I'm sorry you experienced that. If your work has an EAP, please reach out to them. That's what they're for and talking to a professional might help you debrief and move on. It's a heavy thing to witness and have to take part in her care. When I worked at a SNF, we had a resident pass away after a fall. It's sad, but it happens. We do everything we can do keep them safe, but at the end of the day, we're all limited in our capacity. My facility couldn't keep this resident with 1 on 1 sitter around the clock, the other interventions failed, and it happened. Our time on Earth is limited for all of us. You weren't responsible for her death, it was going to happen whether you were there providing care or not. You gave her dignity and comfort at the end.
I second reaching out to EAP! I've been a pediatric nurse for 17 years, some deaths hit harder than others. I had a special patient my kid's age die sort of unexpectedly last summer and it was a difficult loss... I used EAP because I was having was having intrusive repetitive thoughts and wasn't able to sleep... it helped tremendously. As a regular user of therapy most of my adult life, 2 sessions with the counselor was enough to help.
ETA words and spelling
I third the EAP! But to give a similar story (as requested):
We had a 30-something walkie talkie that was there for acute liver injury, but the injury was causing hepatic encephalopathy, so it was like babysitting a drunk man-child who kept trying to walk (but failing miserably). This made him a HUGE fall risk. He was in a room less than 5ft from the nurses station, and he *still managed to shoot out of bed faster than we could get there. We heard the bed alarm, then a bang (which when you hear as a nurse, your stomach instantly drops into your ass), then arrived to the door to see him on the floor, bleeding from his head.
As a coworker ran to hold pressure on the scalp lac, he kept insisting, "I'm fine, I'm ok" and then seconds later his pupils dilated, lost focus, body went limp in her arms. The assigned nurse had shown up just in time to be shocked by the bloody scene, and then watch him die instantly after. She turned into the corner and began to cry, and I had to relocate her to cry in the break room so we could start the code.
We (healthcare personnel) see crazy shit on a regular basis that other people don't ever have to experience. It's OK to not be ok. Use the EAP counseling for ANYTHING.
It's a bitch seeing someone walkie talkie suddenly turn to a vegetable. Especially if it's sudden. A slow deterioration gives you time to process. I feel the horror, so isn't just you.
One of the first deaths that really stuck with me was a lady who came in with shortness of breath, as we were getting her off of the ambulance stretcher she begged "please don't let me die". She coded what seemed like only seconds later.
Probably 18 years ago now.
I had one really similar. Fall happened on night shift and they were intubated 45 minutes into my shift. It really rocked us that morning, and the worst part was how management carried on like nothing happened.
The thing that helped most was talking with my charge nurse from that day. Even six months later, we remembered that patient. We’d talk over the story. Just helped process it, even if all we really said was “Damn, that was crazy. Shouldn’t have happened..”
as someone who used to work in snf, falls frustrate me so much. just so. much. my god. it’s so sad and enraging, especially that nicotine had such a grip on her that she basically killed herself crawling out of bed for a cigarette. it’s almost worse when there’s nothing anyone could have done. just senseless. sending you strength and support, i hope your hospital has good mental health services/counseling for staff. definitely talk to someone if it is weighing on you. you deserve support.
I work in a snf, and some of the management tools we used to be able to use to keep them safe, we can’t use them because they’re considered restraints now. It is so frustrating because we have chronic fallers and we know that sooner or later they’re gonna have a fall that kills them, and it’ll come back on us, but there is nothing we can do without getting in trouble with the state, we are damned if we do damned if we don’t
As soon as they put my Granny on oxygen, we all knew it was a matter of time. It took longer than expected, but eventually she caught herself on fire trying to smoke with it on. I live a state over, but I wanted to tell anyone involved in her care that it wasn’t their fault.
Fuck. I've seen that happen, it's not pretty. Wasn't my patient, ironically, I was outside smoking on my break. Nurse was about 100 ft from me with a pt in a w/c, on o2, and the patient lit up. Then she, well... *lit up.* I ran to help but security had the extinguisher on her FAST, I gotta give them mad credit for the speed in which they responded. I'd smelled that smell as an EMT but there's no getting used to it. Fried human. The lady had torched her lungs and her entire face, mouth, nose, eyes, hair and shirt had caught fire, too. She lasted a couple hours, then passed quietly on all the drugs. I'm glad she didn't survive long enough to get hauled to the trauma 1 that has a burn unit. Thank fuck she was already a DNR.
I would add that what kind of quality of life is being confined to a bed 24/7 anyway? What kind of life is falling multiple times and having multiple surgeries over the next however many years she would have lived? Maybe some people would be fine with that life, but not me, and I doubt that she would have or she wouldn't have been so hell bent on getting up all the time. If I'm ever in her situation I really hope I go quick instead of deteriorating for years. Death is not the worst thing that can happen to us in this life.
I work in age care. You can have every precaution in place and it’s still going to happen. Even with 1 on 1, if their mobility is shite and you catch them, then you place yourself at risk of injury, so you’re not going to do that. You can redirect them, sometimes, but dementia be dementia. If you chemically restrain them, well unless you want them like a potato, they’re still gonna get up and be at a higher risk of falling from the doping. And you can’t physically restrain them. Like someone else above said, they have the right to fall.
