kalycat

Oh @KatieMI!! I just had to post and wish you well. I’ve followed your posts for years and remember you mentioning your allergies in a thread where we were discussing restaurant food and epi pens. I am so, so sorry this happened to you! I am glad you are on the mend, and dammm straight you deserve a Chanel belt bag for your O2! I hope that as of this writing you are doing physically better. I am stunned beyond belief that anyone of any age would do this — especially with the emphasis on nut allergies in school nowadays — I am absolutely floored. Wishing you and your family a peaceful December filled with health and love.

It's a loss. A true loss. There will be somewhat of a grief process around it for sure. Try to use this time to regroup and work towards your dreams/goals, particularly ones outside of work. Give yourself some quality time. Major life changes, especially u planned ones, very often bring with them a sense of upheaval. Focus on your goals and be kind to yourself. Take up a new hobby or spend time writing. Even though your time there came to an end, you will go on, and you can take with you all the wonderful experiences and love that you cherished there. Best wishes.

It's actually part of orientation to our CVICU that you observe a CABG or other open heart procedure - you spend two days in the OR. I think it's awesome. I used to work as a circulator and then went to the unit, and the context and breadth of experience has been a tremendous asset. It also has helped give me rapport with some of the surgeons when I wake them up in the middle of the night. I feel we're pretty lucky on our unit - the vast majority of the surgeons, Anesthesiologists, etc treat us as valued members of the same team, and a couple of days in the OR helps solidify that relationship. One of our valve and robotics guys is huge about getting people in to the OR even beyond orientation. He feels it helps us be even more invested in our outcomes by observing first hand the amount of work put in to improve the lives of these patients. Sorry I don't have any funny phone anecdotes to add but wanted to comment on that!

Add me to the list of people who were actually bullied at one time - the time I transferred to my "dream" unit. Believe me, the behavior went far beyond jamming a copier or eye rolling. Think screaming, malicious rumors, personal attacks, being set up, and anonymous hate mail. I am a confident and articulate person most of the time. I give people the benefit of the doubt and roll with strong personalities as I am aware that I have one myself. I believe in the team though - that we don't all have to be best friends to be successful. I'm still not sure, two years later, what I did that caused the initial offense or made me a target. I was aware in advance that the unit was going through a major cultural transition and tried to be reserved, open minded, and an active listener while on orientation. It was frustrating and stressful as I was trying to draw on all my previous knowledge to make the situation better. I only made it worse. Some of the behaviors I experienced may have fallen under hazing, and I rolled with that. But one particular person took it really far. I tried to approach management and my educator to express my concerns in a professional way, but I don't think I advocated for myself strongly enough. I stuck it out as long as I could, but when I started absolutely panicking on my drive to work and dreading every phone call, as well as becoming so distracted in my practice that I *did* make mistakes, I left. My husband thinks I should have fought it with the union. I don't think it would have mattered or helped, honestly. I had mentors that stepped in and tried to fix the situation, but it wasn't enough. I walked away and do not regret it. I love my job and have since advanced to a high acuity CVICU and advanced heart failure program, and it was an excellent fit. I'm learning every day and love that. Perhaps I simply gave up - but putting my practice and patients at risk because I was so anxious and in my head was an untenable consequence for me. It took me awhile to bounce back, but I did. I still reflect on the situation, but haven't had many new answers. Working in high acuity critical care develops a lot of strong personalities. For the record, I think that we overstate the bullying issue (jamming copiers) in some effort to bring it to light and mitigate it. Unfortunately, imho, that does a disservice to the cause just as much as ignoring it does. I worked in business management and then mental health prior to becoming a nurse. There is incivility everywhere. We must find the balance between developing new nurses who critically think and have a thick skin and truly malicious behaviors, which I believe are relatively rare. Being a new nurse is stressful and it can be difficult for some to not take critiques and corrections personally. It's just part of growing as a nurse. Being hyper vigilant to suspected bullying only makes the problem worse and makes it harder to be a "fit" somewhere. Good self care and a good support system can help put things in perspective. I personally do not share my story much, but it stays with me to a degree. I feel that this article did generate some very valuable discussion, even if it somewhat missed the mark.

I've used both the DOS based meditech and the windows based "upgrade" one. Both were absolutely terrible and the second took 75 clicks to locate a simple lab result. I love epic as much as it's possoble to love the endless charting. At least it's fast and laid out in a way that makes sense, in my opinion.

