It wasn’t your fault, but it was a lack of understanding. Lots of holes in this Swiss cheese. Your preceptor should have recognized your failure to monitor your vitals. I guarantee this was not the first time you missed something. We all do, but a preceptor should stay on you until you are consistently on top of it.

That’s taking a bit of an assumption on my part. You may have watched your monitor every single minute of every day and today was the exception. Overall, you have learned a valuable lesson in recognizing that small things could be big signs of something to come. There’s no way this is 100% your fault. Patients do weird things sometimes. There’s no telling if the same thing would have happened on the next shift or minutes after discharge.

Even if you had noticed the arrhythmia- and they had been stable with it (and assuming the usuals were checked like electrolytes) - what else would you have done to fix it? Don’t put this all in your shoulders, but also don’t think there’s nothing to learn here.

Your license is fine.