Patient Death - Caregiver Grief

[Caringhand333]

Hello, 

 I have been a nurse for 4 years but began travel nursing only about a year ago. I went to a hospital that I was way in over my head at but didn't realize until something horrible happened. It was a community hospital that had very few resources, was a trauma stepdown unit when I only had tele experience and the patient population was very demanding- not hesitating to scream at you to get your attention. I assumed that because I was approved for the assignment that I was suitable for it but looking back all these years later I was not. I remember I was being bullied by some of the nurses and the patients. Had a very hard time receiving any help, and was drawing all my own labs and doing my own vitals and patient care while taking care of patients that I was not used to caring down on an acuity level. Everyday going to that hospital was like drowning before you even set foot on the floor. I remember feeling like there was just no way to get everything done and I would just be scrambling. I had worked at several hospitals before this and never felt this way. I cant remember a lot from this day because it was so traumatizing to me. I am still receiving therapy for it years later. But I that day I just remember being pulled into a million directions and not getting a chance to even really look at my patients chart until they coded. He was walky talky and when he started to complain of abdominal pain I came over and did a focused assessment and noticed his abdomen was distended, medicated him for pain and called the MD but not long after he began to code and there was massive amounts of stool coming out of his mouth. I am assuming it was a bowl obstruction of some sorts. I cannot stop beating myself up for that day, not checking him and his orders in a timely manner. I didn't admit him and I am not even sure why he was there because I got so caught up in the millions of orders that I was trying to complete on time . I had never been so overwhelmed by screaming demanding patients, wound care orders that took a whole hour to do, millions of labs , vitals, meds all with no help that I think that I just lost sight of what was really important. I have tried talking to a therapist etc about it but they don't understand medicine so its hard. I know that most likely if he was that sick there was not that much that I could have done and that the whole team failed him likely. But for some reason I feel so guilty I have even contemplated suicide because I feel like such a failure- like I neglected my patients because he didn't have many meds and seemed fine---until he didn't. I already know I screwed up but if anyone has any kind words of advice it would be greatly appreciated. It's now like 6 years later and I think about it almost daily. 

SIncerely, 

nurse

[Been there,done that, ASN, RN]

"I cant remember a lot from this day because it was so traumatizing to me. I am still receiving therapy for it years later. "

You did what you were supposed to do. Medicated and notified of the change in condition. Instead of blaming yourself, ... blame the medical team. Any patient that ends up vomiting stool...would have had  obvious symptoms during a medical exam during a medical exam. They should have taken him to surgery STAT.

It was THEM not you. Let it go.

[HiddenAngels]

YEs do not beat yourself up over this.  Unfortunately, this is a typical day for a lot of us.  I feel you.  Yes that most def sounds like some sort of obstruction and he should have been scanned.  You did what you could, you assessed him, made the doc aware and everybody's bodies are different.  This could totally have been something else and you probably wouldn't even have posted, but it was and it's okay to vent.  That's the thing with nursing -  We are trained to stay astute in a room full of crazy, and you did.  We are not machines (virtual hug)

Even though you're a traveler if you ever feel unsafe, express your concerns to your agent and also the manager of that dept.  As a last resort, I would have broken that contract.  Make sure you're always signed with 2 or 3 agencies.

Don't ever let anything jeopardize your license.  You've worked too hard for it.   

[NursesRus]

Thank you so much the both you you have no idea how much better I feel with kind nurses perspectives. I know I’m the future if I ever feel that overwhelmed again that I will def not be staying at that job. I’m so grateful to you both angels. 

[RNperdiem, RN]

You assessed, medicated and called the doctor. You did what a good nurse should do. You did not ignore his distress even though you were being pulled in a million directions, and it could have been easy to dismiss. Nurses who have worked these kind of places understand this.

The nurse isn't the only healthcare provider. Did the doctors miss something? Were they checking the labs, vital signs and radiology readings? 

I am glad to hear you are in therapy, and hopefully making progress. I hope working in an environment like that assignment you had taught you to never work in a place like that ever again.

[JBMmom, MSN, NP]

I'm sorry to hear that this has weighed upon you for so many years. As others have said, you can't put the responsibility for this tragic outcome solely on yourself. You were unfortunately put into a situation for which you weren't prepared and you were doing your best. Perhaps if you had been able to advocate more strongly that you weren't clinically prepared for this assignment you wouldn't have gone through this, but the patient just would have ended up dying with another nurse. Vomiting feces is a sign that something has gone very wrong and had probably been ongoing long before your shift started. You did what you could, assessed and notified, and unfortunately things didn't end well. Be kind to yourself, you've carried this too long, try to move on and let it go if you can. Take care. 

[Jenni Binford]

Hi,

I feel your heartache, I had a similar experience, but it was a little old lady, very sweet, who was admitted with abdominal pain. I remember it like it was yesterday. Luckily, she was admitted to a GI Doc, and he ordered an NG tube when I called him about the pain and vomiting. 

When you get feces back and you fill the canister it's pretty horrendous. She did end up coding and quickly passed. I wasn't in the same scenario with the crazy patient load and not having adequate support, that was your problem right there. It was not your fault; you did all you could do to try and keep up. That was a no-win situation, and you learned to not work in that environment. When we Nurses are working on a unit where we can't give adequate care (never mind striving for exceptional) but adequate, we know it could blow up at any time, the stress that causes doen't quit when we clock out and go home. Knowing you have to return soon is a dark cloud over your time home, there's little rest in anticipation of returning to the same overwhelming problem. This not only affects our ability to do our job, but it is also very detrimental to our own health. 

I finally quit (retired) after almost 30 years at the same hospital. My last 12-hour shift, I got one 20-minute break. There are a lot of reasons that occurred, none of them being a good work environment with sufficient nurse support. Enough was enough, I had to take care of me. 

I am now working as a freelance healthcare writer and am loving my nursing job! Wishing you all the best,

Take care of yourself and have grace for yourself!

[vintagegal, BSN, DNP, RN, NP]

Umm bowel obstruction doesn’t happen in a few minutes, who was checking to see if he was having any BMs? Charted bowel sounds? Relaying changes to physician? No the hospital and the other nurses failed this client- looks like you were the only one who did an assessment on him.

[Nurse Beth, MSN]

I hope you will take all this good advice to heart. Acknowledge that you did the best you could under the circumstances.

Forgive yourself.

If you still feel suicidal, please get professional help.