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.

[Mulan]

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.

You know, you don't know that.

Maybe it was just this person's time to die.

Even if everything was done perfectly from the first second, the outcome may have been the same.

[SubSippi]

It sounds like you did your best, which is all you can do. And I guarantee you'll be more prepared for a situation like that next time, because there will be a next time!

There's no way to know if the patient would have lived if you did something differently. But if you keep learning and keep doing your best, at the end of your career, you'll have done way more good than harm...a net positive, if you will (ha).

[copeRN]

Don't be upset, don't lose sleep and no more smoking! You don't want a trach either!! Love your self and love what you're doing with your life. You are smart or you wouldn't be where you are. You are doing great!

[LakeEmerald]

How you could have time to really critically think with 28 - 40 patients is beyond me. I can't believe this ratio. Seems like the facility should have put their trached/serious patients in an area where they could get more nursing attention per patient. At this ratio, your patient could have coded and died while you were rounding on your other patients and you would have never known because it would have taken you hours to get back to her.

Take what you learned from this unfortunate experience and tuck it away in your knowledge file, then, quietly begin applying for jobs with sane ratios. A trached pt without suction? Preposterous! Your facility not maintaining suction protocol? Irresponsible. Where was management's oversight? Allowing a new nurse to juggle this many patients AND a trached pt with no suction at bedside AND under time pressures? Recipe for disaster. Not your fault. When you are spread this thin, it's hard to be safe.

Put away the cigarettes, straighten up your back, and move forward to better days. You need to work for a place that respects you and will give you a reasonable and safe workload. Best wishes to you.

[CrazierThanYou]

I was involved in a sentinel event recently in which the patient died. I don't want to go into any details but I did want to comment on this. I was devastated, I cried all day, not only because I was sure I would be fired, but because I felt terrible about the whole situation. I've attended several meetings since then in which we established causal factors and what can be improved in the future.

My actions may have contributed to the patients death but she had many comorbidities, was on over 40 medications and the dosage of a critical medication had been greatly increased previously, which wasn't brought to my attention.

I've met with our patient safety officers many times and like one said, the ball gets dropped all the time and sometimes the consequences are worse than others. Things are going to happen in your career. Make them learning opportunities and you'll be a better nurse for it.

I hope you can find peace soon. Keep your head up and don't quit!

[sallyrnrrt, ADN, RN]

ditto and amen!!!!!!!!!!!!

amen my sister! Exactly

[applesandfishes]

Jane82,

i'm very sorry for what happened and i am sorry that you are in a bad situation in your career. unfortunately, you were set up for failure basing on patient's history. the urgency of your docs and the staffing issues on the facility. it was just a bad combination altogether.

you did your best with what you know and that's what matters. surely, you did not come in to work that day with the thought you want to inflict harm on your patients. it will be a while before you get over this, but one thing i can promise you is: this will make you a better nurse. this incident will sharpen your intuition. i would be worried if you are not at all bothered by what happened.

there will be people here on this thread that will criticize you for what happened, rather than support you. but do not let that discourage you. do not quit. everyday is a chance for improvement. learn from the experience, read more on trach care and other things you feel that you need to learn more. but do not quit. the world needs more caring nurses like you. skills you can learn, but genuine compassion, you can't. i hope you get over this soon. i'm pulling for you! if you need to talk, feel free to msg me. i'm sending you warm wishes!

[sethula619]

I am not a nurse but a pre nurse if you will, these events will happen and even if you felt it was a direct cuase and event: I current work for telecommication company ready to do nurse ( change incareer ) in a business department and I deal with peoples lively hood!!! There are going to be incidents where sometime my suggestion isn't always the most reliable and can cause millions of dollars in damages I know what you mean In a different sense. My best advice is to learn from it and be more aware. Best wished and luck Seth

[leanne1980]

I feel for you. Please, don't give up. You do the best with what you have knowledge, training and support from the facility. There were other people far more familiar with this patient and their level of acuity on duty that day, so don't let it get you down. Hang in there!!

[suanna]

Let's see; trached, tube feed, O2, mentaly impaired, and a resident of a LTC facillity... I'm thinking this person may have had a few health problems that may have contributed to her demise. If you are going to work in LTC you are going to have patients die on you from time-to-time. If you could have sat in her room for your entire shift, done q5min assessments, convinced her attending doc to come in and hold her hand, odds are she still would have developed some airway secreations and gone into resp distress, and YES, still died. Could you have suctioned her?- maybe, and that could have thrown her into bronchospasm and killed her on the spot. One thing I've learned in 30 years of nursing- there isn't much I can change if a patient with multi-system problems decides to crump on my shift. I can try to correct the most pressing concerns I see, but very sick people are going to die, and I'm not going to stop them. Nursing is going to beat you up enough without you throwing punches at yourself. The "should I have, could I have, why didn't I " isn't going to do you or the patient any good. Next time- you could assess a little longer, suction if there is a doubt, and the patient will die anyway (or maybe on the next shift.), or they mignt get better for a few days- but if a long term sick patient is going belly-up nursing isn't going to change that fact 99 times out of a 100.