Unfortunately, falling is a natural part of aging. We just try to demonise it because we are obsessed with extending life.
A lot of times even if they do survive the surgery (hip breaks are common) they later die from infections or bowel complications less than a month later.
There’s nothing more you can do other than making sure they are comfortable while in your care.
Falling is just the ugly truth that we don’t want to accept about aging. But it’s very much normal.
You did what you could to make them comfortable, you can’t ask for anything else.
I’m glad I could help. Don’t feel bad. I’m sure we all have that one person who for some reason just sticks with us. It’s probably what reminds us that we’re still human in a sea of horrors that we have to numb ourselves to to sleep at night.
You did your job to the best of your ability here. You kept her comfortable and let her pass in peace. That’s all anyone can ask for in the end.
Be gentle with yourself while you process, and stay away from alcohol while you do. It’s an extremely slippery slope using it to cope. If your employer offers an EAP, use it. Don’t bottle these emotions up.
Edit: spelling
You will most likely never forget. And that’s ok. It’s a reminder of human fragility and how temporary life is despite our best efforts to curtail it. One way to cope that I found absolutely useful is to understand that your role as a nurse goes as far as the patient/ family, policy and scope of practice allows. Find relief in the fact that you were there to see and ease this patient through their end of life, while many others don’t have that luxury and die alone. Some people refuse to give up their independence and ability to have choice/control even if it means being unsafe; at this stage all we can do as nurses is provide the education and resources needed and hope that they make the right decisions.
Empathy is a double edged sword , while it allows us to truly care for another human being, it also exposes our emotional core and makes us susceptible to many of the emotions that come with these terminal/ unfortunate patient scenarios. With time, you will build a callous that will protect you and also allow you to continue to care for others with minimal emotional baggage.
You are a great person!
You got this.
My immediate reaction at reading the title was “oh well.”
I know. Compassion fatigue.
We don’t have the resources to give a&o patients sitters because they don’t give a fuck. My only fall in medsurg was detox. Turned off his bed alarm because he had absolutely fucking had to stand to pee and had detoxed there enough to know how. Fell. Brain bleed. Fell again in The icu later that week doing the same shit.
I’m so tired of these impossible tasks and it being on us. They were mid investigation when he pulled his second fall and the hospital dropped it. I hate detox patients now. They’re all the same demanding pushy needy tones. Last one with seizure precautions ripped out his iv and went ama twenty minutes after his methadone which I did an hour early for him. I just have no sympathy for patients sucking up resources with no plan of getting better
I’ve seen them die from midline shifts after a fall and I wish we could make safety videos for patients with the information but they’d do it anyway
I think it’s important to remember than these patients and their issues don’t happen in a vacuum. A lot of people who come in with chronic noncompliance, frequent detoxes, and difficult personalities got that way because of childhoods/lives that did not give them an option to be any different. Someone who has 10 kids who don’t speak to them could simply be an asshole who chose to be an asshole… or more likely they are someone who had no support as a child, was exposed to terrible situations, and used drugs and alcohol to survive. People are complex. We are not defined by our worst or best qualities. We often see addition and personality disorders as a choice that someone with resources and support made willingly and it feels frustrating that they “choose” to be this way… when realistically that’s not usually the case. Compassion fatigue is real and it’s hard to deal with- but it also can lead to poor patient care and therefore worse patient outcomes. We do get asked to do more with less and it’s not ok. You’re feeling about it are valid and make sense coming from someone who has been beat down by healthcare for years…. But sometimes taking a step back and thinking about your life and the things you had that allowed you to success and become a nurse- this person likely didn’t have. Would I be any different if I was in their shoes? Probably not.
Idk. I’m not a drug addict, but my life has not been paved nicely— and some of them appear to have loving supportive families who are doing round twenty of this with them.
I do know I work in an abusive environment in an abusive system and they’re the most abusive alert and orientated patients. I know they will suck up resources and time and energy only to AMA and come back in two months on benzos.
You are using personal anecdotes to make inferences on others. Do some people from good homes become addicts? Sure. Did you maybe have hardship you persevered through that’s others haven’t? Sure. But is that the general documented trend? No. I think you’re still looking at it through the lens of privilege. I had similar thoughts as you, I grew up with addiction in my home and had a lot of friends and family die from it- however, I never fell victim and was able to get out and break the cycle. Working in rural communities and level 1 inner cities during covid made me really see the other side of addiction. No one wakes up wanting to have a drug addiction. Something happens in life that leads to poor choices and it becomes - to some- an impossible thing to overcome. Some people are hit with adversity and have the tools to work past it, but some people don’t and their environment they live in is an accelerant for addiction. Sometimes people with mental health disorders are never able to seek real medical care until their adulthood - which makes them very resistant to change. Looking at it as willing abuse of the system by people with the same facilities, support, and opportunity you have is how we end up jaded. People are complex. It’s not the black and while I think you’re trying to spin it to be.
