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??

[nursemike, ASN, RN]

Last night I covered an LPN who had a patient seizing due to ETOH withdrawl. Our floor has an epilepsy monitoring unit, so seizures aren't new to most of us, but I couldn't help remembering this thread. Luckily, the LPN was a pretty experienced nurse, which took a lot of the pressure off. Also very comforting, by the time the first IV push of Ativan hadn't done anything, we had a crowd (Charge Nurse, another RN, the LPN, and me.)

Would I have known what to do if I had been this patient's primary nurse? For sure I would after reading this thread. Thanks, Almed. BTW, the patient went to the ICU, where last I heard they were still having trouble getting him controlled, though I'm confident they did before long. Pretty scary stuff, though--I've never seen withdrawl that severe, before.

One of the lessons I've picked up, lately, is when I feel the adrenaline starting to rise and the first hint of panic about to set in, to just stop for a second and take a couple of deep breaths. Will I remember this, the first time I find a patient cyanotic and unresponsive? I don't know, but in the abstract it makes all kinds of sense that both the patient and I will be in trouble if at least one of us isn't breathing.

[UM Review RN, ASN, RN]

Last night I covered an LPN who had a patient seizing due to ETOH withdrawl. Our floor has an epilepsy monitoring unit, so seizures aren't new to most of us, but I couldn't help remembering this thread. Luckily, the LPN was a pretty experienced nurse, which took a lot of the pressure off. Also very comforting, by the time the first IV push of Ativan hadn't done anything, we had a crowd (Charge Nurse, another RN, the LPN, and me.)

Would I have known what to do if I had been this patient's primary nurse? For sure I would after reading this thread. Thanks, Almed. BTW, the patient went to the ICU, where last I heard they were still having trouble getting him controlled, though I'm confident they did before long. Pretty scary stuff, though--I've never seen withdrawl that severe, before.

One of the lessons I've picked up, lately, is when I feel the adrenaline starting to rise and the first hint of panic about to set in, to just stop for a second and take a couple of deep breaths. Will I remember this, the first time I find a patient cyanotic and unresponsive? I don't know, but in the abstract it makes all kinds of sense that both the patient and I will be in trouble if at least one of us isn't breathing.

This is a handy assessment tool (and education on how to use it linked below) to get the appropriate help for those in ETOH withdrawal. It saved me from having one patient go into seizures because I was able to identify the tremor, the irritability, and the slight confusion early enough to get him sent to the ICU and medicated appropriately there:

http://www.chce.research.med.va.gov/chce/presentations/PAWS/content/4CIWAAr1.htm

[neneRN, BSN, RN]

Hi. I just learned about this site today, in school, and thought I'd check it out. Some of your responses are pretty ruthless. It's hard for someone to talk about a mistake they've made. When they admit to it and ask for advice I think it's important to not totally rip them apart. I feel bad for her. I bet she never walks away from a situation like that again.

God forbid You (whoever was beating her up) ever make a mistake. If you haven't you are the first nurse to do so. It is important and she knows it. The way you were responding could make someone too scared to go and try. We all work very hard to get through school and to get our license. I was very excited about this site, but gee whiz. I thought nurses should help each other and teach other.

If you read over the threads on this board, you'll see an incredible amount of support to the nurses who are posting about mistakes they have made. We've all been there and we've all made mistakes; if you haven't made a mistake yet, you will at some point in your career. Honest mistakes happen and we learn from them.

The difference in this scenerio is that it was NOT a mistake; it was ignoring the pt, omission of care, even negligence, that could have caused harm because the OP was unwilling to ask for help. If she would have left the room and instead asked another nurse for help, then this would not have been an issue at all. To me, the OP was more concerned with looking capable than with her pt's health and that is not acceptable.

I always tell new grads and students that the scariest nurses are the ones who don't ask questions or ask for help. I would rather have someone ask me 100 questions than act like they know what they're doing when they don't and then risk harming the pt. We are there to help the pts, not to worry about looking new/inexperienced/stupid.

[skittlebear]

:yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat:

I don't think any of us want to shrug off Almed's error with an "oh, well, stuff happens." But I'm among those who doesn't think it needs to end a career. I didn't see any lack of concern for the patient in the original post. "I'm so ashamed" says it all. But it's natural enough, when one is in trouble, to speak mostly of one's own trouble.

You highlighted my remark about knowing where to turn for help, and I think that illustrates the system's error in Almed's situation. Every new nurse ought to know who to turn to--that should be made clear in orientation. Of course, one has the individual responsibility to recognize the need for help, but one needs to know one can, too.

It is true that owning one's mistakes is important. The reason it makes it a lot easier for supervisors to forgive is that you're a lot less likely to repeat an error that you haven't tried to minimize or excuse.

I have little doubt that Almed will make other mistakes in the future. We all will. Those of us who are conscientious will try really hard to avoid them, but also to learn from those we can't avoid.

God bless those experienced, skillful nurses who can still recall how it feels to be a deer caught in headlights. I'm lucky to work with a number of them. If every new nurse had similar mentors, I think we would have a much healthier profession.

[ImaERtraumaRN]

While I know that the OP said that she is ashamed about this behavior, I just can't get over the fact that she just "tucked him back in" and left the room. I am quite certain that this would equate to negligence in any courtroom when considering what a "safe and prudent nurse would do". In fact, I think it goes beyond a med error or other unsafe act because she was aware the pt. was seizing and did nothing. It could very well be seen as criminal if this pt had died from injury or aspiration. If it was my family member and they had lasting effects from this negligent behavior I would have pursued it with the BON and beyond.

