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.

[Nancynurse1983, BSN]

{BigHug}! Don't keep beating yourself up over this. Realize your mistakes and learn from them. You must not lay all of the blame on yourself. Why did the admitting nurse not put suction in her room, I wonder?. This makes me believe that all nurses in your unit need a thorough educational in-service on tracheostomy care and assessment. Perhaps you could offer that suggestion to administration. In the meantime, educate yourself. There was a basic, key, critical thinking skill that you neglected in this case. Your ABC's. You did the appropriate thing by raising her head and increasing her oxygen, which covers Breathing, but what about Airway? With mechanical airways you must always check for patency and suction as appropriate if O2 sats decrease. Did her lungs sound "wet"? Or diminished? How was she moving air? Could she have aspirated, was her cuff deflated when it was supposed to be inflated? What color, odor were her secretions. Any mental status changes or changes in VS besides Sats? From your posting, due to the nurse:patient ratio, it sounds like time management has been difficult for you. Remember your patients come FIRST. In this instance the time should have been given to this woman for further assessment and close monitoring. Remind management that your patients are first the next time they frown on you for being behind and ask for suggestions on how to provide quality care while staying on task. If they can't agree and help you with this, I would start putting in applications elsewhere.

We all make mistakes, I have made many in my few years in providing care and have learned from every single one of them. That is the true character of a good nurse, accepting you were wrong and learning from it. This woman sounds like she had several comorbidities that also may have taken her life. Investing in malpractice insurance might ease your mind if you are concerned about legal liability. Good luck in your career and in trying to get into hospital care :)

[xoemmylouox, ASN, RN]

This is why you need malpractice insurance. We all make mistakes. Typically patient deaths are not just because of one person. They are caused by a breakdown of the system. In this case the right equipment wasn't at the bedside. The staff wasn't trained properly. If you have a trach patient you MUST have suction ready at the bedside. You MUST also have a "back up" trach ready at the bedside in case you need to do an emergency trach change. Unless you are familiar with trachs you may not think if these things.

[Guttercat, ASN, RN]

I think way too many new nurses are still being thrown to the winds with minimal "internship."

When I graduated in 1992, I took a position in an 18 bed ICU that did mostly hearts. I was a brand new grad, and was given two and one half weeks with a preceptor before I was on my own. Within two or three months they floated me to the neuro ICU...with absolutely no orientation to that unit. I was taking care of six ICU patients in a room...by myself with not even a CNA. I was extremely fortunate that no one died as a direct result of what I did or did not do (that I know of).

The OP has a valid point in that Sub Acute units are no longer always filled with "stable" patients on a tube feed and IV ABX q 8. They are arriving at Sub Acutes far sicker than they were 20 years ago.

[nrsang97, BSN, RN]

Jane82,

You can't keep blaming yourself. You need to take this as a lesson and not do the same thing again. I have made some mistakes in my 12 years of nursing that is for sure. If I said I never did then I would be lying for sure. Do not quit this job until you have another position. You will get more comfortable as time goes on. At least in the hospital you could call rapid response to come and assess to see if you needed to do anything further.

Talk to someone if you need to. If you ever feel that you need to address something with the doctor then do so. Even if they say "Why are you calling me?" reiterate your concern. Document you called.

Things will get better. It is clear you have learned from your experience.

[tony55!]

I am not going to judge what you did that night. I worked Med-Surg when I got out of school. At night we had 11 or more patients. One night I had 3 codes. I don't recall the details. I prayed about it and like you evaluated what I did. Over the years I have learned that my responsibility stops after the code. One time after a code, a co-worker said , "You , saved him." I said , "No, God did." I can't save a person and I can't take a person. Therefore, all you can do is your best and the rest is in God's hands.

[Do-over, ASN, RN]

Self-examination and reflection are important. Make a list of what you learned from the situation. Let it go and move on. It is that simple, but far from easy.

This will not be the last patient that dies, and it won't be the last time you question your actions.

As some others have said, I too have patients that haunt me. I have learned to just let them in, and accept that I am not perfect.

[eaus]

First of all, accept yourself as an imperfect person. Anyone who points a finger at you is a bully.