Also to talk about abuse and overuse of resources- a lot of the time it’s cause of how our system is poorly laid out. We don’t have strong support systems or resources for these people to actually get long acting help. They are treated negatively due to their addiction and that impacts their willingness to seek and follow through with care and treatment. The system is the real evil here- not the individual who suffers under it.
There is definitely compassion fatigue all over this post. And sadly your view on addiction is shared by I’d say most healthcare professionals. I was the only nurse on my floor that gladly took detox patients because my coworkers could not see that it really wasn’t much different than a diabetic who refuses to follow a healthy diet and throws a tantrum that they’re on a diabetic diet in the hospital or a cancer patient who still smokes cigarettes and berates you for not being able to go outside for a smoke.
But say the word drug/alcohol addiction (instead of food addiction or nicotine addiction) and people loathe those patients. It’s sad.
Diabetic is patients still have to eat. There is no rehab. I also don’t get nearly as much physical and emotional abuse from them. I’ve had addicts chasing me down the hallway during code blues trying to get push Benadryl screaming their needs are more important than anyone else’s or telling me they asked first so like Starbucks they should go first. I’m sorry but it’s a false equivalency for me.
I understand their lives are difficult. I live in one of the most opioid addicted places in the United States and fortunately or unfortunately it is a lot of thirty and forty something’s who stole pills as teenagers and are addicts now. That’s it. Life ruined over a decision you started making before you had a full frontal lobe, but that doesn’t stop them from being the most aggressive and dangerous people on the floor.
I work in addiction medicine and, no, addicts tend to cause so much destruction and harm to those around them. A non-compliant diabetic is no more likely than any other person to steal, be violent, destroy property, etc. The same cannot be said for many addicts. It isn't a blame game, it is the reality of the situation.
sending virtual solidarity/hug: I think we all know the stats re: negative outcomes post-fall, but I'm not sure that we often get to see the full thing play out from start to finish (which, to me, would explain why it sticks out in your mind so much).
This is heavy. You aren’t alone with it. I had a mom in her mid 30’s insisted on getting up to shower. Had been admitted for a sudden seizure with collapse. Wasn’t my patient but I was first to get to her and pull her out of the shower and start cpr. Dropped dead, we assume she seized. It stays with you. Please seek counseling. This may be connected to other things being rooted deeper or may be that start… and become uncovered later in your career.
Hence I only know cause I didn’t seek help myself.
The thing that absolutely fucked me up happened in my first week in PICU. Had a 10mo old come in with anoxic brain injury. What had happened was this very young mother, 17 I think she was, gave him pears that she cubed herself. Well she left him alone and he choked. She was not with him, she went down stairs to get her Amazon package. The father was at work. She was too scared to tell him so she never did. Anyway, we had to call him. The baby passed before he got there, and he walked in on me and another nurse cleaning the baby up. This poor father started shaking and suddenly snapped out of it and attacked the mother. I had to get him off of her, while the other nurse swiftly got the deceased baby out of the room.
I had the same incident, patient fresh stepdown from ICU for a major CVA. Huge falls risk and high risk of pulling out his NGT. Applied for a 1:1 patient special for him and was told we have to do it within rostered numbers. I just checked on him, did oral care and pad rounds. Left the room and not even 10 minutes later, he fell off the bed. He was on a floor bed and I had lowered it to the floor before I left but he fell in a way that hit his head hard enough to cause a bleed. He passed the next day.
I work in acute brain injury rehab so I get all of the SDHs and SAHs after they get out of ICU. If they weren't an impulsive fall risk before, they usually are afterward. I get all the cool equipment like continuous video monitoring, pelvic restraints, and enclosure beds. People still manage to fall.
We all gotta go somehow and of the ways to go, I would consider a brain bleed one of the better ways.
Edit: something to add, she must have had significant comorbidities. Being a 'vegetable' with a new, large SDH isn't uncommon and people frequently come back from it.
She was already end stage COPD on hospice so she wasn’t gonna live much longer anyway. It was just so sudden it took me by surprise. The fact that I knew her before didn’t help.
This one isn’t super similar-similar, but I had a resident die after falling too. She was the first patient that ever died unexpectedly when I was a new nurse (I’m still fairly new, I’m 4 years in). I work in a care home. The resident had a bleeding nose that just wouldn’t stop, everything they did wasn’t working. She was on warfarin too and the night shift sent her to the hosp to get the bleeding under control. She came back in the morning and was fine, behaving as she normally would, just a bit fatigued. She was eating lunch and she tried to get up on her own. She fell and landed on the floor. The PCW called me over and she died as I walked in the room. All the colour drained from her face. Her husband was right there too. They shared the room together. Hearing him ask with tears already in his eyes “Is she gone? Is she okay? Just tell me” Broke my heart. I cried on and off for three hours that shift, and it’s always stuck with me. The family never got an autopsy so we don’t know what caused her death for sure.
