Ele_phant

Recently at my work (medical ward) we've been experiencing many complex patients, post covid patients seem to be extremely complex, more frail, and youngish cancer patients with multiple metastases. Plus opening visiting back up to very anxious and mistrustful relatives. The past month we've had a lot of palliative patients, end of life. We've also had patients that are palliative, awaiting hospice, but also undergoing medical intervention, drains, scans, IVs, blood tests. Which is difficult to manage when you are trying to prioritise these patient's comfort and QOL as they will likely be dead in a month. 2 of the palliative cancer patients developed infections, one had SBP after ascitic drain inserted, the other developed e.coli. Another frail elderly lady that had seemed she might pull through also developed sepsis and died on the ward quite quickly after being made EOL. All of this very distressing for the anxious relatives. I just feel worried that I am contributing to them developing infection. I feel that it is in some way my fault but I can't logically say how. I have very strict hand hygiene between patients /thoroughly clean equipment between patients. I use ANTT on dressings/IVs, I don't cut corners in these areas. But I just feel responsible and fearful that I am somehow responsible for the deterioration. Do you ever feel this way with patients? What are some ways that a nurse may contribute to a patients deterioration without realising it? Of course not the obvious hygiene, positioning, escalation of obs, but other more obscure ways?

I work on an elderly care medical ward. My patient was fine in the morning, admitted with AKI and deranged electrolytes. Then after lunch he projectile vomited and desaturated, needing 2L of o2. I was very worried he had aspirated, request chest physiotherapist review him and medical team. Both were not very concerned, felt he could self clear the secretions, to monitor overnight if worsened then would be for chest xray and antibiotics. His work of breathing was increased and I was just worried about him. His heart rate was up to 116bpm, I asked the doctor if I should do ECG, she advised recheck in 1 hour. Patient was also due IV magnesium which was delayed as had just came up from pharmacy and I was preparing to give. After 1 hour, patient was agitated, desaturated to 88% on 2L o2 and HR was up to 185bpm. I put patient on 15L/100% o2 and 3 lead heart monitor. Rhythm looked abnormal so I put out peri arrest call. Peri arrest team treated patient with IV beta blocker, HR came down to 125bpm and rhythm became regular. O2 was weaned back to 2L. I can't get over feeling I didn't care for the patient properly. I feel I should have just done an ECG instead of relying on doctor to agree with doing one. I also feel I should have chased pharmacy for the magnesium earlier in day or borrowed from another ward, but sometimes pharmacy get frustrated with you continually calling them to chase meds. The patient was stable when I left, HR still high but considered safe to stay on ward. I feel I failed and I felt the crash team blamed me although they didn't say anything. Our staffing has been bad and I'm worried maybe I was too tired from previous shift To focus properly. Do you think I caused this deterioration

I work on a medical ward, we are the covid ward so are currently taking a mixture of patients. My hospital has decided to close the covid surgical ward so now we are taking a lot of surgical patients. I came on night shift to a newly admitted patient with a tibial fracture. When I met him his cast had been cut open completely. The ortho doctor entry was the only documentation since admission and the plan just stated: check INR, NBM. The nurse I took handover from said the team had come and cut the cast open during the day and then left. To me the cast looked a mess and I assumed was doing nothing to support the leg as it was wide open. I assumed the doctor had just cut it and not bothered to completely remove it. So I removed it completely. When I changed the patient I used sliding sheets and didn't move his lower body. I supported the leg either side with pillows. I contacted the ortho doctor on call overnight to say the day team had removed the cast/he had no support what action should I take. The on call said no action overnight just keep ankle elevated. The next morning the ortho team returned and were angry the cast had been removed. They wrote in the notes that they had given specific instruction to rebandage the cast. But there was no instruction to rebandage or even that they had cut open the cast and the day nurse did not hand anything over to me. I realise now I made a massive error removing the cast, I should have sought advice before touching it. The general rule is if you don't understand, don't act. But I also feel that the surgical team assumed that a medical ward know how to handle a surgical patient when actually they need to document clear plans. They also didn't ensure the correct bloods were ordered for theatre or that the patient had fluids as NBM, I chased these things overnight. I'm not making excuses but I'm on a medical ward with end of life patients, a deteriorating patient and dementia patients. Because of this I have a bit of a 'let's get on with this/get it sorted' mindset (the exact reason I think medical and surgical patients shouldn't mix. Anyway I incident reported myself and the patient was moved to a surgical ward the next night. When I handed over to the surgical nurse they were equally angry with me saying I should have rung the surgical ward for advice. I realise I made a mistake, how bad do you think this error was? Do you think it showed worrying poor judgement?

There's 2 retirement age nurses on my ward and they are both excellent and have great intuition about what patient's need. One of them struggles a bit with the computer but there is always someone around to help. I always have a better shift taking handover from one who doesn't say much about what tasks she's done or are due but will tell me exactly what each patient needs that day - and she is normally right! I think that is old school nursing and really important for good care

When I first started my training and the 12 hour shifts were a shock to the system I woke up kneeling on the floor face down on my bed, panicked, ran into the kitchen I shared with housemates I'd known one week and shouted at them 'has anyone fed that woman in my bed'. They burst out laughing and I just backed out the room

Do you ever feel bad or 'spoiled' on your off days? I've worked a lot of extra shifts last 3 weeks and now have 3 days in a row off. I've been looking forward to it so much but now feel like I can't enjoy it or that I don't work enough. Do you ever feel like that? Yet, I know if I booked more shifts I'd be knackered.