When we start out as new nurses we make mistakes. Sometimes you don't know that you can't

handle an assignment until something bad happens. Any nurse who says he or she has never made

a mistake that affected a patient is a liar. My first year as a nurse was a nightmare. I cried quite a bit.

But, there is always the nurse who points a finger and say things like "you should have done this or that"

Yes, there are nurses like this wherever you work. Just do your best. Realize nurses, doctors, RTs-we are all prone to

mistakes and some mistakes may be very serious. Learn from what you do or don't do. I am now at the end of

my career. You become stronger and smarter as you go. If you like nursing stay with it, grow and learn. If every

nurse quit because he or she made a serious mistake, there would be more of a shortage than we currently have.

Forgive yourself and find a better place to work.

[#NurseB]

\ said:

I am not going to judge what you did that night. I worked Med-Surg when I got out of school. At night we had 11 or more patients. One night I had 3 codes. I don't recall the details. I prayed about it and like you evaluated what I did. Over the years I have learned that my responsibility stops after the code. One time after a code a co-worker said , "You , saved him." I said , "No, God did." I can't save a person and I can't take a person. Therefore, all you can do is your best and the rest is in God's hands.

Great way to look at it!

Op, a bad nurse would not look back at what she could have done better but a good nurse does, and that is what you are doing. Everyone makes mistakes. Learn from this and use it in the future to be an even better nurse!

[Sugarcoma, RN]

Dear OP,

There is absolutely no way to say that you caused this patient's death. DIB has so many many causes. This patient's history of CABG with trach still requiring O2 to support oxygenation tells me that they were very very sick. The type of patient that just sits in their bed ticking away (time bomb). This person was so debilitated they had little to no physiologic reserve and the slightest insult could send them over the edge. There are a million things that could have happened. They could have thrown a clot (surgical history), they could have aspirated (tube feed) they could have been very septic, etc. For all we know this patient could have been allergic to bees and a bee flew into the room and stung them. Outrageous? Yes. But so is blaming the death of this patient on you.

I am very disappointed by some of the responses you have received here.

If I had to critique your performance I would say that you should have further assessed this patient. An episode of acute hypoxia warrants further investigation. A full set of vitals, a visual inspection of the trach site, auscultation of lung sounds. The doc really should have gotten a chest xray and abgs. Now should you have suctioned this patient? Secretions may not have been the issue but it is something you can do right away and see if it helps or not. So I would say yes.

Please know that you could have done all of these things and this patient still could have coded and died.

OP you are a new nurse. I remember those days well. Ugh! Struggling through my shifts barely able to complete my med pass and charting. I know for a fact I missed things. We ALL have. Scariest of all is that we didn't even know we did it.

I can tell you emphatically that nothing beats experience. I look back at the nurse I was 4 years ago and shudder. I am sure in another 4 years I will do the same. That is one of the funniest things about this profession. We value education so much but not experience. So sad in my opinion. I work with nurses that have been bedside for 20 or more years. They leave me in awe much of the time and I consider myself to be a very good nurse. I often joke with them that when we walk into a room together they have already assessed the pt. and know what they need while I am still trying to find the light switch! There is simply no way around it. The only thing that makes you better is practice and unfortunately we get to practice on people.

You have nothing to feel guilty about. You found a patient in resp distress, sat them up, increased their o2, and notified the doc. These are first line interventions for a pt. with trouble breathing. You did a good job. I am quite sure had the patient not improved you would not have left their side. Over time you will develop your nursing judgement and you will more readily know when a patient requires more intense observation. You will begin to get a feel for those patient's who are about to "crump" even when there are no concrete clues that point to it.

Please forgive yourself and move on. You put forth your best effort. You genuinely care about being a good nurse. You are smart as evidenced by the actions you did perform. You are a good new nurse and you will be a good experienced nurse. You obviously care about your patients.

Now you have learned a couple of the dirty little secrets about nursing. The first being that you will never have the time, support, equipment, or training to nurse like you want to. Regardless of the setting. I will say that sub acute is a special level of he@!. Experienced nurses with excellent time management skills drown there. Why do you think they are always hiring?