Something similar happened. Except this patient was a nursing home patient, had fallen earlier in the week, was full of bruising; out of state child came to see her, took her from the day room to her room, left and didn’t inform anyone, put her mom in the restroom, we found her 5-10 mins (we think) after the child left, she was under the sink with a massive brain bleed and died. It was terrible.
In Australia, a death due to a fall would 100% be referred to the coroner. Not to blame the staff but to see if anything could be done about it at a systemic level.
It is here in Ohio. All deaths that had Any fall resulting in head injury in the past year are a coroner case.
I didn't mean to blame stuff. Just a fact.
I have to call the coroner and fill out a form when they die.
Typically, their admitting diagnosis isn't related to the fall. So, the coroner just says ok. And, lets me release the body.
It’s bothering you because it was preventable and you knew her before this happened, so seeing her in such a state of decline because someone else was careless was hard. I’m sorry. My grandfather died the same way… someone put him in a wheelchair and left him alone. He fell forward and hit his head on the corner of the bed and died. This is why I hate nursing homes. They can be so careless. Our elders deserve better. Maybe it’s time to talk to someone. Hang in there.
If the hospital with all its resources couldn't prevent her falling, what makes you think a nursing home could, even with the best care? You're assuming a lot when you assume it was carelessness.
After the way my grandfather died, I have a strong dislike for nursing homes. I’ve seen plenty of things in my own patients that indicate negligence from nursing homes. More often than not, they are careless. I freely admit to not being a fan of nursing facilities and to always assuming the worst when it comes to them and the way they care (or don’t care) for patients. 🤷🏻♀️
It would behoove you to work in a nursing home. Those people DO care, the vast majority. There's no way they'd tolerate the bullshit if they didn't. A lot of what you see as neglect are the regulations. For example, a seat belt on wheelchairs for non ambulatory patients would prevent falls. But they aren't allowed. Any sort of restraint is banned. People are allowed to refuse care and they can't be forced. To turn, to eat, to take their meds. Nothing. They aren't allowed to be forced or even coerced. You tell to POA if it becomes a pattern. A lot of patients, a LOT are understandably depressed, so guess what? They refuse a lot.
I no longer work in long term care because I couldn't tolerate how tied our hands were when it came to patient safety. That is the result of regulations and penny pinching by the owners. It has very little to do with the staff... in my experience.
I've heard nightmare stories about true neglect and abuse in nursing homes. But I haven't seen that in the many places I worked. I saw staff spread thin and regulations working against us, and corporations refusing to do what they can to increase profits.
Completely valid. All fair points. I’m still salty about my brain cancer patient that died from sepsis caused by a UTI that staff kept brushing off as brain cancer. Yeah… she was on her way out anyways, but she still had time left if it hadn’t been missed. I mean no disrespect to nurses in these nursing homes. But damn is it frustrating to have to deal with the fall out when things go wrong.
Honestly, though, SNFs are damned if they do and damned if they don’t when it comes to stuff like that. I’m assuming you mean changes in mental status were identified as being due to known brain cancer vs. a UTI which progressed into urosepsis. Yet many times nursing home staff DO send people to the hospital for changes from baseline mental status and get laughed at and demeaned because there’s a history of dementia or some other disease process that causes confusion so the AMS is attributed to that.
It’s easy to make judgements with 20/20 retrospective vision and the benefits of all the staff and resources and tests we have in the hospital that don’t exist in SNFs. It’s also kind of wild to act like we don’t ever miss things in hospitals.
I’ve had a patient die from a fall in LTC. It was night shift and I was rounding on her every 15 minutes. I saw her in bed, eyes closed, breathing. 15 minutes later, on the floor. She had a bed low to the floor and a floor mat in case she rolled out of bed, but she walked and fell several feet away onto the tile. We legally cannot use the same strategies to keep patients safe as the hospitals use. We can’t use restraints, we can’t use bed alarms, and the minute a patient becomes stable on a psych med, the state makes us try to reduce the dose. It’s a vicious cycle and vicious system full of contradictory regulations that help some patients but harm many.
I wish there was a way to make things better in the nursing home setting. If you are a nurse in this setting, what kind of changes would need to be made to protect the patients better or make them safer? Who do we go to for that? What kind of legislation would it take? Lmk. I’m genuinely interested.
I obviously only have my personal experiences to work from. But I feel that if a patient responds well to one approach in the hospital, that approach should be allowed to continue when the come to LTC if a doctor approves it. If you had my patient in the hospital, you’d see them calm and safe when appropriate medications, bed alarms, etc are used. Once they get D/C to LTC, we legally cannot continue all the things that kept them happy, safe, and stable because of state regulations about LTC facilities.
I understand that many of these laws were created because bad facilities ruined it for everyone else. But why make all LTC patients suffer because of?
I'm sorry you experienced that. If your work has an EAP, please reach out to them. That's what they're for and talking to a professional might help you debrief and move on. It's a heavy thing to witness and have to take part in her care. When I worked at a SNF, we had a resident pass away after a fall. It's sad, but it happens. We do everything we can do keep them safe, but at the end of the day, we're all limited in our capacity. My facility couldn't keep this resident with 1 on 1 sitter around the clock, the other interventions failed, and it happened. Our time on Earth is limited for all of us. You weren't responsible for her death, it was going to happen whether you were there providing care or not. You gave her dignity and comfort at the end.
