New nurse guilt

FinallyNP · Jun 6, 2019

Aw i’m so sorry to hear your story. We all have stories like this. I think things like this can be very traumatic. I had a similar situation happen to me, I work in ICU and had a post op patient who was really just supposed to be there so she could have a private room after a bowel surgery. She and I laughed, joked all morning. I put her on the bedpan, came back a few mins later and she was slurring her speech. We called a code stroke, etc. long story short she started crashing fast, we intubated her, started drips, etc but she ended up dying later that day. Apparently her bowel perforated and she went super septic and that caused her to crash. I was so traumatized every time I got a post op patient after that. It still bothers me to think about that lady.

I say this to say there’s nothing you did to cause him to have a PE. but I can identify with how losing a patient can really stick with you and make you question yourself. I think talking to other nurse friends helps, my coworkers all shared their stories of patients they lost that stuck with them and it helped me feel better. I personally think as nurses we should go to therapy because we see so much.

Hope you feel better ❤️

Davey Do · Jun 6, 2019

8 hours ago, PsychRN_2018 said:
What is your advice?

Not to beat yourself up over this situation, PsychRN.

I know I know I know... Shoulda coulda woulda....

You started your narrative off with "should do a year of medical" as if you could have and would have been able to save this patient's life.

Know this: We all do the best job we can at any time given the circumstances, we could all have done a better job after the fact, and hindsight is 20/20.

As FinallyNP said, "We all have stories like this". For example, one story that comes to mind was just last year on the geriatric psych unit, I called a rapid response when a code blue was necessary. When I left the room, with another RN with the patient, the patient was breathing. By the time I got to the nurses station the patient had gone into arrest.

I immediately called a code blue, everything went pretty much as it should have, but the patient died.

As I did and you did, Psych RN, we all do the best job we can at any time given the circumstances.

The very best to you.

beekee · Jun 6, 2019

I remember with much guilt one particular case as well. I’ve had other patients go south, but my first has stuck with me hard over the years. Intellectually, I know I didn’t cause the patient’s demise, but I still can’t shake it. Hugs to you. It’s hard when things like this occur.

However, I have a slightly different take on it. You have started to develop that “spidey sense” that tells you something is wrong. You knew something was off and you kept advocating for him, even when the MD scoffed at you. That’s what nursing is all about and you did it well. Continue to trust yourself when things don’t seem right.

I hope you are able to find some peace. From my perspective, you are an excellent nurse and did well in this difficult situation.

allnurses Guide · Jun 6, 2019

This is from a physician perspective, but the concept of secondary victims is still the same for all of us.

Your error was one event in a series in which it sounds like you did everything right. You are a human being. You did not intend harm and you didn't cause this gentleman's demise. Far from. You were absolutely aware, present and assessing him at all times. I hope you find peace about this. I see a lot in your story actually that you should be proud of, not ashamed of.

JKL33 · Jun 6, 2019

It's good that you had the benefit of a debriefing (too bad it wasn't promptly offered) and that you were able to learn the outcome of the case.

We can't prevent everything and sometimes (maybe often) even if things had been done differently the ultimate outcome would be the same. Did you cause this patient's demise? NO. That said, there are some nursing process things that could have gone differently here based on the information given. Since I would guess nearly every nurse has had, as part of their story of professional growth, a situation that has caused them to do something fundamentally different in the future, the wise and healthy thing to do is just critically evaluate our own actions (with help if necessary or appropriate) and then move forward.

By debriefing I'm not sure if you mean emotional support and a chance to talk about and process the code and the events leading up to it, or a review of actions to uncover opportunities for improvement - which is most what "debriefing" has come to mean these days. I hope you were given the benefit of both of these types of debriefings and if not I would seek them out.

Everything is okay. ??

NightNerd, MSN, RN · Jun 6, 2019

20 hours ago, PsychRN_2018 said:
Hello everyone. I just need some advice. I graduated last May and went straight into Psych as that is my passion. I contemplated if I should do a year of medical for experience but decided otherwise. Long story short I recently had my first code and it was horrible. Through my residency, nursing school, and career I have been, what I thought then, lucky. Since November I have been assigned charge nurse on this unit. This day was as every other. Charge nurse on this unit and another nurse split between my unit and the other unit across the hall. So my patient was voicing complaints that he did not feel good all morning. I could tell something was off. He was an older man with multiple issues, copd, a fib, etc. He told me she couldn’t breathe and wanted to rest, and I let him. I went to administer his afternoon calcium channel blocker but looked at recent vitals. His bp had been elevated for the past few shifts. When I went to his room, the patient still stated he was not feeling well. So I told him I had his immediate release calcium channel blocker and this could make him feel better but I would call the doctor. So I handed him the medication cup as I was taking his blood pressure. I have never given a medication like that without checking the bp first, but for some reason this time I didn’t. This is when panic sat it. The blood pressure reading come up and my stomach sank. It said 70/40. Now, I knew this wasn’t right. We have had multiple issues with this machine. I retrieved a manual blood pressure cuff and took it. I was so overcome with anxiety I could not focus. So I retook the blood pressure and again got the same thing, 110/65. Can I say that with 100% confidence, no because I was scared and anxious at that time. After taking the reading, My anxiety lessened. I still sensed something wasn’t right. So I watched my patient over the next 30-45 minutes closely as he ate lunch. We rechecked his blood pressure and it was 90/60. Still unsure I called the physician. I relayed all of his symptoms and his vital signs. He ordered a workup for this patient and came to se him a few hours later. The patient denied everything to him and stated he wanted to rest. A few hrs pass and vitals are being completed. My aides convey they can not obtain a temperature so they did a rectal one. 97.5, bp 110/75, 78 hr. I called the physician. He seemed annoyed but stated he wanted him moved to a more specialized floor so he could monitor him. I did everything I could to get him off the floor quickly but everyone else did not. 1 hour later the aids are checking the patients and yells he just went unresponsive. His vitals plummeted, weak and thready pulse, oxygen in 70’s. I immediately called for help and to transfer patient to emergency room. He died a week later.
I don’t know if it is because this was my first time handling an event like this or what but I convinced myself that calcium channel blocker I gave did this. That somehow that obscure blood pressure was right and mine was wrong. I went through a few weeks of hell until finally I went to turn in my badge. It was then I was debriefed. The doctor said it was a pulmonary embolism. Even though I have had multiple people tell me this wasn’t my fault, I don’t know if I just feel ashamed because I knew better than to give that medication before taking vitals or if this is the trauma of the whole situation. I think about this everyday and reassure myself everyone makes mistakes, but just keep beating myself up.
What is your advice?