The second is that there will always be those who will be quick to point blame in your direction. Monday morning quarterbacks who seem to take delight in pointing out what they perceive to be the shortcomings of others. They will be doctors, managers, CNA's, but most especially they will be other nurses. I do not know why but many nurses seem to love "out-nursing" their peers. Just look at some of the responses you have received. These holier than thou nurses have apparently never suffered a lapse in judgement or made an error. Please know that even if you do everything perfectly they will still find fault.

I have to wonder where is the outrage at this facility, you know, the ones who are collecting the cash. Why do they have such ridiculous ratios? Why was there no suction in the room for a trach patient? Unless this patient was admitted 10 minutes ago by the OP the OP bears no responsibility for the lack of suction in the room.

Ditto for the doc who did nothing.

[MissingMyErica]

To all the self righteous "nurses" out there who have nothing better to do but make this girl feel worse about herself, all I can say is...."Karma is a *****". Remember the old saying about stones and glass houses? Are you people really that amazing at being nurses that you could handle a patient load of 28-48 patients and NOT make the same mistake as a new nurse? I've been a nurse for over 17 years and I've ONLY worked in acute care....I've seen dozens and dozens of mistakes made by new nurses and seasoned nurses! No one gets into nursing with the intention to harm someone, but mistakes do happen and wouldn't it be nice if you could be supported by your fellow nurses instead of being made to feel like a murderer! To the OP.....I am honestly so sorry that you had to have such a horrible experience. I'm sorry that nursing has turned into big business and you weren't given the tools or the time to grow as a nurse before being put into such a scary position. I'm sorry you have to listen to ignorant, self righteous nurses make you feel even worse about yourself. Ignore them, unfortunately in every area of nursing...acute or long term care, you will come across these miserable, judgemental people. Just take comfort in the fact that they too have made mistakes and are just too arrogant and self righteous to admit it to you or themselves. Everyone has made a mistake that in some way, big or small has caused harm to a patient. It's the decent nurse that realizes that we are all human and that all we can do is learn from them, try harder and move on. Now, stop smoking and quit taking sleeping pills....pull up your big girl undies and MOVE ON FROM THIS! Use your time in a more constructive way and look for a better, safer job. Good luck.

[jtmarcy12, BSN, RN]

OP: You did the best with what you knew. Look for the lesson and move on. Do a scavenger hunt again if you have not already had one. Locate all the essential equipment needed to perform your job. These LTC are the PITS and there should be more regulation so that each nurse, cna,lpn does not have so many patients. There is NO WAY one person can safetly care for that many patients on any given shift. Don't beat up on yourself and never let anyone else beat up on you (there is not one single nurse on this planet that knows everything!!). We are not God so no one will ever know what actual caused or contibuted to her death. You are new and learning. Some of us have been where you are and can't or will not admit it. Review your critical thinking and assesment skills and move on. God Bless!!!!

[jtmarcy12, BSN, RN]

To all the self righteous "nurses" out there who have nothing better to do but make this girl feel worse about herself, all I can say is...."Karma is a *****". Remember the old saying about stones and glass houses? Are you people really that amazing at being nurses that you could handle a patient load of 28-48 patients and NOT make the same mistake as a new nurse? I've been a nurse for over 17 years and I've ONLY worked in acute care....I've seen dozens and dozens of mistakes made by new nurses and seasoned nurses! No one gets into nursing with the intention to harm someone, but mistakes do happen and wouldn't it be nice if you could be supported by your fellow nurses instead of being made to feel like a murderer! To the OP.....I am honestly so sorry that you had to have such a horrible experience. I'm sorry that nursing has turned into big business and you weren't given the tools or the time to grow as a nurse before being put into such a scary position. I'm sorry you have to listen to ignorant, self righteous nurses make you feel even worse about yourself. Ignore them, unfortunately in every area of nursing...acute or long term care, you will come across these miserable, judgemental people. Just take comfort in the fact that they too have made mistakes and are just too arrogant and self righteous to admit it to you or themselves. Everyone has made a mistake that in some way, big or small has caused harm to a patient. It's the decent nurse that realizes that we are all human and that all we can do is learn from them, try harder and move on. Now, stop smoking and quit taking sleeping pills....pull up your big girl undies and MOVE ON FROM THIS! Use your time in a more constructive way and look for a better, safer job. Good luck.

DITTO AND AMEN!!!!!!!!!!!!