I'm so ashamed...

[ALMED]

I'm so ashamed, I can't sleep, eat or think of anything else. I'm a new RN, passed my boards in July and have been working nights since. I started that night on the wrong foot taking that room in the first place, B bed was my son-in-law's father, I'm not even sure the policy on taking people I know, I just knew he would be more comfortable with a familiar face. But that's not the problem, the gentleman in A bed was suffering from ETOH W/D, had a seizure that I witnessed near the end of my shift, and what did I do? nothing, tucked him in and left the room. That is so out of character for me (or so I thought). I was faced with a crisis, I did not know what to do, so instead of asking for help, I ignored it! My stomach is flipping thinking about it. Maybe hospital nursing isn't for me, maybe LTC is so I can send them to a hospital when thing happen. Maybe it's the shift, I am not myself at home either, not smiling, being grouchy. I just don't know. I do not trust myself right now. Any advice??

[UM Review RN, ASN, RN]

Yes.

This is nursing and no matter where your area is, you will be faced with situations that would try the wisdom of Solomon.

You will not always be the vision of competence, you will not always be able to keep your cool under pressure, your brain will not always be in "Intelligent" mode, you will make mistakes.

You've had how much orientation? How much preceptorship before going on your own?

You need to have a talk with your nurse manager. But more than being honest with her, you need to be honest with yourself. Part of learning to be a good nurse is to find your weak spots and strengthen them.

Ask yourself:

At the time that the patient had the seizure, did you recognize then that it was a seizure?

Did you know what to do for an ETOHer who is actively seizing? Did you have standing orders or would you have had to call the doctor and get orders?

Did you tell the oncoming nurse about the situation so that she could follow through?

Were you tired?

Are you feeling depressed since you graduated?

Are you feeling overwhelmed with the amount of work you have to do?

Is help available to you when you need it?

Is nursing what you thought it would be?

Answering these questions as honestly as possible (to yourself, not necessarily on this public board) can help you to determine exactly what went wrong on your end so that it won't happen again.

[nursemike, ASN, RN]

Thanks, Angie, for such good advice. As a new nurse, I am finding self-appraisal to be a real challenge. I know I have made some errors--mostly little stuff, but a few that are more troubling. I've also made decisions that weren't necessarily wrong, but that I'm not as confident about as I would like. At times, I've been pretty worried that I have gotten into something I'm not quite up to, but my peers, preceptors, and management have generally been very encouraging and supportive. Many of these are people I respect, so when they say I'm doing fine, I have to give their opinions some weight.

My evaluations have all been "meets expectations" for the various dimensions, but I haven't consistently met my own expectations. I reconcile these by assuming that my employer's expectations for a new nurse just aren't that high, and that my own may not be entirely realistic. Even so, I think it's important to keep striving toward excellence, even when mere competence seems like a difficult goal.

I like your systematic approach to analyzing situations that arise. I don't think "mistakes happen" is a good enough answer, true as it may be. One needs a way to think through a situation, decide just what when wrong, where, and how to avoid it in the future, and to do it without needlessly beating oneself up. We are human, and we are learning, and it ain't easy.

To the OP, I would only add that one of the most important skills I have developed as a new nurse is knowing when to call for help. It helps a little that I have been around to see experienced, skillful nurses needing some back-up from time to time. To think of an extreme example--have you ever seen a one-person code team? I have even seen a couple of instances where my strong back was able to help out a much more skillful nurse who lacked the physical strength to accomplish a task without help. It seems to me that ETOH withdrawl would easily qualify for the sort of emergency that requires teamwork.

As I read your post, it sounds like the patient in question wasn't even yours, so certainly calling the assigned nurse would have been a good place to start. Most of my charge nurses would also want to be involved. Rallying the troops would not only bring the needed expertise, it would afford you the chance to help out and observe, and start to develop your own expertise. And that would be true, even if it actually was your assigned patient.

The fact that you care enough to feel badly suggests that giving up may not be the answer. After feeling like hell over one of my most embarassing mistakes, I reached the conclusion that the only good that could come of it was that I would never make that particular mistake again. I now own that bit of knowledge in a way I probably wouldn't from just reading about it in a book.