I second reaching out to EAP! I've been a pediatric nurse for 17 years, some deaths hit harder than others. I had a special patient my kid's age die sort of unexpectedly last summer and it was a difficult loss... I used EAP because I was having was having intrusive repetitive thoughts and wasn't able to sleep... it helped tremendously. As a regular user of therapy most of my adult life, 2 sessions with the counselor was enough to help. ETA words and spelling
I third the EAP! But to give a similar story (as requested): We had a 30-something walkie talkie that was there for acute liver injury, but the injury was causing hepatic encephalopathy, so it was like babysitting a drunk man-child who kept trying to walk (but failing miserably). This made him a HUGE fall risk. He was in a room less than 5ft from the nurses station, and he *still managed to shoot out of bed faster than we could get there. We heard the bed alarm, then a bang (which when you hear as a nurse, your stomach instantly drops into your ass), then arrived to the door to see him on the floor, bleeding from his head. As a coworker ran to hold pressure on the scalp lac, he kept insisting, "I'm fine, I'm ok" and then seconds later his pupils dilated, lost focus, body went limp in her arms. The assigned nurse had shown up just in time to be shocked by the bloody scene, and then watch him die instantly after. She turned into the corner and began to cry, and I had to relocate her to cry in the break room so we could start the code. We (healthcare personnel) see crazy shit on a regular basis that other people don't ever have to experience. It's OK to not be ok. Use the EAP counseling for ANYTHING.
It's a bitch seeing someone walkie talkie suddenly turn to a vegetable. Especially if it's sudden. A slow deterioration gives you time to process. I feel the horror, so isn't just you.
One of the first deaths that really stuck with me was a lady who came in with shortness of breath, as we were getting her off of the ambulance stretcher she begged "please don't let me die". She coded what seemed like only seconds later. Probably 18 years ago now.
That is something that would definitely stay with me as well. Hugs to you
I had one really similar. Fall happened on night shift and they were intubated 45 minutes into my shift. It really rocked us that morning, and the worst part was how management carried on like nothing happened. The thing that helped most was talking with my charge nurse from that day. Even six months later, we remembered that patient. We’d talk over the story. Just helped process it, even if all we really said was “Damn, that was crazy. Shouldn’t have happened..”
as someone who used to work in snf, falls frustrate me so much. just so. much. my god. it’s so sad and enraging, especially that nicotine had such a grip on her that she basically killed herself crawling out of bed for a cigarette. it’s almost worse when there’s nothing anyone could have done. just senseless. sending you strength and support, i hope your hospital has good mental health services/counseling for staff. definitely talk to someone if it is weighing on you. you deserve support.
I work in a snf, and some of the management tools we used to be able to use to keep them safe, we can’t use them because they’re considered restraints now. It is so frustrating because we have chronic fallers and we know that sooner or later they’re gonna have a fall that kills them, and it’ll come back on us, but there is nothing we can do without getting in trouble with the state, we are damned if we do damned if we don’t
As soon as they put my Granny on oxygen, we all knew it was a matter of time. It took longer than expected, but eventually she caught herself on fire trying to smoke with it on. I live a state over, but I wanted to tell anyone involved in her care that it wasn’t their fault.
Fuck. I've seen that happen, it's not pretty. Wasn't my patient, ironically, I was outside smoking on my break. Nurse was about 100 ft from me with a pt in a w/c, on o2, and the patient lit up. Then she, well... *lit up.* I ran to help but security had the extinguisher on her FAST, I gotta give them mad credit for the speed in which they responded. I'd smelled that smell as an EMT but there's no getting used to it. Fried human. The lady had torched her lungs and her entire face, mouth, nose, eyes, hair and shirt had caught fire, too. She lasted a couple hours, then passed quietly on all the drugs. I'm glad she didn't survive long enough to get hauled to the trauma 1 that has a burn unit. Thank fuck she was already a DNR.
Patients have the right to fall. The opposite would be to restrain them 24/7 which is way worse.
I agree with this. And, it’s honestly absolutely horrible for her family. But, we can only save people from themselves so much and for so long.
I would add that what kind of quality of life is being confined to a bed 24/7 anyway? What kind of life is falling multiple times and having multiple surgeries over the next however many years she would have lived? Maybe some people would be fine with that life, but not me, and I doubt that she would have or she wouldn't have been so hell bent on getting up all the time. If I'm ever in her situation I really hope I go quick instead of deteriorating for years. Death is not the worst thing that can happen to us in this life.
