Patient died...

netglow, ASN, RN · Feb 4, 2012

Now, now. Don't get in a fluster!! People go into the hospital because they are sick. Many die. Sure you know that, but have you had time to realize it? Probably not. One minute fine, the next not so fine.

Yes, it is normal for you to ask about your patient. Ask your instructor if she could help you to find out. Time has passed and the chart is now closed most likely and it would not be legal for you to hunt on the EMR for your patient. Your instructor can talk to the NM who will know what happened for learning purposes.

But try to stop worrying. It was not you.

Edited to add: This is not, how can I explain, "concerning" to her, and unless something stunning had happened while the patient was in your care, she will not have concerns. As your instructor, she is in communication with your RN for the day, and is able to review your documentation of care you gave that very day before she leaves. However she might forget that you might be worried and need some information - it is part of learning.

nurseprnRN, BSN, RN · Feb 4, 2012

dear, his time had come. sats in the 60s aren't compatible with life for long. he was in the care of others a whole lot more experienced than you for a whole lot more time, too. it didn't have anything to do c you at all. please don't make yourself crazy over thinking it was. believe me, if you had been doing anything inappropriate, someone would have picked it up right fast.

one of the biggest problems the medical model of care has, in my opinion, is that death is always treated as a horrible outcome or failure on someone's part. it (mostly) isn't, especially in someone like you describe.

death is a part of life. the dying process is not fast, except for trauma or exceptional cases-- most people die for about 6 months. this man had been dying for long before you saw him. i know it's hard for you to think about that. that's because, in my opinion, our culture also hides death so well, or distorts it so well in the movies and tv, that young people don't know what it's all about. in the movies, it's over in seconds, cue the violins. if you haven't already had it assigned, go on to amazon or someplace and find yourself a copy of kubler-ross's on death and dying. i had it assigned to me as a sophomore student and it transformed my life.

hundreds of years ago, and sometimes maybe not even that long, when grandma had her stroke, or uncle got kicked in the head by a mule, or developed symptoms of advanced malignancy, they were put in the warm room behind the fireplace and tended until they died; everyone, including the children, came to see them; everyone attended the wake in the front room and funeral and went to the churchyard for the burial. and mourned, and then life went on. older students who have lost parents and grandparents have a better understanding of this than most younger ones, many of whom may not have even lost a grandparent yet.

rest easy tonight. your patient is no longer suffering.

prmenrs, RN · Feb 4, 2012

"...A very happy man in his late 80's. He was in the hospital for Poss. pneumonia, SOB and had an extensive history for CHF, pulmonary hypertension, diabetes etc. "

You have my sincere condolences and prayers. You have experienced your first pt. death. Always an unsettling experience, but one which we all must traverse, and most of us have some of the same feelings you are going through right now.

I sincerely doubt that anything you did or did not do was a factor in his death. The reality of hospitals is that people do die. Men in their late 80's w/the medical history you describe die. I'm not trying to be hard-hearted or mean, it's just a fact of life.

Don't quit nursing! You obviously care a lot about what you are doing and are conscientously trying to do your best. You are shocked and grieved by this man's death. Acknowledge how you feel, and DEFINITELY talk to your instructor about it. This is a "teachable moment" for you and your class. Now is the time to talk about death, dying, and the very difficult emotions that come along w/that life passage.

If you haven't studying stages of grieving, do so now, it will help you cope. If you are religious, say a few prayers for the man and his family. Write about how you feel, how this affects you. But you do need to go on--tests and papers await!

No matter how many times a nurse cares for a pt who dies, or even works on a floor where a pt dies, we all usually feel momentarily bereft. We all a reminded of our own mortality. We don't have the luxury of really expressing our sadness--there are other pts who need care, and we must "carry on". It's ok to feel sad, it's ok to shed a tear in front of the family, esp. if you've been very involved w/his/her care for a long time. If another nurse's pt dies, help w/after care, and support that nurse.

I can't say it gets easier, but you do know how you will feel, and that helps. The first time is definitely the hardest.