I'm sorry to hear this. I've worked at facilities that had fatigue guidelines before - but they seem to be few and far between. Unless her work hours were in direct violation of policy, I personally would avoid that topic in your appeal. Management may have even asked this preceptor to work different/extra days/shifts so that you would have consistency in orientation with a primary preceptor and to expedite the process of getting you on your own; you may not have the whole story. I know it seems cruel to say this, but to clear your name it is going to be critically important that you focus on *your* actions and your subsequent reflection. You could possibly work in contributing "system" factors that you thought about as contributors during your reflection on the incident, but even that is risky. Anything that will be perceived as you being on the defensive or not owning up to your role will cause them to rule against you. They don't have a lot of motivation to rule in your favor, from a purely strategic business standpoint. For what it's worth, it seems your preceptor was ill suited to her role at best, and possibly completely out of touch with modern nursing practice at worst. But you have to focus on you - be humble, contrite and reiterate how seriously you took this and how it has changed your practice. Punitive culture like this should be a thing of the past. This is the ethical equivalent of putting sugar in OJ for hypoglycemia, so maybe this facility's culture is just *that* out of whack. No matter the outcome I do wish you well. Not trying to add insult to injury in any way, but trying to give you some tools to change the overarching outcome. I wish you well.

This is a very interesting discussion. I don't work for MultiCare, but this may be applicable in my region. When I used to work the floor, we had "break buddies" at night with no resource nurse, and it could be an utter nightmare. Even on stepdown where we only took 3-4 patients, these were post open heart, post arrest, VADs and transplants. It was totally possible that more than one patient would crump at a time. Also, if you were partnered with someone who took a very long break, went late in the shift, etc, it could be truly awful for workflow. Now I'm CVICU full time and we have a free charge as well as at least one, and often two depending on census, resource nurses. If you are in a one to one assignment because you have a device patent, fresh open, or arrest, usually the resource nurse breaks you. I personally like to stay nearby and keep my phone. I feel that I get breaks during my shift and that my down time is adequate - I'm just more comfortable maintaining the primary role for my patients. (If that makes sense). Our acuity varies wildly but is typically quite high - I don't take an uninterrupted hour break. (Which some night staff do). My work flow just doesn't support that - I prefer small breaks when my patient's status allows. Not trying to be a martyr but I definitely am a control freak! I take 30 minutes and eat, recharge, was some laps, and then head back. I don't expect that everyone would do this. I just think it would be weird to be told I would have to leave for a full hour (how things are done at night) and at a specific time. I agree with the others who have stated that implementation of this may be a train wreck. Thanks for posting this, Klone!

I read through this whole thing and was hoping someone would mention this. I've only been a nurse for 4 years and was told numerous times in nursing school to never do this. OP: I'm a CICU nurse in a high acuity facility. Everyone here has given you excellent information. We too have a standardized hypoglycemia protocol. It doesn't matter if you're treating labile BGs or BPs or anything in between, if you do an intervention to address an issue, CHECK YOUR WORK. Re-assess, and document that you re-assesssd. We do primary nursing care, but I've worked with techs/PCAs in the past... my rule of thumb is that the minute the pt has a concerning abnormal, I take over that task until I am reassured that the pt is stable. I don't think much of your preceptor or the culture at your facility. I'm not sure why she was bringing up a skin assessment when you clearly had other issues going on. Also, I have a hard time imagining a tele floor that can't do dextrose or insulin drips. Our open heart patients are sometimes on insulin gtts for 2-3 days post op and on a tele unit for most of that time. I wish you the best and I agree with the others - your facility's actions do not reflect "just culture". Know your protocols and know where your resources are. I like to pick the brain of my colleagues as well, but until you know who to trust for advice, look it up on whatever standardized resource your facility uses. In my State, one of the few things RNs can do without an order is a blood sugar check. Use your tools, and check your work. You will bounce back from this.

We have a special sign with a dove on it that's kept with our other iso precaution signs. It's just our way of letting others know what is going on -- lab, other nurses, etc. With 72 beds, we can have a ton of staff around and things can get hectic.

