Panic attacks following never event.

emmy27 · Jan 6, 2017

Remember, there is no reward for maximum stubbornness/sticking it out in a miserable position the longest. Also, enduring miserable working conditions is not a useful form of penance. You are not obligated to continue to work in a unit where you're mistrustful of your coworkers and believe they may be of you. There is nothing to prove.

Seconding everyone's recommendations to get some counseling, whether it's through EAP or an independent therapist. If something is affecting your sleep and your state of mind at work, it's not just making you miserable, it's potentially setting you up for other avoidable errors, which is the last thing either your patients or your mental health need.

SmilingBluEyes · Jan 6, 2017

Some years ago, my unit experienced a "never event" involving a labor and delivery situation. All staff involved were given a debriefing session and allowed to discuss what happened, how it happened and to "get things off their chest" about it. It was healthy and helped a lot. We were also offered EAP assistance if needed.

You are experiencing classic PTSD symptoms and certainly need professional help. If you do not want to use those resources offered where you work, do get them from somewhere. They won't resolve on their own.

Best wishes.

taivin · Jan 7, 2017

There is a list of "never events" listed on the CMS site. It's called a never event because it's never suppose to happen. If one of the events happens and the patient is harmed; the hospital must foot the bill for recovery from event. If you are a practicing nurse you should know what the never events are. Falls, UTI associated with a catheter, air embolism, any injury incurred at the hospital while patient admitted, advanced bed sores, etc...

It doesn't matter what unit or facility you work in...the never events apply to all staff in any facility. The NQF updated theirs in 2012 and CMS has their own parameters that are directed at healthcare staff. Educate yourself to protect yourself.

nutella, MSN, RN · Jan 7, 2017

OP - I am so sorry that it happened !

I agree that going to a mental health professional could be helpful.

But I also think that your reaction is sort of "normal" because as nurses, when things like that happen, we feel guilty and shamed. It is never our intention to hurt anybody but things can happen - because we are human. We make mistakes and can only hope that the outcome is not terrible. It is really not the question if we make a mistake - the question is when.

And I think that isolation makes it so much worse. In addition it seems that there could be judgement involved from other nurses - which makes the whole situation probably worse.

Only another nurse understands what a nurse goes through in their day to day work and how it impacts their life.

Of course your self-confidence got a hit as well and you have anxiety.

If you feel that you cannot trust your own judgment anymore - which could create huge anxiety - it is important to understand how the event happened. Most likely there were many factors that contributed. It is hard - self forgiveness is not that easy.

If you liked to work in critical care and still like your job but are mostly affected by anxiety that something else might happen, I would toughen it out longer. The fact that you are still working, still have the same job tells me that management judges you as a safe nurse that is capable of doing a good job - otherwise you would be gone from the job and the organization.

The only way to overcome that anxiety is to work and to reassure yourself that it is ok. Once your brain and emotions have "learned" that there is not a daily disaster and that it happened but that it is not happening all the time, your anxiety can get less.

LetLoveNReasonUnite · Jan 7, 2017

I would definitely recommend talking it out with an EAP and being gentle with yourself as you go through this healing process. If you are losing sleep and feel like your judgement is not as good as it once was, perhaps you should take some time off on sick leave (just for a little bit) while you reflect a bit more on what happened. The last thing you'd want to do is make a similar mistake. Does not sound like your current environment is very supportive. If you feel like you are being watched because they know you screwed up, you are much more likely to make a mistake.

