New nurse feeling guilty about first death

[midnighttokens]

I am a new nurse. I graduated in August and I just got off orientation 2 weeks ago. I never worked healthcare before this. I’ve been working med surg but I get mandated to our COVID unit a lot.

Last night, I had my first patient death in the COVID unit and I am feeling really guilty over it. My fellow nurses I was working with told me this is a normal feeling, but I can’t get over it.

We are really short staffed, no aides throughout the entire hospital, and I feel like I don’t get to spend a lot of time with my patients or provide adequate care, especially in the COVID unit. I guess that’s where most of my guilt comes from.

If I was just able to spend more time with them, do more, then maybe she wouldn’t have died.

She did stop eating and drinking and taking her meds and the doctor already informed the family that without IV fluids or an NG tube she would most likely die, but the family did not want any of that. I guess I just need reassurance from my fellow nurses that I won’t feel like this forever. 

[JKL33]

This feeling is a common phenomenon...I don't understand it exactly. Maybe there is something healthy that comes from going through the process of feeling guilty about death and then later feeling more accepting.

The guilt feelings we may have in these scenarios simply aren't very rational. There is a major disease process underway and in this case you are talking about, choices about treatment approach that have been made by patient/family to allow the expected trajectory (death) to occur.

One of the problems is that we have been taught certain duties and ethics-related things about our role as nurses but then immediately find ourselves in situations where things just aren't that clean. Everything we are involved in nothing more than an opportunity to do our best in very difficult situations--but we can't ever make sure that the best imaginable outcome is what happens (since that's impossible).

Everything is okay, and you are okay. You could not have changed this. Things have ended according to the wishes of the patient/family. I believe that if you think this through very open-mindedly, you will probably experience personal growth and a better understanding of yourself as both a person and a nurse.

Don't be afraid to talk to someone at your EAP (employee assistance program) if that might help you.

?

[Sour Lemon]

15 hours ago, midnighttokens said:

I am a new nurse. I graduated in August and I just got off orientation 2 weeks ago. I never worked healthcare before this. I’ve been working med surg but I get mandated to our COVID unit a lot. Last night I had my first patient death in the COVID unit and I am feeling really guilty over it. My fellow nurses I was working with told me this is a normal feeling, but I can’t get over it. We are really short staffed, no aides throughout the entire hospital, and I feel like I don’t get to spend a lot of time with my patients or provide adequate care, especially in the COVID unit. I guess that’s where most of my guilt comes from. If I was just able to spend more time with them, do more, then maybe she wouldn’t have died. She did stop eating and drinking and taking her meds and the doctor already informed the family that without IV fluids or an NG tube she would most likely die, but the family did not want any of that. I guess I just need reassurance from my fellow nurses that I won’t feel like this forever. 

I don't "get" the guilty feelings, either. In fact, I feel much worse preventing natural death in cases where there's little to no chance of recovery.

The family sounds caring, and so I would assume she had a good life and went on her own earlier-expressed terms.

[Anne Swepston, ASN, RN]

I believe that every situation is different.  I remember my 1st, and only death, after caring for the patient for 8 consecutive night-shifts, and then came in on my 9th night, and to my surprise the patient was still on the unit (as he was to have been discharged that morning).  I did my assessment and noticed multiple changes in condition, and responded to each of them, one by one.  By mid-shift the patient was transferred to the ICU, (I had not even passed meds to my other 4 patient's), then my patient had been sent to the ER, and a code was called, then another.  Then the House Supervisor appeared in front of me to ask if I was OK.  That's how I realized the patient had passed.  Til today, I still carry guilt about his passing.  I'm one who is usually told by other's that I'm doing too much, I document too much ... etc.  I can't help that part of who/what I am.  But perhaps, if I didn't do "so much" the patient might have been able to last long enough to get home and see his son face to face; which is what he was anticipating.  I think guilt is healthy to an extent, it show's you are human, compassionate, caring and not jaded like some.  However, there is probably a point when guilt becomes unhealthy, and hopefully, that's when your co-worker's can help you to resolve your guilt, before it becomes over-powering, and eats at you too much.  BE SAFE ?

 

[Corey Narry, MSN, RN, NP]

I feel like right now, we have to make a distinction between how the pandemic is affecting our abilities to provide a standard of care and how frustrating and guilt-inducing that can be for nurses. I'm talking about a unit so overwhelmed with patients that monitor alarms and call lights are no longer getting answered because we're only triaging those on the verge of dying because that's what you do in dire situations.  There are reports of such situations in most countries badly affected by COVID-19 including the US.

OP, hopefully, that's not your scenario.  Based on your account:

18 hours ago, midnighttokens said:

She did stop eating and drinking and taking her meds and the doctor already informed the family that without IV fluids or an NG tube she would most likely die, but the family did not want any of that.

Personally, I think that's a choice the patient and loved ones made and I personally would respect that.  I think we all have our own ideas of what quality of life is and some of us just don't think it's worth it to keep living under artificial means of sustenance.  COVID 19 can be life threatening especially to the high risk groups (ie, elderly) and many people who recover have debilitation conditions. I think your team made an excellent "goals of care" discussion with this family and the patient and they made their choice. It would be great if we as nurses who try to save lives could also be just as available to our patients in their death.  Hopefully, you feel better about this in time. 

[amoLucia]

Anne - welcome to AN. I usually make this speech to new members to recommend that they consider their changing screen names to something anonymous. Too many OTHER folk reads read this open site. Social media is not always friendly!

[Guest856929]

Before you devolve into preventable depression, you need to develop better coping mechanisms: mine is amnesia r/t things I cannot control.