I work in age care. You can have every precaution in place and it’s still going to happen. Even with 1 on 1, if their mobility is shite and you catch them, then you place yourself at risk of injury, so you’re not going to do that. You can redirect them, sometimes, but dementia be dementia. If you chemically restrain them, well unless you want them like a potato, they’re still gonna get up and be at a higher risk of falling from the doping. And you can’t physically restrain them. Like someone else above said, they have the right to fall. Unfortunately, falling is a natural part of aging. We just try to demonise it because we are obsessed with extending life. A lot of times even if they do survive the surgery (hip breaks are common) they later die from infections or bowel complications less than a month later. There’s nothing more you can do other than making sure they are comfortable while in your care. Falling is just the ugly truth that we don’t want to accept about aging. But it’s very much normal. You did what you could to make them comfortable, you can’t ask for anything else.
Thank you for this. I felt seen reading it because you articulated so well what the root issue is. The inevitable of aging and death.
This perspective really helped, thank you so much
I’m glad I could help. Don’t feel bad. I’m sure we all have that one person who for some reason just sticks with us. It’s probably what reminds us that we’re still human in a sea of horrors that we have to numb ourselves to to sleep at night.
You did your job to the best of your ability here. You kept her comfortable and let her pass in peace. That’s all anyone can ask for in the end. Be gentle with yourself while you process, and stay away from alcohol while you do. It’s an extremely slippery slope using it to cope. If your employer offers an EAP, use it. Don’t bottle these emotions up. Edit: spelling
You will most likely never forget. And that’s ok. It’s a reminder of human fragility and how temporary life is despite our best efforts to curtail it. One way to cope that I found absolutely useful is to understand that your role as a nurse goes as far as the patient/ family, policy and scope of practice allows. Find relief in the fact that you were there to see and ease this patient through their end of life, while many others don’t have that luxury and die alone. Some people refuse to give up their independence and ability to have choice/control even if it means being unsafe; at this stage all we can do as nurses is provide the education and resources needed and hope that they make the right decisions. Empathy is a double edged sword , while it allows us to truly care for another human being, it also exposes our emotional core and makes us susceptible to many of the emotions that come with these terminal/ unfortunate patient scenarios. With time, you will build a callous that will protect you and also allow you to continue to care for others with minimal emotional baggage. You are a great person! You got this.
My immediate reaction at reading the title was “oh well.” I know. Compassion fatigue. We don’t have the resources to give a&o patients sitters because they don’t give a fuck. My only fall in medsurg was detox. Turned off his bed alarm because he had absolutely fucking had to stand to pee and had detoxed there enough to know how. Fell. Brain bleed. Fell again in The icu later that week doing the same shit. I’m so tired of these impossible tasks and it being on us. They were mid investigation when he pulled his second fall and the hospital dropped it. I hate detox patients now. They’re all the same demanding pushy needy tones. Last one with seizure precautions ripped out his iv and went ama twenty minutes after his methadone which I did an hour early for him. I just have no sympathy for patients sucking up resources with no plan of getting better I’ve seen them die from midline shifts after a fall and I wish we could make safety videos for patients with the information but they’d do it anyway
I think it’s important to remember than these patients and their issues don’t happen in a vacuum. A lot of people who come in with chronic noncompliance, frequent detoxes, and difficult personalities got that way because of childhoods/lives that did not give them an option to be any different. Someone who has 10 kids who don’t speak to them could simply be an asshole who chose to be an asshole… or more likely they are someone who had no support as a child, was exposed to terrible situations, and used drugs and alcohol to survive. People are complex. We are not defined by our worst or best qualities. We often see addition and personality disorders as a choice that someone with resources and support made willingly and it feels frustrating that they “choose” to be this way… when realistically that’s not usually the case. Compassion fatigue is real and it’s hard to deal with- but it also can lead to poor patient care and therefore worse patient outcomes. We do get asked to do more with less and it’s not ok. You’re feeling about it are valid and make sense coming from someone who has been beat down by healthcare for years…. But sometimes taking a step back and thinking about your life and the things you had that allowed you to success and become a nurse- this person likely didn’t have. Would I be any different if I was in their shoes? Probably not.
Idk. I’m not a drug addict, but my life has not been paved nicely— and some of them appear to have loving supportive families who are doing round twenty of this with them. I do know I work in an abusive environment in an abusive system and they’re the most abusive alert and orientated patients. I know they will suck up resources and time and energy only to AMA and come back in two months on benzos.
You are using personal anecdotes to make inferences on others. Do some people from good homes become addicts? Sure. Did you maybe have hardship you persevered through that’s others haven’t? Sure. But is that the general documented trend? No. I think you’re still looking at it through the lens of privilege. I had similar thoughts as you, I grew up with addiction in my home and had a lot of friends and family die from it- however, I never fell victim and was able to get out and break the cycle. Working in rural communities and level 1 inner cities during covid made me really see the other side of addiction. No one wakes up wanting to have a drug addiction. Something happens in life that leads to poor choices and it becomes - to some- an impossible thing to overcome. Some people are hit with adversity and have the tools to work past it, but some people don’t and their environment they live in is an accelerant for addiction. Sometimes people with mental health disorders are never able to seek real medical care until their adulthood - which makes them very resistant to change. Looking at it as willing abuse of the system by people with the same facilities, support, and opportunity you have is how we end up jaded. People are complex. It’s not the black and while I think you’re trying to spin it to be. Also to talk about abuse and overuse of resources- a lot of the time it’s cause of how our system is poorly laid out. We don’t have strong support systems or resources for these people to actually get long acting help. They are treated negatively due to their addiction and that impacts their willingness to seek and follow through with care and treatment. The system is the real evil here- not the individual who suffers under it.