[Tweety, BSN, RN]

First and foremost you should turn your attention to the patient. The MD needs to know the patient had withdrawals severe enough to have caused a seizure.

Come clean about the incident. Ask your manager what you should do now that the event has passed. Getting it off your chest will make you feel better.

When a patient has a seizure, there really isn't anything you can do but keep the patient safe during the event, which sounds like you did. But someone still needs to be notified.

Mature, honest and safe nurses make mistakes but are upfront, facing the consequences and learning from them.

This is lesson-learning time for you.

Don't beat yourself up, sounds like your depressed and may need to talk to your MD about it. New grads typically go through a roller coaster ride for a while. I know I did.

Good luck.

[KatieBell]

First thought is that you are either not adjusting to night shift, or you may be depressed.

A seizure is an emergency. You really can't just tuck someone in and leave the room- because it could increase in intensity, the patient could injure themselves, or not be able to manage secretions and their airway. And a person going through etoh withdrawal, may need medication to stop the seizure.

[Daytonite, BSN, RN]

I hope the patient is OK and suffered no ill effects from his seizure. I know I won't be popular and well-liked for saying this, but being ashamed hardly cuts it here. The bigger question is do you know what you should have done? Someone in alcohol withdrawal who has a seizure may not be receiving enough medication to prevent this from happening. The man was in the facility in the first place to be safe from the effects of DTs. What would it have taken to go get another nurse to ask for an opinion as to what was going on with that patient?

I suggest that you read up on alcohol detox and become a walking encyclopedia on it and what to do about seizures, how they are treated, what the seizures mean and why you want to prevent a seizure, in anybody. You need to review what to do when someone has a seizure and what to assess them for. You note the time, the length of time the seizure lasts, the activity that took place during the seizure and you attend that patient to make sure they don't injure themself during the seizure activity. They are also sometimes incontinent during or just after the seizure and sometimes they stop breathing and require supplemental oxygen.

Whether or not you decide to report this incident to your manager is your concern. I would start disciplinary action on someone upon hearing of this situation as I feel this is a serious failure of duty and an incredibly bad judgment call. I can understand fear that new grads have about reporting errors that they make, especially a big one like this, but I strongly suggest you hit your nursing textbooks and find out exactly what you should have done in this situation and vow to never let this happen again. Blaming this on the hours of the day a person works is a bogus excuse and does not demonstrate taking responsiblity for failure. In your entire post you mention no concern for how the patient subsequently fared; only concern for yourself. Very, very poor judgment was exercised here. I wouldn't trust you either. If you confess to this, your manager may not trust you anymore. There is a very heavy, very deserved weight on your shoulders right now. You dug your own hole. I hope you have learned a very hard lesson from this.

[UM Review RN, ASN, RN]

I hope the patient is OK and suffered no ill effects from his seizure. I know I won't be popular and well-liked for saying this, but being ashamed hardly cuts it here. The bigger question is do you know what you should have done? Someone in alcohol withdrawal who has a seizure may not be receiving enough medication to prevent this from happening. The man was in the facility in the first place to be safe from the effects of DTs. What would it have taken to go get another nurse to ask for an opinion as to what was going on with that patient?

I suggest that you read up on alcohol detox and become a walking encyclopedia on it and what to do about seizures, how they are treated, what the seizures mean and why you want to prevent a seizure, in anybody. You need to review what to do when someone has a seizure and what to assess them for. You note the time, the length of time the seizure lasts, the activity that took place during the seizure and you attend that patient to make sure they don't injure themself during the seizure activity. They are also sometimes incontinent during or just after the seizure and sometimes they stop breathing and require supplemental oxygen.

Whether or not you decide to report this incident to your manager is your concern. I would start disciplinary action on someone upon hearing of this situation as I feel this is a serious failure of duty and an incredibly bad judgment call. I can understand fear that new grads have about reporting errors that they make, especially a big one like this, but I strongly suggest you hit your nursing textbooks and find out exactly what you should have done in this situation and vow to never let this happen again. Blaming this on the hours of the day a person works is a bogus excuse and does not demonstrate taking responsiblity for failure. In your entire post you mention no concern for how the patient subsequently fared; only concern for yourself. Very, very poor judgment was exercised here. I wouldn't trust you either. If you confess to this, your manager may not trust you anymore. There is a very heavy, very deserved weight on your shoulders right now. You dug your own hole. I hope you have learned a very hard lesson from this.

