Requesting words of encouragement… I’m a new grad having a breakdown at work right now.

[BeatsPerMinute, BSN, RN]

I'm orienting in the cardiac ICU and tonight I just cracked. So far I've lost four patients, including one last night. It was awful because it could have been prevented. Despite continuously updating the doctors, they wouldn't put in any new orders for him. Just monitor him,” they said. Mid shift he coded and we lost him.

I'm exhausted tonight.

My patient looks bad: vented/sedated, febrile, lactic/trops/sugars/ WBCs/ BP/HR increasing, poor renal fct, on many drips and not doing well. Something bad is going to happen. While hanging a new gtt I froze in the room, started feeling tightness in my chest, hyperventilating, and crying. I don't know what to do. What if he codes?

My preceptor sent me away to hide for a bit. I've locked myself in the staff bathroom. I feel so pathetic.

I soooo want to be a cardiac ICU nurse. I don't want to give up. As stressful as this is, I love what I do. But many these people are so sick and I feel like I'm going to kill somebody. Though I'm just following orders, it was my hands that killed people. My orientation is ending next week and I feel so overwhelmed.

Does anyone have any advice for pushing through this? Also, please share stories of similar experiences, so that I don't feel so alone right now.

Thank you.....

[dream'n, BSN, RN]

It's hard anytime to lose a patient, but with 4 deaths in two shifts, maybe the acuity of the unit isn't for you. Sounds like these are very, very sick people and having the ability to internally disconnect while being empathetic is not a skill you've developed. This isn't wrong or right, but can seriously play havoc with your mind, soul, and emotions in this type of unit.

Not saying you aren't a great nurse, but maybe this just isn't your forte. This type of unit requires a particular personality make up.

Right now take a deep breath and remember you can focus and do anything for 12 hours. Go back and do all you can with your preceptors assistance and examine your feelings about the job when you are off shift.

[LakeEmerald]

Sometimes we can't always prevent a death. If new orders were requested from more than 1 MD last night and you were instructed to monitor, maybe that's all that could be done.

How was it your hands killed people? Instead of: They were tremendously sick and you did everything within your power to help?

My only suggestion is, if you continuously updated the doctors and felt like you were ignored, then your next step is to work up the chain of command until you are sure the patient's status has been understood and needs are addressed. But also realize, sometimes the MDs have more wisdom and insight, and know they've done all they can and the patient is in God's hands under the current plan.

You work with critically ill patients. The fact is, you are going to lose some of them. I work in the ED and we do lose some. You do all you can, but you can't win them all.

Keep doing all you can whenever you can and be kind while doing it. Show your patients compassion and kindness so if it is their last day you can feel peace knowing they felt truly cared for.

Hang in there Beats!

[Libby1987]

I'm not acute care let alone critical care, but just want to send a hug your way.

[twinmommy+2, ADN, BSN, MSN]

Have you had a discussion with your preceptor? Maybe she can give you more insight into what was going on and why the docs didn't write for more orders as well. Preceptors are not only a wealth of information when it comes to the business of nursing, but also personal experience and how to handle the tough parts that they don't cover in policies and books.

Everyone has a day when they need to step aside. You have to remember to breath and get back in there.

[Lev, MSN, RN, NP]

I work in in the ER and it seems like the critical patients come in droves. I don't know how it is in ICU. There will be weeks where I have an ICU every other day and then there will be a period of calm.

Either way, I just want you to know that you are not alone. I don't think I'm the only one who has had experiences that "haunt" me. I should have, could have, would have done better IF. When your mind starts going down that path, try to turn it in the opposite direction. As a new nurse, a big part of adjusting to nursing, especially with critical patients, is the ability the disconnect. Tune out. Meditate. Don't let it get to you. But if all else fails don't be afraid to let out a good cry. It's important to keep in mind that you can never know what the outcome will be. If you could predict the future you would be getting rich telling fortunes not slaving away on the unit. Count each and every situation as a learning experience, make a mental note, and MOVE on.

You will be fine.

[NickiLaughs, ADN, BSN, RN]

30% of ICU puts die. There are doctors that ignore you, and sometimes the reality is no matter how hard you work on that Pt, even if they improve for a bit, they still die. The sicker they are, the less likely they are to make it. ICU nurses are fighting for that small chance. It's a hard job, and requires a certain type of personality. I did it for three years, I learned a lot and I left.

I would try to seize this opportunity and give it a year. You may find its really not your area and you need a place with better outcomes.

I went to ER because we get to see pas either improve very quickly or die very quickly. For me it's a happierplace because most my patients go home.

Hugs to you, take a deep breath and keep trudging. Remember you are not alone.

[calivianya, BSN, RN]

You can't take death so personally. Saying your hands killed a patient is making it personal. Unless you walked up to a non-vented patient with a 30mg PCA morphine syringe and pushed the whole thing, or set your IV potassium to run at 999/hr, or just turned off your pressors and walked away, or made some other error, you didn't kill your patients. Their disease processes did, and you just couldn't stop it. There's a really big difference there.

Every patient you have ever had in ICU would be dead right now if they had never made it to the hospital. The fact that you're talking about only four that have died is pretty amazing when you really think about it. Your patients are literally on the verge of death when they get to you, and the majority of the time, you pull them back successfully. 100 years ago, 100% of your patients would be dead. The fact that anyone survives at all is a testament to the power of the medications and technology we have access to now. It is in no way a reflection of you when these high tech extraordinary measures fail.

[Dranger]

Patients die in the ICU all the time, I remember one time we actually ran out of body bags we had lost so many.

The "just monitor" line given by the docs is just another phrase for nothing else we can do. Think about your patient, look at the differentials and interventions. What other options could they implement? A lot of the times there is nothing else.

Take the emotional out and look at the system objectively. You'll be a better nurse for it.

[CrunchRN, ADN, RN]

Kind of neat that you care and don't blow it off, but you have to find a way to do what you do and not let it kill you. I am pulling for you.

[annabanana2]

Not an ICU nurse, not even an acute care nurse, but was very recently a new grad so I know the "oh my god what am I doing how did I end up here I can't do this" feel. Take a big deep breath. Notice the feelings you're having but don't dwell on them. Let them go.

I obviously don't know your patients or their stories, but I do wonder if perhaps for some of them, death was maybe a blessing, and perhaps that they were fortunate they were able to die in a hospital with a nurse that cared for them.

[NICUNurseEliz]

I started as a new grad in pediatrics and watched multiple children die within my first month of starting. I remember that feeling of panicking that I would lose another to the point that it was almost paralyzing at work and depressing me when I wasn't working. What I realized was that I was never mentally dealing with the previous deaths I saw. Coping became a lot easier once I acknowledged the deaths, briefly grieved for the kids, and then moved on instead of pushing my feelings down and trying to ignore them. I'm not saying that this is what you're doing, but it is an easy trap to fall into as no one tells you how to feel when you've lost a patient.

In short, you are not pathetic! You are a compassionate young new grad, but you are not pathetic. Find healthy coping mechanisms and talk to people you can trust. Good luck! Being a new nurse is hard but it gets better!