My advice: be kind to yourself, do whatever makes you happy to be alive today, and spend time around supportive people. It is common to feel this way after your first (few) emergencies like this. It sounds like you did an admirable job of assessing and advocating for your patient; this was not your fault. I repeat: this was not your fault. Now you keep saying it to yourself.

You will learn something from every situation, even ones with sad outcomes like this one. In this case, it's clearly made quite the impression on you to verify BP before giving a calcium channel blocker. That's a good thing to do going forward - still wouldn't have changed the outcome here, but it's a good thing to put into practice nonetheless. Now, focusing on everything you did right is also very important. You kept reassessing your patient. You didn't rely on automatic equipment known to be faulty and got your own BP rating. You kept updating the doctor and advocating for your patient, even when you sensed some annoyance. You did the best you could for your patient, and you did the right thing. Remember that. You did the right thing.

This is a sad situation and I feel for you. I'm sorry that you keep reliving this; no doubt that's making it harder to move on. Please talk to your employer and see if there is an EAP you can utilize, or talk to your own counselor if you have one. If your employer can offer any further debriefing, I encourage you to pursue that. Talk with nurses you are close to; they will get it and may help you process some of what happened. And celebrate any victories you have at work. It sounds like you are caring and conscientious, and you must take care to recognize all the ways you are a good nurse - because you are.

Best of luck to you, PsychRN_2018.

allnurses Guide · Jun 7, 2019

I think most of us can relate to what you are going through right now, PsychRN_2018. I'm glad you didn't turn a few weeks of obsessing on this to months or longer obsessing on this before you recognized the need to talk to someone about it.

Your instincts and behavior indicate to me a high potential to be an excellent nurse. Best to you.

browneyes3000 · Jun 7, 2019

I agree with nursel56 that most of us can relate to what you are going through. You have to remember your patient "was an older man with multiple issues, copd, a fib, etc". Death is inevitable. It was his time to go so nothing you could do to change it. It was in God's hands.

Leader25, ASN, BSN, RN · Jun 9, 2019

In Psych you never know what is next .That is why we are against floating a nurse to any specialty area, from an unlike dept. I was floated and was trying to check the big list of meds,when the aide called me to check on a patient,she was lying across the bed,locked up her legs through the side rail openings,stuck there,coded,urine dripped out,being an ICU nurse [but not for adults,] I automatically reached for O2 and suction,then realized there was none,walls are blank here.Code team arrived,charge nurse disappeared,no nurse manager to be found, supv shows up shoves a clip board at me and tells me to run the code,I looked at it and nothing I recognized was on it,.I did the best I could ,handing syringes needles etc,wheeling huge O2 tank......

Eventually they took her to another floor for care. This Supv,[who did nothing herself to help] screams at me that I should have run the code.Later on I found out that the code cart was not up to par,and the nurse manager and charge nurse had to answer for that.

Too close for comfort....and they wonder why nurses leave.

Things happened ,never beat yourself over it,you are a nurse,not a martyr.

jiowa12 · Jun 9, 2019

I’m so sorry that that happened to you. I’ve only been a nurse for a short while but I have empathy for you. My second week on my own I was admitting a patient for what I got in report was a gi bleed. I work on a cardiac floor so all our patients are monitored. This was my first blood transfusion. I was with the patient for the first 15 minutes and everything appeared find. The patient was talking with his son and was close to the nurses station. The son leaves and patient decides to stand up to use the urinal. He was ambulatory at baseline. I see him stand up finish with the urinal I put him back in bed. He starts to say I don’t feel alright when he went asystole on the monitor. I coded the patient for an hour before going to icu. I learned a lot about myself and handling code situations after that. I was fortunate to have good debriefing. This will be a learning experience for you and I agree that you should take care of yourself.

StudentNurse_Sak · Jun 9, 2019

So sorry to hear this happened to you! I am currently a nursing student in the Nursing_ASN program and should be finishing the end of this year. I do sometimes fear how my first days will be as a nurse. Thank you for sharing your story!