Hang in there, you have a lot to give to [and get from] nursing! :hug:

samiam4 · Feb 4, 2012

I just wanted to thank you all for your kind words. I really appreciate you taking the time to respond to my post. I feel a little better about the words you all speak. I will definietly talk to my teacher about it. I am still upset about the whole situation being that it was my first death experience. I guess I feel guilty because the patient was under my care at some point during his hospital stay, and I felt like I didn't give my best care to the pt... I talked to my mother who is an LPN and works at a nursing home and experiences death often and she told me not to worry....Although, that's all I can do. I think time will heal, and I will look into the recommendations you all said. Thank you so very much

nurse2033, MSN, RN · Feb 4, 2012

You should speak to your instructor about this, and they should respond with education and support. Many things kill patients but it is mostly disease or old age, certainly not because they got their Prevacid late! (or whatever). I know this was a shock to you but it does happen, and sometimes more than once a week. It is one thing that makes nurses special, the ability to face the realities of life on Earth. Dealing with this yourself will help you assist your patients and families deal with it themselves. The odds that you had anything to do with his demise are minuscule at best. You should feel good that you had the chance to see that he was in good spirits in his last days. Hang in there and best of luck.

DixieRedHead, ASN, RN · Feb 4, 2012

Honey, people die. It is as natural a part of life as being born. We had a girl in our nursing class who when we first went to the hospital her first three patients died before she even got there. We called her the Angel of Death (nurses' humor).

fmxkrazyone · Feb 4, 2012

When I was in nursing school in my first semester my first 3 patients all died after I had cared for them. I would have them on Monday and Tuesday and I would find out the next week that they died. I was upset because I thought it was me, being a brand new nursing student I was afraid I was doing something wrong, but it turns out that it wasn't really me, they were sick and unfortunately it was their time. It was difficult to accept at first because you talked with them and laughed with them and built a relationship and to hear that they had died, it was devastating, but that is part of nursing.

Nurses spend a fair amount of time with patients and all you can do is care for them the best you can and know that you did your best. When I lost my first patient as a nurse in my first job I was sick over it. She was a DNR and I couldn't do a thing except keep her comfortable which I hope I did. I lost her on my shift, I was the last person she saw, I was there for her last breath and I cried and it was awful but when I look back at that night I know in my heart I did the best I could for her and I live with that.

Always do your best for you patients, be their advocate and do right by them and if they die at least they went with the best care you could give them.

qcc2011grad · Feb 4, 2012

What do you think you could had done to keep him alive? this question is not mean for you to answer but mostly for you to assess your feelings on end of life issues. It is just like saying if I have done something different the outcome will be ..sososo what is meant to be will be. When is time for patients or when is our time to pass away interventions whether pharmacological , or even invasive procedures are just temporary fixes.

IMO speaking with your instructor may even make you appear as if you did do something wrong if you need to speak because you need closure then go ahead and as someone else stated read Kubler- Ross book on death and dying this should had already been introduce to you in the beginning of nursing school. Also when you take report on a patient who is unstable to desat to low 60 is critical . What meds is he on Medications gives you a overview into their disease process is he taking Dig, BB, d/x heart failure is he DNR, DNI.

I hope I am not being judgmental I just want you to understand death is part of life and as someone previously mention this is a special part that makes nurses unique as sometimes we are the last person a patient sees before they take their last breath.

I would recommend if your school provides a clinical rotation to a hospice hospital go and do it do not deny the dying or have a negative view of death feeling guilty or feeling that healthcare providers must intervene to try to prolong life for the sake of the living is not been compassionate . I wish you the best.

MN-Nurse, ASN, RN · Feb 4, 2012

A very happy man in his late 80's. He was in the hospital for Poss. pneumonia, SOB and had an extensive history for CHF, pulmonary hypertension, diabetes etc. When getting report from the nurse on tues she told me his O2 would desat into the 60's overnight but would be better 80's-90's during the day when awake (and it was)...

The patient was dying and I'm guessing was DNR. From your OP, you don't even know he passed away. Even if you do know for sure he passed, there was NOTHING you could have done to save this patient. (Nor would you want to, more on that later.)

Further, short of putting a pillow over his face, there was nothing you were going to do in clinical to kill him.

Stop wringing your hands, put your nurse hat back on and think about what the goals of care were for that particular patient. End of life care is a very, very important aspect of nursing care. My concern in this case would not be that the patient died or what heroic measure could I have taken to prolong his life. My concern would be: "Did I do everything I could to keep him comfortable while he was in my care?"

We all have to take into account our personal feelings and deal with them. But remember, this is not about you. This was someone's father, brother, or son, but he wasn't your father, brother or son; he was your patient.

