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.
Sound advice in this thread. Don't beat yourself up & know you did your best, especially following up and keeping the doctor up to date on the patient's status change.
Don't ever stop caring, it's a necessity in healthcare and you have it covered. I was told when you stop caring, stop nursing. You got this.
I’m sorry this happened to you. You sound like a very compassionate person. Everyone is saying that you did everything you could, but the truth is when you’re patient said he couldn’t breathe, was tired, and needed to rest, he should have been assessed —- breath sounds, pulse ox, respirations, heart sounds, appearance, blood pressure and pulse. If he had a huge drop in BP he was decompensating, at this point the rapid assessment team could have been called. This is probably difficult to remember when the psych nurse, as you said, doesn’t care for this level of acuity often. You are not the first and you won’t be the last so forgive yourself. All of the nurses I’ve ever heard of make mistakes. You can still go on to be a wonderful nurse, but you have to forgive yourself first and remember that you truly cared for this patient.
I’m sorry this happened to you. You sound like a very compassionate person. Everyone is saying that you did everything you could, but the truth is when you’re patient said he couldn’t breathe, was tired, and needed to rest, he should have been assessed —- breath sounds, pulse ox, respirations, heart sounds, appearance, blood pressure and pulse. If he had a huge drop in BP he was decompensating, at this point the rapid assessment team could have been called. This is probably difficult to remember when the psych nurse, as you said, doesn’t care for this level of acuity often. You are not the first and you won’t be the last so forgive yourself. All of the nurses I’ve ever heard of make mistakes. You can still go on to be a wonderful nurse, but you have to forgive yourself first and remember that you truly cared for this patient.
OP also stated they did everything possible to get the patient transferred to a higher level of acuity but no one would support them in that decision. Maybe a call to the RRT team would have helped but OP sounded the alarm as best as they knew how considering they were also in a state of anxiety.
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.
I believe be confident and know no nurse is perfect all you can do is you’re very best job!
NurseBlaq
1,756 Posts
Sound advice in this thread. Don't beat yourself up & know you did your best, especially following up and keeping the doctor up to date on the patient's status change.
Don't ever stop caring, it's a necessity in healthcare and you have it covered. I was told when you stop caring, stop nursing. You got this.
Keep going, don't give up!