Situation Haunting Me

Published

Specializes in Emergency.

I have had several situations from work bother me for a day or two, but this one has stuck with me for weeks. I was working with a Dr. I have never worked with before, I am a fairly new nurse. I had a pt. who seemed to me to be circling the drain. I politely mentioned this fact to the Dr. and he ignored me. 30 min. later the pt. was getting worse--she seemed to be septic, BP going down, breathing faster, cool extremities, unable to obtain accurate spO2. I took the liberty of discussing with the pt. if they would want everything done if the pt. were to die and they said yes. I told the Dr. I was really worried about this pt., showed him vital sign trend--still nothing. I asked if I could start antibiotics and blood cultures, he agreed. BP still going down, this pt. looked like she should have been intubated 20 minutes ago, I got the Dr. to come look at pt., still nothing. I prepared the room for a code, got an order for dopamine after bothering the dr 6 or 7 more times. Well, to make a long story short the pt. died. I was pretty much standing there with BVM in hand waiting for it because I was positive she was about to die. I had already called respiratory as well. When she did die, I ran the code since no one else would take charge, I have only been in a few codes (and ACLS) so I can't say that things went textbook perfect.

I just keep going over every detail of this case in my head over and over and over again. I shoud have had someone defib her earlier since the Dr. wasn't having anyone do anything, I should have gone to my charge nurse to tell her that my pt was dying and no one is listening to me. I should have gone to talk with the family after the death but I chickened out. I know that I did the best I could possibly do with what knowledge and ability I have, but I can't help but think that we could have saved this lady if someone would have just listened to me. I should have screamed at the Dr. or something, but I guess being new I didn't want to be the boy who cried wolf. Maybe she would have died anyway, but the bottom line is, I don't think we did everything we could have done for her for an hour before she died.

Up Vote Up Vote ×

Wow. I am soo sorry for you and what you had to deal with, in a doctor who appears to either not have cared or ???, but at the very least he should have explained his reasoning to you.

I think you did a great job. Telling and re-telling the doc. Trying your hardest to point out something that should have been obvious to the rest of the staff. I understand how you second guess yourself - what you could have or should have done - if you had it to do over. Unfortunately, you don't.

But please don't beat yourself up over this. You recognized a problem, repeatedly told the doc, and did everything you could have done. Is there no de-briefing in your unit. That might assist you to deal with this aftermath.

To tell the truth, think I would have later taken the doc aside and (politely, like I was dumb and just wanted his exalted thinking) asked what was going on and why he didn't call a code earlier.

But.....so easy to be a Monday morning quarterback. You have nothing to feel wrong about. So sorry for you, the patient, her family etc. Guess the thing to do now is simply chalk it up to experience, and know what you might do if it were to occur again.

Best of luck to you!

Up Vote Up Vote ×
Specializes in Critical Care.

Nursing is on the job experience.

That's a cheeky comment in light of what happened, but nothing I can say can change that and none of your second guessing can, either.

So the question becomes: what did you learn and how will you apply it in a similar, future situation?

My experience is that my intuition in such things are normally more right than not, and the quicker and more assertively I act on that intuition, the better off the chances for a better solution.

~faith,

Timothy.

Up Vote Up Vote ×
Specializes in Telemetry, Case Management.

Sounds like you did the most and best you could in a bad situation. You made known what needed to be made known, and no one took up the responsibility. You did all you could, so don't feel bad.

Up Vote Up Vote ×
Specializes in ICU, ED, Transport, Home Care, Mgmnt.

I am going to assume that you documented all your contacts with the doctor. Next time you don't get an adequate response from a physician then tell your Charge Nurse and she should tell your supervisor if it continues to be a problem. And again document who you told and what. Do adverse event forms for lack of response. I am guessing you don't work in a teaching hospital. Private staff privilidges can be revoked by a hospital if the physician doesn't take good care of the patient. Have you talked to your nurse manager? If not, do so ASAP. I'm sorry you had to go through that, it should never happen, but there are doctors out there who just shouldn't be seeing patients.:angryfire

Up Vote Up Vote ×

Happy,

For future FYI I ALWAYS practice CYA (cover your ass) and chart...MD aware of BP, whatever/fill in the space; no further orders at this time...MD made aware of pt's continuous decline; no further orders at this time...and just continue to be a great pt advocate! Sounds like you were on the ball to notice your patient's distress and to continually try to do something about it. Esp. for a new nurse to recognize and react...way to go!

Kristy

Up Vote Up Vote ×
Specializes in OB, ortho/neuro, home care, office.
I am going to assume that you documented all your contacts with the doctor. Next time you don't get an adequate response from a physician then tell your Charge Nurse and she should tell your supervisor if it continues to be a problem. And again document who you told and what. Do adverse event forms for lack of response. I am guessing you don't work in a teaching hospital. Private staff privilidges can be revoked by a hospital if the physician doesn't take good care of the patient. Have you talked to your nurse manager? If not, do so ASAP. I'm sorry you had to go through that, it should never happen, but there are doctors out there who just shouldn't be seeing patients.:angryfire

Very good.

In the hopital I just left, we had a team that we could call if the patient just didn't seem right. I'll be darned if I can remember what the team name was, but it was part of the 100,000 lives saved program. Maybe you should mention this to the department heads for further follow up. This is something that was 4 months or so in the making and was implemented flawlessly. This would've been a powerful CYA statement when you called them when the doctor was refusing to do anything. It could've saved the patients life, I'm going out on a limb by saying this, but with an hour prior to the actual event, I'd actually say, they probably would've saved the patients life, even if it was only temporary.

In either case, you did what you could. You can't go back and change a single thing. You learned from it, the family lost a family member, and I'm assuming her diagnosis was pretty dire for her to die so quickly, but in either case, you did exactly what you should have. Instead of beating yourself up, pat yourself on the back, you kick royal butt :)

Up Vote Up Vote ×
Specializes in ER, ICU, Education.

Did you call and code and noone came. Time to find a new place to work. You should not be the one that is worried.

Up Vote Up Vote ×

How old was the patient?

Maybe it was just his/her time to go, regardless of what was done or wasn't done.

Use it as a learning experience. (What should I have done? What will I do next time?)

Good luck!

Up Vote Up Vote ×

It sounds like you did everything you were supposed to do. If this is weighing so heavily on you, maybe you can go talk to the MD to get his perspective, that is if he is someone who you can ask questions to. If not, talk to your nurse manager. This may be a case that risk management should at least be aware of.

Just wondering, what was the pts age and history? Was she mentally alert and able to make decisions?

Up Vote Up Vote ×
In the hopital I just left, we had a team that we could call if the patient just didn't seem right.

I'm guessing that you were not in the ED. :) In my experience this type of team is used for floor nurses because they don't have immediate access to doctors like the ED does. The ED usually is it's own code and rapid response team.

Up Vote Up Vote ×
Specializes in ER, ICU, Education.

Did she call a code and no one came? That is pretty negligent on "their" part isnt it? Why does she feel she needs comforted. I would still be raising #$^*

Did I miss something eairler?

Up Vote Up Vote ×
+ Join the Discussion