New Nurse

Id this your first patent death? It sounds like it is, and I'm so sorry. Before reading further, please know based on what you wrote, this is not your fault!! {{hugs}}

So now to the CYB 101.

Just document everything! I hope you did at the time the on-call said not to mover the resident if she did not want to go, and then you documented the conversation with the resident and that she was A &O enough to make that decision. If not, you'll know to do that in the future.

And you cannot transport a patient from one facility to another without a doctors order, it's called dumping and it's illegal. So I would not beat yourself up saying you should have sent her anyway.

When ever there is a change in the patient...

get your VS,

do a focused assessment (in this case I would have looked at last BM, listened to make sure bowel sounds were positive and listen to lungs to make sure there was no aspiration and observed breathing for any difficulties.)

I would have called the on-call and presented the information and charted everything. The vomiting, the assessment, the phone call, what I relayed and MD's answer.

Then I would go back and speak with the patient and then document that conversation. If the patient was not competent to make a decisions I would have let the MD know and contacted the family to make the decision.

This is a time where timely charting can do a lot for you, because while you are charting things are routine still.... and it doesn't look like you are going back to try and cover up. That being said, you will not always do timely charting. And unfortunately the sicker your patients, the more likely that you will chart a few things, or take notes instead, and to chart later. So you go back and chart everything as soon as you can, and don't sweat, we do the best we can, they don't hand out crystal balls at nursing graduation, don't expect yourself to have foreseen this.

You ARE NOT a killer!! Don't get so inside of your head and feelings that you believe that, or believe that people are "looking at you" in that way.

I am going on 6 months of being a nurse. Today, I was taking care of a resident all was fine. I work a double shift so on my first shift the resident was fine walking around asking for coffee. On my second shift cna helped her lie down for a nap. Upon walking down the hallway to give someone medicine I notice that the resident had vomited on the bed. I went in to assess her I ask her if she is okay she said she doesn't feel good. I take her vital signs all within normal limits. I call doctor but get an oncall doctor. I tell her the vital signs. She says if the resident doesn't want to go to hospital take vital signs every 4 hours and push fluids. I keep doing rounds on her giving her water. On my 3rd hour take residents vital sign bp is low. I go get the head nurse she cant take bp. Resident pass away. Head nurse calls oncall doctor says she gave me orders to send her out. Head nurse tells me I did a good job don't worry about it.

Now I feel bad cause I just should have sent her out and I might lose my license and job. I feel so stupid. Everyone keeps looking at me like Im a killer.What should I do?

Right here, and moving forward until you retire, is where you double up on your documentation. If you have already, then you triple your documentation to cover yourself. As soon as you see anything changing from the baseline, pull out your pen, note the date and TIME of your observation, and keep following up until you report off to the next nurse.

Practice learning to be more assertive with your residents. Explain that you respect their wishes to decline transfers, but your observation is different from their usual behaviors (norms), and that you'd really like to make sure they're ok. If they still refuse, document this, notify the next of kin as they may be a little more persuasive. Document this as well.

As TheCommuter said, there's no need to worry about losing your license. Although you are expected to give the very best care possible, the vast majority of LTC residents will meet their expiration in the confines of those walls. In each case, as the nurse on duty, you will still feel some degree of guilt or responsibility, especially if death occurs within the midst of your shift. Just make sure your documentation captures the events of situation.

A side note: nobody's looking at you as a killer. That's the guilt feeling (paranoia) that usually accompanies the loss of someone entrusted in your care. My first experience happened in 2002. I'd been nursing for 16 years, was on duty for 15-20 minutes at a hospital when my 92-yr-old, full-code patient coded and died. (This was long before the days of bedside reporting). I was leaving out of another patient's room when I saw my colleagues rushing to his room. His death was clearly not my fault; but I was so distraught and inconsolable that the hospital supervisor instructed the charge nurse to send me home for a couple of days, giving me a warning (jokingly) that I had better be back by day #3.

Don't worry....just learn from this. And!!!! Be sure to eyeball each of your residents before accepting the shift. The last thing you want is to accept an assignment which already contains a deceased resident. FYI...