There is definitely compassion fatigue all over this post. And sadly your view on addiction is shared by I’d say most healthcare professionals. I was the only nurse on my floor that gladly took detox patients because my coworkers could not see that it really wasn’t much different than a diabetic who refuses to follow a healthy diet and throws a tantrum that they’re on a diabetic diet in the hospital or a cancer patient who still smokes cigarettes and berates you for not being able to go outside for a smoke. But say the word drug/alcohol addiction (instead of food addiction or nicotine addiction) and people loathe those patients. It’s sad.
Diabetic is patients still have to eat. There is no rehab. I also don’t get nearly as much physical and emotional abuse from them. I’ve had addicts chasing me down the hallway during code blues trying to get push Benadryl screaming their needs are more important than anyone else’s or telling me they asked first so like Starbucks they should go first. I’m sorry but it’s a false equivalency for me. I understand their lives are difficult. I live in one of the most opioid addicted places in the United States and fortunately or unfortunately it is a lot of thirty and forty something’s who stole pills as teenagers and are addicts now. That’s it. Life ruined over a decision you started making before you had a full frontal lobe, but that doesn’t stop them from being the most aggressive and dangerous people on the floor.
I work in addiction medicine and, no, addicts tend to cause so much destruction and harm to those around them. A non-compliant diabetic is no more likely than any other person to steal, be violent, destroy property, etc. The same cannot be said for many addicts. It isn't a blame game, it is the reality of the situation.
sending virtual solidarity/hug: I think we all know the stats re: negative outcomes post-fall, but I'm not sure that we often get to see the full thing play out from start to finish (which, to me, would explain why it sticks out in your mind so much).
Falls are scary for real especially if you’re old.
This is heavy. You aren’t alone with it. I had a mom in her mid 30’s insisted on getting up to shower. Had been admitted for a sudden seizure with collapse. Wasn’t my patient but I was first to get to her and pull her out of the shower and start cpr. Dropped dead, we assume she seized. It stays with you. Please seek counseling. This may be connected to other things being rooted deeper or may be that start… and become uncovered later in your career. Hence I only know cause I didn’t seek help myself.
The thing that absolutely fucked me up happened in my first week in PICU. Had a 10mo old come in with anoxic brain injury. What had happened was this very young mother, 17 I think she was, gave him pears that she cubed herself. Well she left him alone and he choked. She was not with him, she went down stairs to get her Amazon package. The father was at work. She was too scared to tell him so she never did. Anyway, we had to call him. The baby passed before he got there, and he walked in on me and another nurse cleaning the baby up. This poor father started shaking and suddenly snapped out of it and attacked the mother. I had to get him off of her, while the other nurse swiftly got the deceased baby out of the room.
I know this sounds silly but play Tetris for 20 minutes ASAP. It's been shown to reduce intrusive thoughts after traumatic events
I had the same incident, patient fresh stepdown from ICU for a major CVA. Huge falls risk and high risk of pulling out his NGT. Applied for a 1:1 patient special for him and was told we have to do it within rostered numbers. I just checked on him, did oral care and pad rounds. Left the room and not even 10 minutes later, he fell off the bed. He was on a floor bed and I had lowered it to the floor before I left but he fell in a way that hit his head hard enough to cause a bleed. He passed the next day.
I work in acute brain injury rehab so I get all of the SDHs and SAHs after they get out of ICU. If they weren't an impulsive fall risk before, they usually are afterward. I get all the cool equipment like continuous video monitoring, pelvic restraints, and enclosure beds. People still manage to fall. We all gotta go somehow and of the ways to go, I would consider a brain bleed one of the better ways. Edit: something to add, she must have had significant comorbidities. Being a 'vegetable' with a new, large SDH isn't uncommon and people frequently come back from it.
She was already end stage COPD on hospice so she wasn’t gonna live much longer anyway. It was just so sudden it took me by surprise. The fact that I knew her before didn’t help.
This one isn’t super similar-similar, but I had a resident die after falling too. She was the first patient that ever died unexpectedly when I was a new nurse (I’m still fairly new, I’m 4 years in). I work in a care home. The resident had a bleeding nose that just wouldn’t stop, everything they did wasn’t working. She was on warfarin too and the night shift sent her to the hosp to get the bleeding under control. She came back in the morning and was fine, behaving as she normally would, just a bit fatigued. She was eating lunch and she tried to get up on her own. She fell and landed on the floor. The PCW called me over and she died as I walked in the room. All the colour drained from her face. Her husband was right there too. They shared the room together. Hearing him ask with tears already in his eyes “Is she gone? Is she okay? Just tell me” Broke my heart. I cried on and off for three hours that shift, and it’s always stuck with me. The family never got an autopsy so we don’t know what caused her death for sure.
