MET Calls Gone Bad

[Rachellynn11, ADN]

Hi everyone,

I just need a space to vent, there is only so much more I can to my friends, family and certain co-workers. First let me give you a little background info, I'm a new nurse, about a year now on a surgical unit. As all of you may know, inpatient in general is brutal right now. We are severely understaffed, lack supplies and have high patient ratios. I also truly feel I get dumped on. At first I caught myself feeling like all I did was complain when I'd have heavy assignments, but now with everything happening to me lately it's the truth. There is such politics on my floor, especially with the seasoned nurses who are in charge, they just pick and choose their assignments.

Anyways, being a post-op floor I deal with a lot. In this scenario, specifically talking about the Whipple procedure. Within 2 weeks I have had two patients die after my shift. I just mentally and emotionally can't deal with it. The first patient apparently developed aspiration pneumonia as a post-op complication. He sat on our floor just deteriorating until I took over and felt as though it should be escalated. I told the APRN who just said the pulmonologist was consulted and neb treatments were appropriate at this time, pretty much brushed it off. But they just weren't working. I even went up to the surgeon when he made rounds and said the patient doesn't look very good, never mind his lung sounds but his abdomen was definitely more distended, he disregarded it because he had a bowel movement. I still felt weird. It took the very last hour of my 12 hour shift for another PA to understand the urgency, a very long story short he ended up in ICU, the very next morning he died. 

Well now here we are two weeks later, I have another post Whipple patient, all is okay until the last hour of my shift when she projectile vomits blood clots. So bad I actually used a plastic spoon to fish them out to show the covering PA and MET team how serious this was. She ended up in the unit. Fast forward to this week, she became stable enough to come back to us after getting a hepatic artery pseudo-aneurysm angio. Again, last hour into my shift and I hear her calling out in pain, she's on the toilet with her abdominal midline dressing pouring out frank red blood, her bowel movement didn't have any blood though. When I got her back into bed, again projectiles so much blood and clots I am still traumatized. Her BP dropped and she was tachy. I immediately MET called her, at about 2230. This is where things just get stressful for me. The surgical PA came to assess her, I collected a STAT CBC but it came back WNL. The PA said it was probably because the body didn't catch up yet with the blood loss, and to recheck again in an hour. At this time all we were doing was giving her a bolus to help her BP, and I gave her some Morphine. The MET team left. Her abdominal incision surprisingly wasn't bleeding anymore, just putting out this tannish/pink mucous discharge. She was somewhat comfortable from the morphine, still tachy and her BP slightly improving at 118/72 with the bolus running. I was waiting to draw a repeat CBC at 2330. Not even a half hour after the MET team leaves, my charge nurse calls out after checking in on her and tells me to MET call again, she's in a fixated stare and not responsive. Another BP reads 88/50. The blood is sent. They order 2 units of blood. The blood bank calls and says there's no cross or type on file. I ask the team if they want the blood released as an emergency, they say no that they are transferring her to the unit and will do the cross and type there. I feel very, very uncomfortable about the lapse in time this patient didn't receive blood. I left my shift a little after midnight. I received a text in the middle of my sleep saying she went into cardiac arrest when they performed an open lap at bedside and found dozens of clots. 

The pressure, guilt and sadness I feel over is impossible to explain. I know I did all that I could do, and followed orders but something is just not sitting well with me. My manager did the best to make it seem like she cared about my well being this morning, but was very adamant about the time line. I documented all that I could in a note, the surgical PA's name and all, and what she instructed me to do. I just feel like I don't really have support from management.

Any words of advice would really help me right now xo

[JKL33]

I'm sorry. This does sound very stressful. It also sounds like you are trying to do your best for patients.

There's much that could be said...but I guess the most important thing is to remember that if you've reviewed your care (your assessments, your communications with others, your escalation of concerns, etc., etc.) and know you are doing what you can do, then the issue turns to acceptance of the fact that you aren't in control of everything, you can't do everything, you don't make all the decisions and you aren't to blame.

 

On 10/5/2021 at 9:27 PM, Rachellynn11 said:

My manager did the best to make it seem like she cared about my well being this morning, but was very adamant about the time line.

Meaning that she was faulting you for something to do with the timeline of this patient's deterioration?

If so, it comes down to whether you objectively overlooked things or didn't press issues enough if a provider seemed to under-react to your patient's need. You can review those things privately and carefully self-evaluate your performance. If you've spoken with a provider and their response seems to be inappropriate for the need you have expressed about your patient, be straightforward and request additional evaluation. Have good assessment data to give to them so that they understand the situation and your concern. Document your notifications and their orders and your interventions and the patient's response. Continue to re-assess your patient. Don't forget your CN and supervisor if you believe the providers are underestimating your patient's need. If I were really concerned about a patient and dissatisfied with the response I would escalate in any way I could think of, including calling other providers, etc.

Beyond all of that, you do deserve managerial support. Given the situation as it is right now, I would be inclined to look them straight in the eye and say, "I have done my best here and I deserve your support." If they are inappropriately blaming you, either outright or through suggestion, again, be straightforward: "The way you are speaking to me is not appropriate."

Let this settle...just take some time to relax if you can. Then consider revisiting it with your manager. Get feedback and respond. Make it clear that you expect only constructive criticism, not fanciful/imagined heroics that you supposedly should have been able to do. And make it clear that you expect support. In my opinion you have some leeway to take kind of a hard line. They are putting you in an impossible situation (lack of help and other resources) and you can make some "demands" of your own as long as you keep emotions in check and remain professional.

Sorry about all of this. Hang in there.