RNAPRNGOAL · Feb 4, 2012

Wow, thsi definately brings me back to nursing 101, that first day of clinical (boy i was prepared, i research my patients history, diagnosis and meds) all to find out that he or she passed! I was shocked but then i thought oh poor ......... i said to fellows students I COULD NEVER WORK IN HOSPICE!!! My instructor would look at me everytime... and guess what. I am an Oncology Certified Hospice RN. Its crazy where life takes you. Death is a part of life, we have no control as caretakers, its all in GOD's hands when it is time to go home. Bless all of you, I am certainly proud of who I am now decided to further my education to NP. I am nervous but excited at the same time!

IEDave, ASN, CNA, LVN · Feb 5, 2012

I'm a nursing student in my 3rd semester and my pt died the other day. I have anxiety, chest pains, and a horrible stomach ache after finding out my patient died. It is my worst nightmare.
I had clinical on Tuesday and I found out on Thursday (kind of) that he died. We usually get the same patient's when we go into clinical. My teacher said "you have two new patients today" and my stomach dropped. My instructor didn't say if my pt passed away or not. So I said "ok."
So I went on with my day looked up my current patient's info and saw my pt. from tuesday still on the pt. list for the floor. About an hour later his name disappeared. The nurse that had the pt. with me on Tuesday came in to work at 7am and went up to the night nurses on the floor and said "What happend?!" I just had this feeling something happened to MY pt. from tuesday.
My pt.'s room from Tuesday was being cleaned by the custodial people. His bed was empty and made. I just knew it was him that something happened. I didn't get to talk to anyone about it and didn't ask what happened b/c I didn't want to be the nosey nursing student. When I had the pt. it was on tuesday and it was a very busy day with med passes. I felt that, on tuesday, I did not provide the best care for him. I know that I'm a student but, I feel like what if it was something that I DID or DID NOT do that contributed to his death early Thursday morning?!
I have a hard time prioritizing my care and I'm still learning....I had clinical on Tuesday the pt. died early Thursday morning. I'm guessing something happened in his sleep? When I had him as a pt on tuesday morning he was doing great, in good spirits, laughing and joking. A very happy man in his late 80's. He was in the hospital for Poss. pneumonia, SOB and had an extensive history for CHF, pulmonary hypertension, diabetes etc. When getting report from the nurse on tues she told me his O2 would desat into the 60's overnight but would be better 80's-90's during the day when awake (and it was)...
I don't know why I feel like what if it was something I did that caused him to die...I feel like I can't accept him dying and I don't know why my instructor didn't tell me what happend...I feel like I want to throw up. Any advice? Comfort words and experiences people can share? Should I talk to my instructor even though she doesn't know that I know about the patient passing? Help...I feel like I should quit nursing school........

Evening, Samiam:

You just ran into the #1 reason I chose nursing as my new career: for me, it was the realization that being my mother's primary caregiver for the last 4 years & 2 months of her life was the most emotionally satisfying & meaningful period of my 49 years on this earth. And, yes, I had to deal with her death as well.

Believe it when we say "there's nothing you could have done", because we DON'T have that level of control over mortality - ultimately, people die and we cannot change that fact. With time, I hope you can get to the point where you can understand, not just intellectually but emotionally, that you've been given a very special gift - to share, even if only briefly, another human being's last days before he experiences the last great adventure any of us will ever know; the end of his existence here, and a new beginning elsewhere. As others have noted - in the past, the passing of a loved one was a shared experience, done at home, amongst friends & family. Sadly, in this day & age we've gotten away from this, which certainly doesn't help the grieving process one bit.

As far as discussing this with your instructor - do. As with the rest of your clinicals, this is a learning experience, and it's most definitely a topic worthy of discussion. You'll likely be doing your classmates a favor as well; it's good odds that others won't have had this experience either, and could probably use a few pointers on how to face this particular challenge.

On quitting nursing school - no. You now are in the process of acquiring an insight into a part of life that is at best poorly understood, and that insight will be of considerable value - not only to yourself, but to your patients and (even more importantly) to their family members who remain behind. You now have an obligation to, not only those future patients & their families, but to the gentleman who passed on to honor his legacy as well. Do not fail them.

And, as always, my sincerest condolences on your loss - feel free to contact me via PM if you feel the need.

Blessings,

Dave.