I am so sorry for your loss. I suffered the loss of my first daughter in the mid second trimester due to a variety of complications. My experiences are what, in part, inspired me to become a nurse (almost 20 years later!). My experience was a very, very traumatic emergency c-section delivery, and the surrounding situation was traumatic as well. I do not work OB. However, in the years following my loss, I served as a parent advocate for families who had kiddos in the nicu or who were going through a demise. I also became very involved as a volunteer with perinatal palliative care programs. I can say that time helped with compartmentalization. I actually attended some complicated deliveries with various outcomes while in nursing school, and while I had much to think about on my way home, I did not feel triggered and did not have recurrent PTSD-like symptoms. For me, my drive in the early years following my loss was to use my experience to try to help others. For whatever reason, these experiences helped me heal, and as a nurse a professional detachment was relatively easy to develop. I'm not sure if that's because I'm in denial, or if because my first instinct was to become wholly focused on the family and situation at hand. Everyone is different, and some of us have greater tendencies toward maladaptive coping -- mine might be that I am an adrenaline junky and always sought out ways to test myself and emotional limits; that may have not been healthy, but it is who I am. There were a few deliveries in our main OR when I was a circulator that were quite sad, and honestly, because we often crash sedated the patient and I wasn't in "nurse support mode" talking to the family and fully engaged with a conscious mom, I actually felt more of the physical signs of anxiety than when I was face to face working with a family. Not sure if that makes sense. When I was circulating, the patient was out, father not present, and I was more focused on technical tasks, there was more room for my mind to wander back to my own experiences. Never set a timeline on your healing -- be gentle with yourself and take it one step at a time. Check in with yourself often and use your resources -- your support system. best wishes to you, your family, and moving forward with your education. ❤️

While I agree that we need to put our own perspectives aside since it's about the patient and their goals, I feel very strongly about being an advocate for mitigation of suffering. Very strongly. I have seen strong, healthy men of 90+ lose all semblance of dignity in a very short period of time secondary to a sudden cardiac diagnosis. In the old days, these patients would pass in their sleep at home, etc. I have seen sharp, beautiful elderly ladies, passionate about their modesty and philosophical about their end of life, end up with every terrible intervention under the sun; even knowing them only a short time, I knew we were going against their wishes. I have seen a wonderful former military and law enforcement officer go from walking independently in from the ED gurney to his patient room reduced to a pegged, trached, screaming and incontinent soul, crying out for days on end for us to kill him or for Jesus to save him. He had suffered a v-fib arrest on the way back to the floor following a normal stress test. The family could not agree on a plan of care. He lingered on our unit for weeks before going on comfort care/inpatient hospice. He died within hours of tube feeds being halted. I'm sorry, but these are examples of doing harm. We need to advocate for our patient's dignity. I believe this. We cannot force our viewpoint, but we can educate, listen, try to assuage fears. Involve a multidisciplinary team to help make these tough decisions; transparency and realism can go a long way with an indecisive family. I recently cared for a patient with late stage Alzheimer's, tube fed, bipap dependent, who was approved for open heart surgery. I was absolutely shocked. I have no idea what went in to the decision making process here -- I can only make judgments from the outside looking in. Our surgeons usually don't go in for something like that; we have a very solid team in the ethics department. Nonetheless, it happened. I have suffered multiple losses in my life; some would say a statistically improbable amount of loss. I've been the person making the decision to withdraw care. But I agree with Nutella -- it's a multi-faceted problem; families are divided and fear "killing" their loved one and don't want to live with guilt. In the examples listed above, the patients DID make their wishes known during the admission process, both to staff and to their family. However, in the absence of the official documentation, a family divided can do a lot of damage. I know that in at least 3 recent cases (including the police officer) the patient verbalized their wishes to at least one family member before things turned bad - often in a casual "in passing" but sincere style. The family were just unable to support their loved one's wishes one last time, for a myriad of reasons. I've also had a couple of cases where the patient just as clearly stated "don't ever give up on me" to their family members. In those cases, I have no problem parking my personal opinion about futile interventions at the door and doing what the patient wants, even if the consequences are terrible -- they made their wishes known. Bottom line - The system *is* broken -- and the results are tragic more often than not. Quality over quantity to be sure; or, if you prefer, more elegantly stated: "It is not length of life, but depth of life." "Is immortality only an intellectual quality, or, shall I say, only an energy, there being no passive? He has it, and he alone, who gives life to all names, persons, things, where he comes. No religion, not the wildest mythology, dies for him; no art is lost. He vivifies what he touches. Future state is an illusion for the ever-present state. It is not length of life, but depth of life. It is not duration, but a taking of the soul out of time, as all high action of the mind does: when we are living in the sentiments we ask no questions about time." Ralph Waldo Emerson, Immortality