That being said, what's done is done and now it's time to learn from the behavior, get to the root of what caused it to happen and move forward. Many new grad RNs "freeze" when faced with an emergent situation because even though they have learned about this very subject in school, they have never had to apply the skill in "real life". So, was the situation that she "froze", didnt know what to do, then was too embarrassed that she didnt know what to do that she didnt tell anyone else about the incident? I think it's plausable. Not an excuse, but plausable.

I think that additional preceptorship is a good choice, but I also think that seeking out other learning opportunities is in order. Seek out every code, seizure and uncommon event on your unit and ask to watch, do or evaluate. While you are still orienting, tell your coworkers to come get you when someone is going bad - and ask what signs/symptoms they noticed. If you have a rapid response team ask to round with them for a shift, or spend a shift in the ED watching trauma or resusitations. Spend a day with respiratory therapy and working with vented patients. My belief is that if you emmerse yourself in the situations you most fear, that soon they will become much more manageable.

[CrunchRN, ADN, RN]

I am curious. Did "Almed" the original poster ever come back and update this? I wonder what happened and if she was able to get past this and become more confident.

[Marie_LPN, RN, LPN, RN]

Most new people don't come back for a long time after getting a ripping, if they come back at all.

[indigo girl]

You know, I can't help but think that there are better ways to give useful advice. Daytonite, the first two paragraphs of your response was constructive. The "dug your own hole" was just devasting. Truly, I don't understand why you had a need to go there. Many of the other posts gave great advice, in particular the one who suggested following a code team, taking part in any and all emergency situations to learn what to do. I would suggest, that doing so also would help the new grad to learn how to handle the emotions that come up for the responders in any emergency.

I'm glad so much great advice, and support were offered, but it is disheartening, that there is such a need to castigate. Can't we do better than that? That is such an old, tired out model, and all it does is make people afraid. It does not make the nurse who acts that way a better role model.

[pricklypear]

You know, I can't help but think that there are better ways to give useful advice....

...I'm glad so much great advice, and support were offered, but it is disheartening, that there is such a need to castigate. Can't we do better than that? That is such an old, tired out model, and all it does is make people afraid. It does not make the nurse who acts that way a better role model.

Good post. It would be nice if we could avoid bashing people and concentrate on helping them get to the root of the problem and figure out how to correct it in the future. I don't think the OP came here making excuses for what happened, she just wanted some support - she was well aware of the gravity of the situation, and didn't need some of the comments that were posted.

[bahamabread]

first off..........to all of you who are being sooo negative to her............hindsight is 20/20 and we have all made mistakes.

however, this goes beyond a mistake. some nurses are not good with emergencies. i know we all think this is inappropriate.........but it's true. i have worked with the best nurses who are such hard workers...........peacemakers..........caring.........can do dressings better than you would believe............can give the best soap and water enema!!!!!!!!! but...........if a pt collapses............i can see the panic in their face and i know i need to just give orders to them because their brain clicks off. and if she is new...........this may add to her distress even more. she needs to evaluate why she really ignored the situation. she may gain confidence as she develpos her skills or she may be bad with emergencies and needs to let her supervisors know her feelings and fears and maybe another area will bring out her other skills that is soo needed in nursing. or she just needs time. but she cant do this again. even if she looks stupid she should call for help and say" please help me with this"

it really sounds to me like the fight or flight response. and she froze mentally.

all is not lost.

most of all she needs to pray and ask god to guide her everyday as she is doing his work and it's all in his hands...........and she should never forget that!!

[Indy, LPN, LVN]

Well, I'm not happy with the situation as it was reported by the OP, but that's done and over with, she's handled it and hopefully learning from it. I'll share my AHA moment in the spirit of helpfulness. The first emergency I had, I didn't know it was an emergency, and I didn't do the right thing fast enough. I had a patient vomiting harder than I ever dreamed possible, nearly coming off the bed (me and the trash can held him on it) with each retch, who was unresponsive between retches, and I didn't send him to Xray fast enough (because I thought he can't go while he's puking). Turns out he had a dissecting aorta, ascending and descending, and he had 9+ hours of surgery and sufferered a CVA in the middle of all of this, not sure when.

That was my first night off orientation. Now I know, they can puke while you drive the bed and if ER/Xray wants the patient back after they hand 'em to you, by god let 'em go quickly. Don't wait for transport, unplug that bed, grab another nurse and git going!

The second emergency I had, I had found myself making an effort to keep her responsive, was noting her color and temp, (gray and cold/clammy/wet) and suddenly she's gotta use the bedpan. So as I go flying out of the room to get one, my charge nurse pulls me aside to ask about her. She asks, "is she gonna be okay?" That was my AHA! moment. I realized what I'd been noticing added up to a crash, and looked at my charge nurse, said "no." She did a double take, said, "no?" I said, "no, she's not, need a bedpan" and got busy. From there it was a rapid response team call, and a whole lot of work that ate up the beginning of my shift. What I learned was that "are they gonna be okay" is really the bottom line. You can assess all you want but you have to consider what it's adding up to, and if you really don't know, then you have to ask until you do know. If your gut says something bad is happening, then that may just be your priority, unless you have multiple crashes going on.

Excuse the rambling. Just thought the OP might benefit from reading it.

[AngelsRN]

Good post. It would be nice if we could avoid bashing people and concentrate on helping them get to the root of the problem and figure out how to correct it in the future. I don't think the OP came here making excuses for what happened, she just wanted some support - she was well aware of the gravity of the situation, and didn't need some of the comments that were posted.

I agree --- everyone makes mistakes and I believe the original post, she was traumatized over the situation and we dont have the whole picture. I believe she was concerned about the patient, but unless she is going to write a book on this site, we are not going to have every detail. It is scary being a new grad, and some nurses forget how that first year can be. Experienced nurses should be supportive, educate and provide learning opportunities for new nurses, not set them up to fail and feel worse about the situation!