Ruby Vee, BSN · Jan 7, 2017

I really need help. I am a nurse working in an intensive care unit with 9years nursing experience and approximately four months ago I was involved in a never event at work.
Since this I have done all the required reading, learning etc and had a couple of debriefs with management and everything seemed to be going fine. Yes I had lost my confidence but I was slowly starting to claw it back inch by inch by working hard and throwing myself into my studying.
Now however, things are not going so well again. I was on a study day where the event was discussed between colleagues (no names were mentioned) and my colleagues had some not very supportive things to say. This has made me paranoid that people know it was me and I am panicky at work and dont trust myself to do anything anymore as dont trust my judgement. I am also finding it hard to trust others as this never event included other people giving bad advice (unintentionally).
I am struggling with my work load, with my colleagues and with emergency situations that previously I would of been able to cope with. I am finding it difficult to sleep and keep waking up, having had nightmares about this situation.
I find it very difficult to work with the consultant that investigated the event and I recently had to spend the day on an out of hospital transfer with the doctor who was involved with the event and I desperately wanted to talk to him about it but couldnt bring it up (obviously this was once the patient had been transferred and we were alone in the back of the ambulance).
Any help at this point would be invaluable. I have a meeting with my manager in the next week and I dont want to blurt this all out to her as hate being seen as weak and not coping.
Sorry it has been such a long post. Please help me.

I had to look up "never event" on Wikipedia, and the list they gave contained more than a few mistakes or mishaps over which the nurse would have had very little control. I don't know what your event was, and it shouldn't be shared here anyway. I will share that I was involved in a sentinel event that happened over a decade ago and resulted from a cascade of communication failures that left me to be the one at the bedside when events came to a head. A very sad outcome for a young woman that could have been avoided by even ONE person communicating the pertinent fact. I went to M & M rounds, and names were not mentioned but clearly everyone knew that I was the nurse holding the bag. Sadly, I took some abuse even from nurses and providers whose timely communication could have prevented the event.

Sentinel events are almost never the result of ONE person making an error; it's usually a chain of errors, and at any point in the chain the event could have been avoided, averted or minimized. Even though that is true, it did little to alleviate the overwhelming guilt I felt (and still feel, right now, remembering). I had over twenty years of experience at the time; but the event eroded my confidence in myself and the confidence that my coworkers had in me. It took me a long time to get it back, but I was determined not to quit.

I experienced all of the feelings you describe and then some. I was suddenly overwhelmed at work, double, triple and quadruple checking even the most minor things which meant that I was always behind. I was sure my colleagues were all talking about me behind my back (they were -- some "kind friends" made sure I knew what they were saying) and I didn't believe that the physicians trusted me. (They didn't -- even though timely communication on the part of a physician or orders to actually address the issue would have prevented the sentinel event.) And because it was a communication failure, I didn't trust my colleagues, either. I had nightmares about the event over and over, and I'd wake up and lie, drenched in sweat and berating myself over and over for my part in the event.

What helped me: Journalling. If I woke and couldn't get back to sleep, I'd write about my feelings until I was exhausted and empty of words. (You have to be careful of journals -- if attorneys suspect there is one, they can subpoena it for a court case. I wrote and destroyed.)

Walking helped. I'd take a long, long walk after work until I could let it go enough to sleep. One night I walked 11 miles and had to call a friend to come and pick up my dogs because their pads were raw and they couldn't walk home. I wouldn't let her take ME home, because I wasn't done.

I found it difficult to work with others who were involved in the event and had the information I lacked that could have prevented the event. I didn't trust them. And it seemed that I was bearing the full brunt of everyone's failure . . . I'd castigated myself over and over for something that appeared to trouble them not at all. I was the one being gossiped about. What eventually helped was the meeting called by a CNS who investigated the event. Not everyone who should have been there was. But she laid out the facts, including the communication failures and her conclusion was that "Given the same information Ruby had, I would have done exactly what she did." The failure was in not passing along the particular information that everyone in the transferring unit had, and the accepting unit did not. No one actually came up and apologized to me, but attitudes began to soften.

Counseling may have helped, and I would recommend it to you. In my case, it wasn't as available as claimed. I worked nights, and the counselor could see me at 1 PM at the hospital (an hour drive each way from my home) after one night shift and before the next. Not at a more reasonable time, or a better day when I wouldn't have been between shifts. I never went.

Time helps, and perspective. Even if the mistake was yours and no one else's (and that is almost never the case), realize that you are human and humans make mistakes. It doesn't mean you're dumb or stupid or a bad person or even a bad nurse. It's just an inevitable part of life.