[CrazyGoonRN]

I started my nursing career in a rehab/subacute facility much like you describe, except I was on days with 20-22 patients to "care" for. I left after 3 months because it is unsafe, and got a job in home health. Now a little over a year later I'm working on a medical-surgical unit in a hospital, and there is SO MUCH MORE support in the hospital than in rehab. It's dangerous in rehab. You did not cause that patient's death. The entire rehab "system" contributed to the death of that patient because it is very disturbing and unsafe as these patients are d/c way too soon in some cases from the hospital to you. And that patient, in all honesty, was just being kept alive it seems. She was ready to go.

Don't blame yourself. Try to get into home health or some other area of nursing. Rehab sucks. And work on the BSN. Nurses who haven't worked rehab don't understand how dangerous and ridiculous it is there. And those blaming you are being ridiculous as well.

This is very very true. I have worked Rehab/LTC for 3 years as an LPN (only nursing job I've had). I have been PRN with full time hours for the majority of the time and worked mostly on the Rehab floor. On the rehab floor during the day 1 nurse has 24 patients and at night 32 patients. These patients are very sick! I have stayed up to 3 hours past the end of my shift to complete my documentation, because during my shift I never had a break to even sit and chart. These patients come here directly from the hospital and require a lot of care. For those who have never had this many patients: Imagine having 24 patients on day shift and having to pass am meds. These patients are leaving the floor for PT, OT and activities constantly. Each patient usually has 10-15 meds scheduled. This is usually because the in house NP puts them on a ton of vitamins when they first arrive at the facility. Can you imagine only having 3 hours to complete the AM med pass for all 24 of these patients, with all the running around you are doing just to find them? I still after 3 years rarely finish my med pass on time. When I do finish on time its because we have a lot of empty beds (fewer patients). I've worked a lot of day shift and a lot of night shift. On night shift it's a whole different story. There are a lot less meds but more patients and more tasks to complete. Night shift is required to have more patients, check all daily orders for their patients to make sure they are correct, check the glucometers, do wound care treatments on all our patients (during the day we have a wound care team that does it), resp assessments on all patients (we don't routienly do full head to toe assessments), change tubing out for all patients that have O2, neb treatments, and tube feedings, usually have several patients who have IV's or PICC's also recieving antibiotics throughout the night, there are always additional steps for things like insulin adminstration or NS flushes b/c we don't have prefilled NS syringes or the insulin pen's (we have to draw it up), night shift also get's the job of d/c'ing foleys if needed, etc.... I could go on and on...

Basically, it is assumed that night shift has more time to complete tasks, but in reality we do not because there are so many additional tasks that individually don't take that long but together take up a lot of time. I have been increadly busy and not been able to give the level of care that the patients deserve. I believe the entire Rehab/LTC system is flawed and I don't know what can be done about it. I am so thankful that I took my NCLEX-RN yesterday (I got the good pop up). I want to move on to a hospital position so incredibly bad. I can't wait to say to Rehab/LTC...

OP we have all made mistakes or given care that is less than what we should have done (even if we deny it or never realized we did it). This does not make you a bad nurse. You did not cause this death. You did intervene and after called the MD. The MD knew the condidtion of the patient and did not do anything but tell you to monitor the patient. You did what you were ordered to do by the Physician who is supposed to know more than you do. Please take care of yourself and do not blame yourself. The better you take care of yourself the better you will be able to take care of your patients in the future.

[akevin]

Don't feel sorry for yourself. I feel how you feel. Cuz me myself is currently working on a sub acute facility. I am an RN who just got her license for nclex RN june2013. I ended up working on this sub acute facility cuz of being tired of passing of resume all over new york but still getting no response from any of the hospital i was applying for. I am the charge nurse of a whole unit floor consisting of 87 residents. And mixed of mentally ill residents, VERY confused residents, trach, picc and iv residents, hospice who are very weak residents, and these alcohol and drug abusive residents. Actually 60% of them are mentally and demented residents. Being a charge nurse , u know what' really tiring and stressing event? Are the daily routine of my 8hrs shift that always ended up 10-11hrs shift cuz load of work are too unbearable to finish. 8-10Monthly's that needs to be done, all doctors orders and specialized ASAP orders, wound care, 5-6 confused residents trying to gate crush the fire exit, residents who wants their pain meds to inc even tho they're not in pain, cna's that were screaming to each other bec they hate theyir assgnments, lpn who doesnt want to accept delegation of assgn, residents who fights and make trouble to other residents and sudden emergency situation like full code, missing medications(narcotic), , un ending computer deadline and a lot more! Think of it for a daily routine and you will realize how to be a nurse on a sub acute facility. And adding the fact thatu are not paid for the extra hrs that u are giving for the management, and the no break as in just candy and water. U will know how hard to be a nurse on a sub acute facility.. Me my self. I Salute all the nurses who works on a sub acute facility. But i don't want to be stuck here, cuz i know i will learn to think more critically and expose to more critical pt. when i get a hosp. Job.