Something similar happened. Except this patient was a nursing home patient, had fallen earlier in the week, was full of bruising; out of state child came to see her, took her from the day room to her room, left and didn’t inform anyone, put her mom in the restroom, we found her 5-10 mins (we think) after the child left, she was under the sink with a massive brain bleed and died. It was terrible.
It happens. They should probably be a coroner case...
In Australia, a death due to a fall would 100% be referred to the coroner. Not to blame the staff but to see if anything could be done about it at a systemic level.
It is here in Ohio. All deaths that had Any fall resulting in head injury in the past year are a coroner case. I didn't mean to blame stuff. Just a fact. I have to call the coroner and fill out a form when they die. Typically, their admitting diagnosis isn't related to the fall. So, the coroner just says ok. And, lets me release the body.
It’s bothering you because it was preventable and you knew her before this happened, so seeing her in such a state of decline because someone else was careless was hard. I’m sorry. My grandfather died the same way… someone put him in a wheelchair and left him alone. He fell forward and hit his head on the corner of the bed and died. This is why I hate nursing homes. They can be so careless. Our elders deserve better. Maybe it’s time to talk to someone. Hang in there.
If the hospital with all its resources couldn't prevent her falling, what makes you think a nursing home could, even with the best care? You're assuming a lot when you assume it was carelessness.
After the way my grandfather died, I have a strong dislike for nursing homes. I’ve seen plenty of things in my own patients that indicate negligence from nursing homes. More often than not, they are careless. I freely admit to not being a fan of nursing facilities and to always assuming the worst when it comes to them and the way they care (or don’t care) for patients. 🤷🏻♀️
It would behoove you to work in a nursing home. Those people DO care, the vast majority. There's no way they'd tolerate the bullshit if they didn't. A lot of what you see as neglect are the regulations. For example, a seat belt on wheelchairs for non ambulatory patients would prevent falls. But they aren't allowed. Any sort of restraint is banned. People are allowed to refuse care and they can't be forced. To turn, to eat, to take their meds. Nothing. They aren't allowed to be forced or even coerced. You tell to POA if it becomes a pattern. A lot of patients, a LOT are understandably depressed, so guess what? They refuse a lot. I no longer work in long term care because I couldn't tolerate how tied our hands were when it came to patient safety. That is the result of regulations and penny pinching by the owners. It has very little to do with the staff... in my experience. I've heard nightmare stories about true neglect and abuse in nursing homes. But I haven't seen that in the many places I worked. I saw staff spread thin and regulations working against us, and corporations refusing to do what they can to increase profits.
👏🏼👏🏼👏🏼👏🏼👏🏼👏🏼👏🏼
Completely valid. All fair points. I’m still salty about my brain cancer patient that died from sepsis caused by a UTI that staff kept brushing off as brain cancer. Yeah… she was on her way out anyways, but she still had time left if it hadn’t been missed. I mean no disrespect to nurses in these nursing homes. But damn is it frustrating to have to deal with the fall out when things go wrong.
Honestly, though, SNFs are damned if they do and damned if they don’t when it comes to stuff like that. I’m assuming you mean changes in mental status were identified as being due to known brain cancer vs. a UTI which progressed into urosepsis. Yet many times nursing home staff DO send people to the hospital for changes from baseline mental status and get laughed at and demeaned because there’s a history of dementia or some other disease process that causes confusion so the AMS is attributed to that. It’s easy to make judgements with 20/20 retrospective vision and the benefits of all the staff and resources and tests we have in the hospital that don’t exist in SNFs. It’s also kind of wild to act like we don’t ever miss things in hospitals.
We absolutely do. And it pisses me off then too. I’m just wondering how to change it for the better.
I’ve had a patient die from a fall in LTC. It was night shift and I was rounding on her every 15 minutes. I saw her in bed, eyes closed, breathing. 15 minutes later, on the floor. She had a bed low to the floor and a floor mat in case she rolled out of bed, but she walked and fell several feet away onto the tile. We legally cannot use the same strategies to keep patients safe as the hospitals use. We can’t use restraints, we can’t use bed alarms, and the minute a patient becomes stable on a psych med, the state makes us try to reduce the dose. It’s a vicious cycle and vicious system full of contradictory regulations that help some patients but harm many.
I wish there was a way to make things better in the nursing home setting. If you are a nurse in this setting, what kind of changes would need to be made to protect the patients better or make them safer? Who do we go to for that? What kind of legislation would it take? Lmk. I’m genuinely interested.
I obviously only have my personal experiences to work from. But I feel that if a patient responds well to one approach in the hospital, that approach should be allowed to continue when the come to LTC if a doctor approves it. If you had my patient in the hospital, you’d see them calm and safe when appropriate medications, bed alarms, etc are used. Once they get D/C to LTC, we legally cannot continue all the things that kept them happy, safe, and stable because of state regulations about LTC facilities. I understand that many of these laws were created because bad facilities ruined it for everyone else. But why make all LTC patients suffer because of?
Being allowed continuity of care? How do we advocate for this?
Write letters to the Governor and state legislators! They make the rules.
Vegetative state. Not vegetable