After this many years (15), I still think about the incident and mourn that young woman. But it's rare now. The anniversary of the event was recent, and I woke up in the middle of the night thinking about it. It took about a year for me to feel back to normal afterward, and probably two years for my colleagues to get over it. The old nurses still talk about it from time to time -- the ones who dislike me still blame me, but some of the others use it as a cautionary tale by pointing out how any one of a number of people could have prevented the event by communicating the appropriate information in a timely fashion. One particular NP was involved in another sentinel event under pretty much the same circumstances -- failing to communicate a piece of information and failing to write orders to address the issue and although she is still employed by the hospital, I notice that none of my colleagues seem to trust her.

You will get thought this. It's awful in every way, most especially for the patient who was harmed. I think we nurses sometimes work so hard to take care of the patient involved we fail to care for the colleague involved. You were harmed, just as your patient was. So give yourself some credit, some breathing space and some care. When you have enough posts, feel free to PM me.

benegesserit · Jan 7, 2017

Sentinel events are almost never the result of ONE person making an error; it's usually a chain of errors, and at any point in the chain the event could have been avoided, averted or minimized. Even though that is true, it did little to alleviate the overwhelming guilt I felt (and still feel, right now, remembering). I had over twenty years of experience at the time; but the event eroded my confidence in myself and the confidence that my coworkers had in me. It took me a long time to get it back, but I was determined not to quit.

Yes, we had an event at my facility - I was there that day, but it wasn't actually my patient. A co-worker took most of the fallout from the event, but I'm 100% sure the situation would have happened the exact same way if he'd been my patient, and I have no hesitation saying so to anyone who brings it up. And it does still come up in conversation about my facility, nearly 5 years later.

It was a systemic problem. While maybe some small amount of responsibility is actually on the nurse, it's definitely the tip of the iceberg.

Thorp71 · Jan 7, 2017

I would recommend that you seek help with EAP, and do not allow this to "box" you in. You can recover from this. This is coming from a nurse and family member who's father died in their own unit from a "never event". I was not on duty when my father died, but I too suffered from PTSD and most of this was from lack of support from management. Those who were involved never even offered their condolences.

LadysSolo · Jan 7, 2017

Ruby, thank you for saying what I was thinking to the OP - these are RARELY totally one person's fault. Usually it is a systems error, or there is more than one person involved but one person usually ends up feeling responsible. It may help to think of all the places that the cascade of events could have been stopped, had this or that happened, to lessen the self-blame. And I agree with counseling, to help put the event in perspective and help you to move on.

moldyoldyrn · Jan 7, 2017

Seek help and depending on the state you are in you may be able to claim against workers comp. It's called a stress claim and you have to prove the reaction you are experiencing is related to the incident. Sounds simple but can difficult to prove. Sort of has to be a "blam" this happened and now I have problems like sleep disturbance, PTSD-like responses, anxiety, depression, etc.. But get help at a minimum, there are many counselors and MDs who specialize in such things.