I was on an immune suppressing med in nursing school - only time I ever got sick that I could directly tie to the hospital; it was norovirus. I changed my meds and lifestyle, don't take that med anymore, and I've been fine. I have pretty severe asthma and I can definitively state that I was WAY sicker when my kids were little than I've ever been as a nurse, and I had an exposure incident where a patient coughed bloody sputum in my face and ended up having something communicable. I don't shower when I get home unless I've gotten something really icky on myself -- I use great hand hygiene, keep my skin in good shape so I don't have fissures, etc, sleep/eat/hydrate/exercise regularly, and keep my shoes clean. I have "hospital only" shoes that I don't wear around in the community and that I sani wipe as needed. No issues whatsoever. I wash my scrubs in warm, hot dryer. I do wash them separately, but it's because lint is evil.

A couple of thoughts to add to the great info you've received... If you think that resources are a major component of your stress, perhaps dayshift on your unit would be a better fit? We staff very lean at night on my busy cardiac transplant and mechanical heart unit, and several of our new grads have gone to days as soon as possible -- reporting much less stress -- even though the shift is busier. You have multiple disciplines around during day shift, leadership, attendings, etc. But you can get orders when you need them, additional specialists are around, and our day crew even has a helper nurse. Just something to consider if you have day shifts opening up with any regularity. I love nightshift because I love the challenge and the autonomy... and I'm a natural night owl. The unpredictability of a sick cardiac patient or an evolving stemi is what makes me fire on all cylinders, so it's a good fit for me. I work at a large teaching hospital and am supplemental at a well respected/established critical access hospital. I feel like small community hospitals are occasionally overlooked. While it can be busy, the stress is much different, the patients are no where near as sick, and the staffing ratios are better. I work med-surg and ED there. I wouldn't recommend ED at a critical access facility if you're not very comfortable with your skills, but med-surg can be very nice and the patient contact is wonderful. You see some variety, you invest in your community. If you like cardiac and are in a metro area, perhaps look at clinic nursing for your heart institute, mechanical heart program, or in pre/post cath lab areas. (We have a dedicated pre-op and pacu for our cath lab and EP patients during the day). While it can be busy, these patients are typically there for a scheduled, pre-planned procedure and are stable outpatients -- Not the same as working in the cath lab itself. I have several friends who work with our mechanical heart program and love it. You truly get to know your patients well and the skills tend to be more technical in nature. Pre/post cath lab and EP can be busy but as I said, stable outpatients and your cardiologists and cath lab team is right there. Can't get much better in the resource department! Good luck!

I've had adults do it - not as often as kids though. Just happens sometimes. Nothing to do but drop a new one.

This is a great little website that I used when I initially took acls. It really helped with rhythm recognition - I wasn't a new grad but hadn't worked on the floor yet; I went straight to the OR and then transferred to cardiac and became a code team member. So, anyway -- great prep. Quick, concise, affordable and very very pertinent to both the written test and mega code. I paid for the membership because I didn't feel like reading a ton of chapters before hand, and thought this was a great resource. Good luck - you've received great advice from other posters as well. We have a really fun group at most of our classes and the collaborative learning environment is really nice. https://acls-algorithms.com

OP, you come across as articulate and well prepared. Part of me wants to tell you to use those skills to reach out to the Powers that Be in advocacy and call your skool out on this BS. Part of me worries how it could affect your future. I graduated in 2014 - we had to pass the ATI predictor with 95% or above; ATI was built in to the program from day 1. Then, if you didn't meet that benchmark, you were required to take Kaplan, Hurst, or ATI Live Review before they would issue your degree. The school offset most of the cost of that review for the few students who needed to go that route. We had 100% first time pass rate for NCLEX. The difference was, all this was spelled out way in advance. The other difference was they actual withheld the degree - passing the predictor was passing the program. I'm with the other posters who are saying this is a last ditch attempt on the school's part to make right with the board for their poor pass rates. I'm so sorry you're going through this!! It sounds criminal. If it's not, it should be. Hang in there.

I don't mean to minimize a Chi-town commute, but I've lived all over the country, including SoCal. Seattle traffic and commuting is literally the worst I've ever seen, complicated further by parking and lack of public transit. You may be able to minimize some of this by working off hours/shifts, but any days you're required to be there during business hours, plan well ahead. As far as being open to outsiders and being blunt... Seattle has a very specific culture. There's tons to do and I'm sure you will find your niche, but there is definitely a certain resistance on the part of hard core Seattieites to what is perceived as yuppie gentrification. Due to all the changes, a lot of the old Seattle character and edginess is shifting. People tend to be resistant to change when they see neighborhoods and hangouts they loved being replaced by chain stores and condos. A lot of this will depend on where you choose to live and where you choose to hang out. The good news is, since it's growing so quickly, you certainly won't be alone as a transplant. Good luck with your interview!

