Chapter 2: Where are you vulnerable?

Poor outcome? When a situation goes badly

“It is hard to avoid a sense of personal failure and shame when we are not able to save a patient. It is especially hard when the family is upset with your services. It is in these moments that you find the team somewhat traumatized”. - ICU Physician

There will always be situations you can’t fix such as when pain that can’t be controlled or when death that can’t be avoided. The more invested you are in controlling an outcome (e.g., "None of my patients will die"), the more negatively you’ll be impacted when that doesn’t happen, even if for reasons beyond your control.

Working in the highly stressful ICU environment means that at some point there will be missteps. You may feel responsible for a poor outcome or a family member may blame you, resulting in feelings of



Guilt refers to the feeling felt when one has done something ‘wrong’ (perceived or real).  What one perceives as wrong is often related to their moral code.





Shame refers to a self-conscious emotion in which one feels unworthy, bad or wrong due to a shortcoming, an act or omission of an act (perceived or real).



Click on the switch button below to explore two types of guilt you may experience and how it can impact you.

Reasonable Guilt Exaggerated Guilt

Reasonable guilt facilitates accountability for your actions. There may be lessons to be learned that can inform and improve your future practice. Allow yourself time to reflect on how you would approach a similar situation differently, both professionally and personally. 

Exaggerated guilt is pervasive and not realistic. You may feel guilt about events beyond your control, and this can keep you caught in the past as you repeatedly replay a certain event in your mind. This loop can prevent you from determining the root cause (which is likely anxiety) and can serve to shield you from acknowledging how frightening and beyond your control ICU work can sometimes be.  

Feelings of guilt or failure, or of letting someone down, can be very troubling and may add to your grief or vicarious trauma response. If you’re struggling with these feelings, consider discussing the case with a colleague or asking for a case review. 

See other support strategies.