A patient of mine died soon after I ended my shift. I have this strong feeling of guilt and I keep asking myself if I missed something. Was there something crucial that I should have picked up on? Could/should I have called a code? Should I have advocated for a transfer to critical care? On and on that crazy train goes.
Obviously I cannot provide a lot of specifics. Generally speaking, this pt was not well. Patient needed several major surgeries badly but was a poor candidate. Pt declined slowly and I had her for several shifts in a row, so it does not help that I was familiar with this patient and family.
Objectively, I know these things happen. Patients die. Patients can decline despite our best efforts. Even the doctors could not proceed with the care that this patient needed, so why do I think I could have done better and "saved" her?
I also worry what the next shift who relieved me thinks of my assessment skills. I am a relatively new RN. All reports of my job performance have been good, but there is always newbie jitters in the back of my head.
I guess I just needed to vent and get support. You guys get it.
Even though I just got my BSN, I'm an older guy, have lost numerous family members, and I sympathize with what you went through. I think the key thing you said is '... this pt was not well. Patient needed several major surgeries badly but was a poor candidate.' To me that sounds like there was little else you could've done. It's also good that you do care. One nurse where I did my preceptorship this past spring was unbelievably callous. I know some nurses get jaded, but this one was just unbelievable to me. So I never get tired of caring nurses! (And don't worry - I think most still do).
Just remind yourself that not everyone is going to make it.
I was taking care of a critically ill infant with too many problems going on to fix them all appropriately and our fellow (who is new, only been here a few weeks) told me, "I just don't want to miss something! I don't want the baby to die on my watch." I had to remind her that we average 1 death a week based on our mortality rates for a year and because we are the referral tertiary center, it's expected that we can't save everyone. And it is NO ONEs fault.
That being said, act on your instincts. I have never been sorry and rarely been made to look "stupid." I acted on my instincts and checked some labs earlier than ordered and oh holy everything we were running EKGs, changing IV fluids (for the third time), and getting stat ultrasounds...
I had those feeling a couple months ago when a pt passed at the end of the shift following mine. I took care of him the first night after a bilateral TKR. He was doing great, pain control with the epidural, good pulses, no SOB, CP, etc. The next night when I came in, I noticed someone else's name listed in his room. I was shocked to hear that in the afternoon when he was up in the PT room, his eyes rolled back, he collapsed & coded. Never did hear for sure, but everyone thought it was probably a PE. I was second guessing myself all night, telling myself "but his lungs were clear, he turned for me, he used his IS/breathing exercises for me", etc. It really helped when I spoke to the veteran day nurse in the morning who I had given report to on this pt & she agreed that there had been nothing that she had noticed with this pt that might have indicated a problem.
djh123
1,101 Posts
Even though I just got my BSN, I'm an older guy, have lost numerous family members, and I sympathize with what you went through. I think the key thing you said is '... this pt was not well. Patient needed several major surgeries badly but was a poor candidate.' To me that sounds like there was little else you could've done. It's also good that you do care. One nurse where I did my preceptorship this past spring was unbelievably callous. I know some nurses get jaded, but this one was just unbelievable to me. So I never get tired of caring nurses! (And don't worry - I think most still do).