We recently had a similar situation. The patient ended up going on palliative care, and the first thing the palliative care team did was discontinue the dilaudid and Ativan in favor of fentanyl for breakthrough pain and a long acting opioid that the patient was on pre-op. The palliative MD felt for this patient's situation, small doses of fentanyl would be less likely to worsen the confusion whereas the dilaudid was much more psychoactive for this patient. Of course, this was in the context of stable labs, no uti, etc. We did see improvement in the patient's orientation. His confusion and agitation seemed refractory to everything including haldol and olanzapine. We ended up adding lamictal, which helped a little. The patient didn't have a huge untreated psych history, but there was a significant history of serious anxiety and episodes of major depression. The startling awake after brief periods of sleep and constant picking at lines, skin, gowns, and the air was very similar to what has been described in previous posts. The reason the patient ended up with our palliative team was that a secondary diagnosis had been being treated successfully, then cardiac issues arose. In this situation, the delirium was so bad that the patient was unable to continue treatment for his secondary diagnosis. Tough situation. We fixed his heart, but whether it was pump head, ICU delerium, or a progression of his disease was unclear. All I know is that the small, short acting doses of fentanyl and returning to the pre-op analgesia regimen as soon as possible *did* help his level of orientation and sleep/wake cycle. The problem is, we were still unable to transfer the patient out for several more days due to all the med changes and behaviors. Additionally, while a fentanyl pca would be okay for our step-down unit, they frowned on receiving a patient who was receiving relatively frequent IVP doses. As soon as the pain was better managed with lower/fewer fentanyl doses and the behavior improved somewhat, we were able to get a bed.

I'm so, so sorry you went through this. I can tell you that I've seen kids in PICU come back from cold water drownings, even in dirty water (a collection tank comes to mind). Every case is different, obviously... but you did everything you possibly could and you did it well. Get support from family, friends and EAP if needed. I'm sending you peaceful thoughts and wishing you and the kiddo's family the best.

I can't compete with some of these stories. Ruby and IIg, you two need to write books. I have told part of thise story in another thread, but never the *whole* story. I was new to cardiac, fresh from the OR. I decided to work some overtime on a holiday weekend. Bad plan. My assignment consisted of a young cardiac transplant patient with multiple issues - renal failure, rejection, needed stents, EF of 20 in the new heart, an older (>3 years) LVAD patient waiting for a heart with a GI bleed, and an elderly patient who had experienced a VT storm and whose ICD kept firing. We were in a staffing transition period were we were full of float nurses who could take telemetry patients but not VADs, transplants, or drips. So it was me and like 2 other core staff. Our float nurses are great, but it's always hard when you're on an unfamiliar unit. No aids. Just about 2100 I hear a truly bizarre sound from the transplant pt's room. The significant other was at the bedside, so I suspected horseplay. What followed was the unmistakable sound of an obstructed airway, followed by a scream. I was in the room before the overhead rhythm alert was called. Patient proceeds to code - badly. Immediately incontinent of stool, significant other screaming their face off. I call a code. As I'm slamming the bed down and starting compressions, I hear the overhead code blue page... to the wrong floor and room. Myself and the other two core staff proceed to start running the code while the house supervisor tries to fix the page (she was on the unit at the time.) The patient had a fresh HD cath placed in the right chest. We are going to town on compressions, stool is flying, and the cath blows. Now we're doing CPR in a semi blood bath, in front of family. The code team arrives and we have further complications -- a difficult intubation. The CRNA tubed the goose twice - and since it was an hour after dinner and we had been bagging forever, a literal vomit fountain ensued, and there wasn't enough suction in the world to fix it. Luckily at this point the chaplain had assisted the family member to our waiting area. The code ended badly. It was also very spooky. After about 3 rounds of compressions on my part, the patient reached up and weakly grabbed my arm, making eye contact. I shouted that the patient was responsive and to check a pulse, but as soon as I stopped compressions, the patient was gone again. We never regained a pulse despite coding for nearly two hours. Postmortem care and clean up for the family was something I will never forget. As I raced to the locker room to change, my vocera rings. My LVAD patient is feeling weak/ill. We were running everything but blood into this patient since they were at the top of the transplant list and had never been transfused. Despite a precipitously low H/H, the patient had been asymptomatic. That changed after ~400 ml of bright red blood and clots were passed in to the commode. As I am calling the mechanical heart attending, the patient's nose starts to bleed. This particular attending was known to be difficult - but I had circulated for him and we got on well. His answer? "Stick a *expletive* tampon up his nose... and maybe one up his ***" **CLICK** I stood there with the phone in my hand and decide to to do what I could. All the labs I could muster, nasal packing, pressure on other sites. Call the code captain and mechanical heart team lead. Got my guts up and called Dr. CrankyPants back in 20 minutes. it ended up that the attending did come in (eventually) we transfused the patient, stopped the developing DIC (he was oozing from everywhere including his driveline site) and about a week later, the patient got his heart - antibodies and all. All the clean up didn't happen that night, of course. I sat down to chart around 0400 at this point. Of course I'm leaving out the calls to family, chaplaincy, medical examiner etc etc. Thankfully I had a strong charge nurse and house supervisor who helped immensely. Just as I can see the whites of day-shift's eyes, my VT storm patient has another round. This was complicated by a very muddy set of advanced directives that indicated he actually wanted the ICD de-activated after a set number of shocks. The code team responded after the third shock (we had intermittent normal sinus), and when the resident who was code lead that night saw my face again, he broke down in hysterics. His only description for my appearance was "you look utterly violated." The patient came around after shock #6 and some meds. When he was responsive again, he just repeated over and over again "I want more time. Do everything." He was 98, and after further stabilization, discharged a week later... with ICD on and ready to rock. I commute about an hour and usually use that time to decompress. After spending 3 hours charting I headed straight to the nearest brunch place with some friends and alcohol and ended up having to have a nap at my buddie's before returning home. I didn't know whether to laugh or cry. I've had some crazy since then, but that one set the pace.