Boomer MS, RN · Jan 7, 2017

I had to look up "never event" on Wikipedia, and the list they gave contained more than a few mistakes or mishaps over which the nurse would have had very little control. I don't know what your event was, and it shouldn't be shared here anyway. I will share that I was involved in a sentinel event that happened over a decade ago and resulted from a cascade of communication failures that left me to be the one at the bedside when events came to a head. A very sad outcome for a young woman that could have been avoided by even ONE person communicating the pertinent fact. I went to M & M rounds, and names were not mentioned but clearly everyone knew that I was the nurse holding the bag. Sadly, I took some abuse even from nurses and providers whose timely communication could have prevented the event.
Sentinel events are almost never the result of ONE person making an error; it's usually a chain of errors, and at any point in the chain the event could have been avoided, averted or minimized. Even though that is true, it did little to alleviate the overwhelming guilt I felt (and still feel, right now, remembering). I had over twenty years of experience at the time; but the event eroded my confidence in myself and the confidence that my coworkers had in me. It took me a long time to get it back, but I was determined not to quit.
I experienced all of the feelings you describe and then some. I was suddenly overwhelmed at work, double, triple and quadruple checking even the most minor things which meant that I was always behind. I was sure my colleagues were all talking about me behind my back (they were -- some "kind friends" made sure I knew what they were saying) and I didn't believe that the physicians trusted me. (They didn't -- even though timely communication on the part of a physician or orders to actually address the issue would have prevented the sentinel event.) And because it was a communication failure, I didn't trust my colleagues, either. I had nightmares about the event over and over, and I'd wake up and lie, drenched in sweat and berating myself over and over for my part in the event.
What helped me: Journalling. If I woke and couldn't get back to sleep, I'd write about my feelings until I was exhausted and empty of words. (You have to be careful of journals -- if attorneys suspect there is one, they can subpoena it for a court case. I wrote and destroyed.)
Walking helped. I'd take a long, long walk after work until I could let it go enough to sleep. One night I walked 11 miles and had to call a friend to come and pick up my dogs because their pads were raw and they couldn't walk home. I wouldn't let her take ME home, because I wasn't done.
I found it difficult to work with others who were involved in the event and had the information I lacked that could have prevented the event. I didn't trust them. And it seemed that I was bearing the full brunt of everyone's failure . . . I'd castigated myself over and over for something that appeared to trouble them not at all. I was the one being gossiped about. What eventually helped was the meeting called by a CNS who investigated the event. Not everyone who should have been there was. But she laid out the facts, including the communication failures and her conclusion was that "Given the same information Ruby had, I would have done exactly what she did." The failure was in not passing along the particular information that everyone in the transferring unit had, and the accepting unit did not. No one actually came up and apologized to me, but attitudes began to soften.
Counseling may have helped, and I would recommend it to you. In my case, it wasn't as available as claimed. I worked nights, and the counselor could see me at 1 PM at the hospital (an hour drive each way from my home) after one night shift and before the next. Not at a more reasonable time, or a better day when I wouldn't have been between shifts. I never went.
Time helps, and perspective. Even if the mistake was yours and no one else's (and that is almost never the case), realize that you are human and humans make mistakes. It doesn't mean you're dumb or stupid or a bad person or even a bad nurse. It's just an inevitable part of life.
After this many years (15), I still think about the incident and mourn that young woman. But it's rare now. The anniversary of the event was recent, and I woke up in the middle of the night thinking about it. It took about a year for me to feel back to normal afterward, and probably two years for my colleagues to get over it. The old nurses still talk about it from time to time -- the ones who dislike me still blame me, but some of the others use it as a cautionary tale by pointing out how any one of a number of people could have prevented the event by communicating the appropriate information in a timely fashion. One particular NP was involved in another sentinel event under pretty much the same circumstances -- failing to communicate a piece of information and failing to write orders to address the issue and although she is still employed by the hospital, I notice that none of my colleagues seem to trust her.
You will get thought this. It's awful in every way, most especially for the patient who was harmed. I think we nurses sometimes work so hard to take care of the patient involved we fail to care for the colleague involved. You were harmed, just as your patient was. So give yourself some credit, some breathing space and some care. When you have enough posts, feel free to PM me.

Wow, Ruby. So many other comments and advice here have been poignant but yours especially. I suspect stories like yours will help her and others. It is truly fortunate that you were able to cope and survive the incident and remain in nursing. I hope the OP takes you up on your offer to PM you.

Tarnee · Jan 7, 2017

Hi there

thank you for your honesty.

it sounds like you are re-playing all aspects of the event in your mind like a movie? Watching it over and over & trying to see it from different angles - I do this too, in the search for answers &/or trying to see what I missed or what I could do to fix the situation.

I believe this is a healthy thing to do - but the problem is if you can't see or find any answers you keep looping the movie on re-play and it consumes your life in a negative way

Perhaps - ditch that tactic & where you see negative things - put your efforts into changing those situations to positive.

ie: when the girls are talking about a situation - either disengage - or join in? - offer solution based suggestions - or a group coffee catch up?

or

when you find yourself lacking confidence - remind yourself who you really are (a confident professional)

your right about blurting this to management...it's not a good idea - I'd suggest seeking an outside independent professional for advice if required.

offer solution based suggestions to engage discussions with management & keep emotions in check (you are a confident professional and that's how you roll)

If it's any comfort..In varying degrees, everyone on the planet experiences extremely bad things and really good things as well...what you choose to focus on, is your choice....

I hope this is helpful..

kind regards

tarn