She's beating herself up and then you come in and finish the job?

I've seen worse errors by new grads, students, and even seasoned nurses. Heck, I've seen docs make way worse mistakes and they're still in practice!

Her entire post reeks of guilt and shame.

The mistake that seems so obvious to us could've been made for a multitude of reasons--not excuses--not the least of which is exhaustion caused by understaffing, poor orientation, lack of preceptorship, inappropriate placement of patients, no standing ETOH protocol or orders... all potentially deadly when combined with her inexperience.

But we know all about those systems problems, don't we, since we discuss them every single day on this board. We've had entire threads on medical errors, errors that docs, nurses and patients make that can cost their lives.

I'm surprised, Daytonite, that you didn't read between the lines on this one. Did you notice that she said she graduated a scant four months before this? That she's fairly new to the board? That instead of being uncaring about the patient, she's possibly afraid of giving details? Did anyone who's answered notice the time and date of the post--way too late to call and try to correct the error, but not too late to fix what went wrong on her end?

You give some great advice--it is very important too, but toward the end of the post especially, you become very harsh with her. You're assuming that she needs to be reminded of the seriousness of the error, and you're assuming that she has not already talked to her manager or preceptor.

I choose to assume that the next seizure was witnessed also and that the patient was ultimately successfully treated

• because this nurse is a new grad,
  
• because this event happened at the end of the night shift
  
• because the day shift nurses are usually scrambling to see patients to get their meds out,
  
• because I've never heard of an ETOHer dying from his first seizure
  
• because ETOHers never have just one seizure.

[LoriAlabamaRN]

What concerns me, is what would have happened if it were more serious. If a seizing patient overwhelmed her to the point where she just left the room, what would she do if she found someone unresponsive? Would she call a code and run it, or leave the room, not tell anyone in report, and go home? She accepted a position where she has responsibility for the patients in her care, and what she did is inexcusable. It is one thing to have to seek help for a new situation, but quite another to leave a patient in a life-threatening situation WITH NO ASSISTANCE for the same reason. Would your sympathy be with this nurse if that patient was your father?

[UM Review RN, ASN, RN]

Here are some of the threads in which errors of various kinds are discussed:

https://allnurses.com/forums/f118/have-you-ever-written-up-yourself-an-incident-report-31687.html?highlight=errors

https://allnurses.com/forums/f8/med-errors-86200.html?highlight=errors

https://allnurses.com/forums/f8/worried-caught-med-error-but-only-cna-129450.html?highlight=errors

And there are many many more.

[UM Review RN, ASN, RN]

Would your sympathy be with this nurse if that patient was your father?

Lori, if you're addressing me, I understand and share your concern, but I'd bet that this nurse, faced with an emergent situation, will never do nothing again.

Yes, I can have sympathy for someone at the same time that I clearly see the error. But as I said in a previous post, that doesn't mean that we have to beat her up with it. She's new, for gawd's sake.

So in turn, I have to ask you:

If the person making the error was a doctor, would that doctor be beating himself up and forever punished by his peers?

[Tweety, BSN, RN]

She's beating herself up and then you come in and finish the job?

I've seen worse errors by new grads, students, and even seasoned nurses. Heck, I've seen docs make way worse mistakes and they're still in practice!

Her entire post reeks of guilt and shame.

I agree we need to help the OP get out of the guilt and shame without adding on it.

But it's not just a simple error. It's a refusal to act in a potentially dangerous situation. This act needs to be admitted to the manager and the MD and the music faced, in addition to getting help for whatever lead up to this action.

It was a blantant, potentially dangerous act by a potentially unsafe nurse. No need to sugar coat it.

This nurse obviously needs no more guilt and shame heaped upon him/her and needs help.

[UM Review RN, ASN, RN]

This act needs to be admitted to the manager and the MD and the music faced, in addition to getting help for whatever lead up to this action.

I just don't want any misunderstanding here. I said that in my first post. However, your response was clearer, Tweety. Thank you.