I know it was serious. I know the other nurses missed things also and if there was a suction machine in there I would have put it together even as busy as I was. I just wish I was the one who could have thought to get a suction machine. Maybe that wouldn't have saved her but at least I could rest easy knowing that I did all I could. I am currently looking for a hospital to work at because LTC facilities are not worried about the nurse patient ratio whatsoever. I know a lot of hospitals nurse to patient ratios are high but I think I could handle 5-7 patients better than 28-40 patients.

[doppelganger2]

Oh my, there are so many things I want to say on this matter......

You contributed to this patients death. Allowing the family believe that it was the hospitals fault for discharging this patient too soon, when in actuality it was you and your facilities negligence for not providing proper equipment and training to its staff.

You stated the pt was sob so you raised hob to 30-45 degrees and increased 02.if this pt was on a continuous feed, their head should have already been elevated to those degrees.

When the pt asked for water but you refused because they are nectar thick liquids only. You should have nectar thick water provided for you and if not there should be the thickening packets so you can make your own nectar thick liquids.

If you didn't think it was a "safe" patient load you should have spoken up.

None of what I'm saying here is going to make you feel any better and it's not intended to. There are serious things that you, other staff and your facility did that contributed to this pts death.

[doppelganger2]

Forgot about you seeking a hospital job. I say good luck with that because the ratios are better than ltc. But smaller ratios mean higher acuity of care and a need for higher level of critical thinking skills.

[jane82]

@doppelganger The acuity level on this unit actually very high and many patients get dumped at this facility that are not ready for rehab and we send them back out quite frequently. There is a LTC unit in the facility also. This was not on the LTC unit this was on the rehab sub acute care unit. I and other staff have spoken up about the ratio with but management doesn’t care. When I was first hired they said it was a patient max of 14. A turn out that only applies to day shift. I did offer the patient nectar thick liquids and they were provided to her. The HOB was elevated 30 degree to start with, if you read my post you would see I only elevated it higher. I never saw the family I am only stating what other staff members told me. Believe me I am not trying to justify anything here. My heart truly breaks for what happened and unless you have been in my shoes you have no idea what I do for these patients. I know I have helped some maybe a lot. I have patient thank me for my care I give them because many people there ignore call lights and treat them poorly. I wish I was better that night and this is something I will have to try and live with. Before this happened I thought seriously about quitting. I wanted to stick it out and I don't want a lap in my employment but I know it is my license on the line. You can't tell me that your critical thinking skills will be sharp when you are caring for 28-40 acutely ill patients per night with a staff that has a low moral for helping others. I will not forget about looking for a hospital job and you saying that is really just hurtful. I know none of you know me but during all of my clinical rotations I had nothing but praise from my clinical instructors on my critical thinking skills and my interaction with patients. I am just too overwhelmed with what I am assigned to do and after these posts I know now that I should defiantly quit.

[stylishgurl]

Hi Jane82 forgive yourself and for every nursing heartaches consider it as your learning pearls.You will experience more and more situations like this where you feel like you could have done something differently.Don't be hard on yourself you sound so concerned and caring be strong.Patients in the hospital might be sicker and demanding but guess what you won't be alone.I always have compassion with new nurses coz I have been there.Trust me it will get better and you will get more skilled as you move forward.

[martymoose, BSN, RN]

Just want to say Im sorry. These facilities SUCK!!! Hospitals ARE discharging people way too soon. She sounded in poor health to begin with( who puts an 85 y/o thru a cabg????) And then to turf her to a snf with a pt load of 40??????

Sorry to say , you got that job cause no one in their right mind would have taken it.

I'm sorry that nursing has let you down. These places don't value anyone with any experience, and wonder why crap like this happens, and then the inexperienced employee is the perfect one to blame.

I hope you get a better opportunity in the future.

[GundeRN]

Just want to say Im sorry. These facilities SUCK!!! Hospitals ARE discharging people way too soon. She sounded in poor health to begin with( who puts an 85 y/o thru a cabg????) And then to turf her to a snf with a pt load of 40??????

Sorry to say , you got that job cause no one in their right mind would have taken it.

I'm sorry that nursing has let you down. These places don't value anyone with any experience, and wonder why crap like this happens, and then the inexperienced employee is the perfect one to blame.

I hope you get a better opportunity in the future.

Exactly! My heart breaks for you! I would like to know the background of those of you cutting this nurse down. I do believe she is suffering enough. This is a classic case of facility staffing issues causing a tragedy and this nurse being thrown under the bus. I used to work in an environment, somewhat like that but from your description, not as bad. It is impossible to be able to think critically when you work in situations that don't give you time to think. And if suctioning equipment was essential to her care, why wasn't it already at her bedside. There should have been an order for suctioning equipment at the bedside. Like you said, if you had seen it there it would have clicked. Nurses who are used to caring for trach patients may find it second nature to think of suctioning, but a new nurse with very little tach care experience?

I am so sorry, I hope you can get out of there soon.