First patient death, I want to quit- am I overreacting?
Will be lengthy so starting with TLDR: I had to do some post-mortem stuff for the first time, and though I completed everything I was minimally required and physically able to do considering it was change of shift, I felt like the help I received was severely lacking. Am I overreacting?
Some context:
- New grad RN of 8 months working ms day shift. I have never cared for a comfort care patient on my own, never experienced patient death throughout nursing school or my short career. It’s all extremely new to me. I don’t really know what I’m looking at, what I’m looking for, what I should be doing for the family, the documentation, the phone calls, etc.
- My preceptor warned me about which nurses I should and shouldn’t ask questions to because they’re mean, hence I’ve only talked to them if I really needed to. These two will be the break nurse and charge nurse.
- Our day shift supervisors are out of the office for the time being, staff nurses have been rotating charge nurse. I understand it can be overwhelming.
Comfort care patient is to be discharged at 6pm. Family is at the bedside. Around 4:30-5, pt becomes unarousable, eyes half open, tachypneic, and sounds like snoring very loudly. Family thinks the time is coming. I tell charge nurse pt is not looking good and ask what I should do about the pending transport. Charge reiterates pt is cc, it’s expected, there’s nothing we can do, we can’t hold pt here until they pass.
Around 5:40, I go back to pt’s room. Pt’s quiet, family says they saw eyes roll back a few times, gasps for air infrequently. I go to my charge, but she’s busy getting updates from other nurses. I can’t find the break nurse.
5:55 I go back to pt’s room. Family thinks they just passed. I don’t know what I’m looking at or what to do. I go back to my charge, tell her about it, I call the doctor. The doctor’s phone number is unavailable and isn’t responding to texts. I see transport coming down the hall. The secretary is finding other phone numbers I can try calling. Charge is at the desk making the night shift assignment. I walk right up to her and ask who should I contact and what do I say? She tells me. Transport comes out to say they think patient is deceased, should we cancel transportation? Secretary tells them to give the nurse (me) a few minutes as I’m working on it.
6:04 MD messages that RN can pronounce death. Charge tells me to put the order in. I ask her to show me how. She tells me to get a second nurse to pronounce. I ask what am I doing, how do I do it? Charge tells the break nurse to help me. Break nurse opens up our hospital’s post-mortem documentation guidelines and asks me if I’ve read through it? (NO!) She then leaves it open for me to start reading when I’d much prefer for someone to just show me exactly what I need to do.
6:10 Secretary deals with transport and gets them to leave. A different nurse comes by to hand me a paper I need to fill out regarding coroner, donor’s network, mortuary, etc. I ask how do I complete this, what do I do? They point to the sections labelled “To be completed by RN,” and say I need to fill those parts out. That nurse walks away and says she’s going to grab one more paper from another unit.
6:15 I STILL haven’t gone back to the patient’s room since 5:55, neither has any other nurse. I get handed another piece of paper with so many freaking words and bullet points and am told to read through each item and see if it applies to pt to fill it out. At this point, I’m at the nurses’ station on the brink of tears about to cry because my patient is DEAD and why is NO ONE WILLING TO SIT DOWN AND WALK ME THROUGH THIS? I’m being handed paper after paper by someone who’ll walk away afterward as if I’m supposed to magically understand what anything means.
Break nurse and myself finally enter pt’s room to pronounce. She comforts the wife while I do the documentation. I am answering questions in Epic I don’t entirely understand. She focuses on comforting the family which is totally reasonable, but I really need some guidance on the documentation so I start hinting to her to please look at my computer screen.
6:30 We’re back at the nurses’ station and break nurse circles back to one of the papers I was given and asks if I’ve done those steps including body care. I tell her no, and I’ve never done body care before. She says do what the paper says and ask a CNA to help me. I became so fed up with the reluctant help that I’ve been getting that I sit down next to my charge and straight up say I have no idea what I’m doing so she can take my requests for help more seriously. I know that she’s overwhelmed with change of shift. She starts looking through the handouts with me and tells me that we don’t have deaths on our unit very often so she doesn’t know exactly what to do either (but she has been a nurse on that unit for 20 years!) She tries to look over which forms I need to fill out, and points to sections labelled “To be Completed by RN.” She tells me that I’ll have to pass some of this onto the next shift. I get on the phone with the donors network for 15 minutes, I ask break nurse to pass meds for one of my pts. I check on the family.
6:54 I ask charge if house supervisor has been notified. She does it then.
7:00 I start handing off my patients but get a call from someone else from the donors network. I’m on the phone for 30 minutes. Break nurse hands me a body bag and checks on a patient of mine whose call light is on. I thank her for her help and don’t see her again.
7:30 I finally start giving report to other nurses until a little after 8. Break nurse went home at some point. Charge went home at some point. I stay back to chart until 9:10. No one checked in with me afterward to see if I completed everything or needed help.
I felt like I was begging for help. I thought it was ridiculous that the charge didn’t so much as step into the patient’s room at any point when I was concerned and kept returning to her for guidance. I was left to make the phone calls and complete the paperwork when the night shift nurse I handed off to (also a new grad in my cohort) said that her break nurse took over all the calls and faxing and helped put the body in a bag. I wanted to quit that night. Everyone was willing to tell me what to do, no one actually stepped in to help me get it done.
Is it an overreaction to say I’m incredibly upset and angry at how this unfolded? Was the support that I got actually reasonable and I’m expecting too much? Is this a normal environment to work in? Is this an environment you’re willing to work in? I’m seriously contemplating putting in my 2 week notice. I cried that night and the following afternoon in a public train on my way to a concert! I understand patient deaths can be extremely distressing, maybe this was my version of it? And it’ll get better? Should I finish out my new grad program which ends in 4 months?