Feeling pretty negligent and the size of an ant right now

Nurses Safety

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I'm even having a hard time right now typing this, as I know I have done wrong and will be the one to fully blame for the situation I am about to discuss. No words can describe how I feel at present.

I am casually employed at a facility where I work both LTC and acute. I was asked to work a few weeks ago in LTC. Having not been on the LTC side for 2 months, I had no knowledge of some of the changes made as well as the new resident. I made my best effort to read his Hx in his chart but only got tidbits of info as the day wore on. This fellow's family was in in the afternoon and were concerned that he had had another stroke. I did an assessment and he "appeared" to be good. I asked other staff about the resident and while it was not normal for him to be acting the way he was, he had been in the same state for the last week since becoming "ill". I told the family I would let the Dr. know when I could. The Dr. who was available that day was busy my whole shift in ER, and, also notoriously known for letting staff in LTC know that unless the resident is his own or is in a medical emergency, do not disturb him. I also had another resident with apparent fluid in the lungs so, I let the ER nurse know that I was leaving the chart for the one resident who needed to be looked ASAP and that I had another resident who needed an assessment as well. This Dr. did not come over after his break and the evening nurse who came on managed to get his attention after I had left. This same nurse was also made aware of the concerns of the other fellow's family and we discussed some of his Hx. The same thing was told me by the evening staff as day staff had said about him acting disorientated and different over the last week. He had been having diarrhea the past few days as well and we all thought he was sick. i though that the evening nurse would have asked the Dr to assess the resident when he came over as well.

Anyways, long story short, evening staff put the fellow on isolation as he had been experiencing diarrhea again. When i came out from report, he had gotten himself up and out to the diningroom alone. He was the same way he was the previous shift, only a little more fatigued and not responding to everything. He ate his breakfast, slowly and then staff took him to lay down after lunch time for a nap. I frequently checked on him, he repositioned himself, he would respond when I would talk to him with yes, no answers. I thought he was experiencing the same illness as what staff had been telling me. Did I get one of the RN's to come assess him-no. Did I let the Dr. in ER be aware of same-no. Why-I don't know, all I can think of is that I was listening to everyone elses opinions and story and didn't listen to myself.

I recieved a phone call about 9 days after the last shift saying I was being pulled in for a review with the residents own Dr. and there needed to be an explanation as to whhy a resident was found unresponsive on my shift. I had no idea this man was unresponsive!! He ended up in acute care , not sure when, why any of the details. I'm a disaster, a complete mess!! I would never have thought i would put anyone in danger. I feel as though I gave a lethal dose of a med by accident, and well I guess this could be in some comparison. My meeting is tomorrow and I was told that I could have my union rep with me.....well the union rep is also the nurse who worked the evening shifts that weekend as well.

Am I to blame? Yes. But there is a part of me who credits some of the blame to the other nurses who were aware of things happening with the resident and telling me not to worry as he had been acting like he was for over a week. I am to blame for listening to them, believing in them, trusting in them and not listening to my own gut instincts. I think this is where I exit out of my short career in nursing and find something else as this feeling of being a horrible cruel person is not what I ever thought would have happened....to me. That is totally not who I am or what many others would say about me, but now I guess I have to look at it as though I am an irresponsible and cruel individual. I am scared sh!tless of tomorrow, don't know what to expect and am so stressed that today I am sick. If anyone cares to give me advice, I would so greatly appreciate it. I need all I can to get through the next 2 days.

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First thing is you need to stop being so hard on yourself. I don't really see exactly where you made a mistake. A lot of people were more knowledgeable about the patient and were continuing along a certain assessment/intervention path, which may have been the incorrect path in this case, maybe not. But I'm not seeing how this is your fault.

It sounds like you walked into this situation right in the middle of everything, and were not getting adequate feedback on the patient situation, and were trying to make some important decisions in a vacuum, and were also looking for some backup from other staff, and for whatever reason they were kind of slow on the uptake.

Sometimes a patient will decline very slowly and as much as it pains me to say this, sometimes staff does not recognize when the decline has gone from a concern to be monitored to something that needs to be acted upon immediately. It happens.

I have seen on occasion that a new person will walk into an ongoing situation like that with new eyes and see things differently, and it sounds like that is what happened to you. But it also sounds like the people who really knew that patient history were on a certain course, probably not the best one, and there was not a whole lot you could have done about that....it sounds like you were doing everything you could.

I have a feeling that this meeting is more about what was going on with the dr. and possible other nursing staff, and the facility wants to clarify the specifics of the situation for no other reason than to have clarity.

My suggestion is that you sit down and make a list, bulleted or numbered, of everything that happened from start to finish so that you have a clear idea of your role in the situation. Do not think about should haves, or would haves or blame or fault. Focus on the specifics only.

And for what it's worth, I don't think you should give up on nursing. You have some really good assessment skills, it's the action on those skills that will come with time. Give yourself that time and you'll do well.

Big hugs.:hug:

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Thank you for your reply, mazy:)

I'm going to take your suggestion and make a list tonight that way I can prepare myself on my way to the meeting tomorrow so I won't "forget" under the pressure.

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Pheww! I can breathe now :) After the crappy week of waiting to find out why I was being investigated, found out it wasn't really about me. Never ever do I want to go through that again, and I really want to put out there for all the importance of documenting!!! CYA

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Can I ask what they were investigating/how it all turned out?

Glad it's worked out for you and you're feeling better, knowing it wasn't your fault :)

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Pheww! I can breathe now :) After the crappy week of waiting to find out why I was being investigated, found out it wasn't really about me. Never ever do I want to go through that again, and I really want to put out there for all the importance of documenting!!! CYA

Yay! I'm breathing easier on your behalf!

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Thanks.

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There was a complaint made by the family directed to the Dr's and the Dr's pointed their fingers back at another nurse and myself. Turns out we did what we were supposed to, so no fault of ours. It was kind of like a quality control invesigation so to speak! All I know is that I'm relieved. Thankfully I did my charting properly as well :)

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The only take away that I get from this is that even though you have discussed a patient with other personnel, you need to do your own assessment near the beginning of your shift so that you have a starting point that is your own starting point. From your post, you did this. You can not expect to use superhuman powers with each and every patient or resident, for each and every shift. You attempted to bring concerns to the attention of the doctor. You fulfilled your responsibilities. Just shows us that sometimes we have to be a little more assertive with our duties and, like you said, do our charting properly. Too bad you had to go through that period of worry but glad that it turned out in your favor.

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