I get to throughly chart... I love the satisfaction of having all the t's crossed. Theres a good code on another unit and the team rocks it. (I don't want you to code, I just want to be there if you do!) My patients are tucked and fluffed and my room is pretty and stocked at the end of the day. That hot cup of coffee tho' --- time for that makes it a GREAAT day :)

~760 bed urban trauma center, Magnet, - no double check. ~ critical access hospital 1, no double check. ~ critical access hospital 2, requires a double check (did some training there) Washington State.

It depends on the gestation and circumstances at my facility. If it is more the products of conception removed during a D and C or similar procedure, then a biohazard bag is used. Usually if the loss is later, the small styrofoam coffins are used - blankets inside but the remains are bagged and labeled w/biohazard stickers. Our morgue storage is weird so I don't think there's a separate area or anything but all involved do their best to be sensitive and respectful.

So yeah, never ever run a high alert Med as a piggyback. (Ask me about the time that a panic stricken nurse on another floor had their "B" line fail on a plum pump due to some sort of tubing issue and the patient got a 500ml bolus of a high alert medication in 30 minutes) A second IV is ideal, but if you can't get one, then y-sited at the lumen closest to the patient is the safest method. On our unit titratable vasoactive drips need a stable access point, preferably a picc or central line. If that's not possible, you can't go wrong with two large bore IVs.

Professional distance is a must in nursing. It just is. It's a must for yourself, but it is also critically important for your patients and their families. You are much more therapeutic when you can maintain an appropriate professional distance, and you will have a longer, more satisfying career if you practice good self-care. I'm on the code team for a level I trauma center and used to work 1500 - 0300 in the OR. I have definitely seen more than two deaths in one shift. Before I was a nurse, I spent many years working directly with families who had experienced the demise of a newborn; this was back in the late 80s/early 90s when such programs were new, and volunteers often assisted with transporting to/from the morgue and helping w/bathing, photos, and bonding time. I felt, and still feel, that it is a privilege to serve those experiencing loss or to care for those who have recently passed. So that's where I'm coming from with this post. I have had patients in my care pass unexpectedly - that always generates some reflection and self-critique of my practice and the case overall, but I've never missed work. I second the opinions above, and also would recommend you spend some time journaling or in self-reflection in order to assess why you feel so strongly about these particular deaths. Are you second-guessing the care you provided? Did one or both of them remind you of a friend/family member? Once you have done this, try to identify some strategies that you can implement in to your practice to establish and maintain therapeutic distance. You may want to consider consulting with your Employee Assistance Program (if available) for ideas.