Feeling wiped out, overwhelmed, etc.

[cherokeesummer]

Hi all, I have to come and ask for some input, I've been trying and trying and I just can't stop feeling overwhelmed. I am working in a critical care environment and maybe that was my mistake for doing that right out of nursing school with no previous medical experience b/c I'm feeling so overwhelmed. An example - I am slow slow slow when it comes to turning vent babies. You have to unhook this and turn that and be smooth and quick but I am not quick enough, I'm too clumsy, etc. I got better throughout the day but still not that good. I know one of these days I'll be that nurse that extubated a baby by accident. I don't wanna do that!

I have been blessed with two GREAT preceptors so far, I have many more to come on my schedule but the two I've had have been very patient but I know that they probably wonder why I am not retaining this. For example an arterial line blood draw, there are these stopcock contraptions to help you get blood and it has the flush and all that stuff in one, its so many things to hold and you have to take so many steps blah blah blah. Or knowing what color tube you need to put blood in. How am I supposed to ever remember that? I can't carry a binder of need to know stuff around with me.

And as many people know and discuss, every preceptor does things differently, all safety but still different and when you are new and trying to figure out how to do something period, seeing all these different ways can get very confusing.

I was crying yesterday on my break and lunch and then on my way home, I was an hour late after report trying to finish up on two vented babies (my first time with vented babies). I cried all the way home and was thinking I need something less acute/critical but there isn't anything in the realm of neonates right now for me other than critical care and I don't really want to do adults unless its mother/baby or L/D. I can't do med surg - had a back surgery recently and I just can't do the heavy lifting. Plus I don't want med surg...those nurses are great, I worship your ability to do all that entails with med surg. Way to go!

So then I come home and we have some personal financial problems right now with our mortgage so then I realized well I have to stay and do what I'm doing even though I feel so stupid and so overwhelmed b/c we need the money. Thankfully I am a pretty ambitious person and will try and try and persist but yesterday I just felt so stupid. I'm not retaining information the way I should. I have no problem really with assessment and cares but its the other things, new orders every time you turn around, xrays, labs, suctioning, family, other personnel etc. It makes for a very busy/hectic day but then I see other nurses (more experienced!) able to do their stuff and chill out and talk or do whatever while I"m going nuts...makes me think I will never get that skilled that I can do things and be relaxed and on time.

Ok enough for me venting but I appreciate any words of support, encouragement or I've been there and I'm doing ok or hey I'm there now too LOL. :welcome:

[NotReady4PrimeTime, RN]

i went to a baby's bedside because he was alarming. i lifted the blanket off the isolette and lo and behold, little baby bug's neobar was not attached to one side of his face.

you're still using the neobar? we got rid of them about 8 years ago. they're prone to failure so much that unless they've been completely redesigned, i can't imagine us every using them again. the bar would detach from the duoderm base patch on the baby's cheek, which was still adhering nicely, but the tube would be free-flying.

nice job... quick thinking, appropriate response, good outcome. you've really become an asset to your nicu, so it's a good thing you're not planning to leave. cherokee will get there too.

[NurseAimee]

you're still using the neobar? we got rid of them about 8 years ago. they're prone to failure so much that unless they've been completely redesigned, i can't imagine us every using them again. the bar would detach from the duoderm base patch on the baby's cheek, which was still adhering nicely, but the tube would be free-flying.

nice job... quick thinking, appropriate response, good outcome. you've really become an asset to your nicu, so it's a good thing you're not planning to leave. cherokee will get there too.

i meant to hit quote but hit thanks instead - but still good to know about the neobar. i've seen them used in various places still too. i did not know that they had problems like that.

[cherokeesummer]

Cherokee, I thought of you today at work. I went to a baby's bedside because he was alarming. I lifted the blanket off the isolette and lo and behold, little baby bug's neobar was not attached to one side of his face. This kid was on the big oscillator, which practically used to give me hives just looking at it.

I grabbed the bag and mask, took the neobar and ET tube the rest of the way out and began bag and mask ventilation while I called for someone to grab the respiratory therapist. When respiratory and the resident arrived, they got the baby reintubated, I even knew to ask if they needed cricoid pressure. We tucked the baby back in, they went on their merry way and I charted the incident.

Five months ago I had a baby self extubate and I handled it, I appeared calm on the outside but was panicking on the inside. We got the baby reintubated, but I made another nurse stay with me while the respiratory therapist got his reintubation kit. I mulled over the incident the rest of my shift and almost called in sick the next day. I decided that this job was too stressful, too much could go wrong, and I was going to need to quit and find a less stressful job once my year was up.

Flash forward to today. I saw the neobar off and did what I was supposed to do, without even thinking about it. I didn't stress out during the incident and I didn't even think about it, until I came to allnurses, because I wanted to share with you that things will be different in 6 months for you. I am by no means trying to say that I have arrived as an expert NICU nurse in less than a year. What I am saying is that every shift you work will expose you to so much. I learned what to do by watching other nurses and learning from my mistakes last time a baby self extubated.

There is no way I am leaving my job when I hit the year mark, I can't imagine having to start over (or leaving my babies). We joke around on my unit that the learning curve in the NICU is so steep it is a vertical line. Hang in there, before long you will be posting encouraging words to the next batch of new nurses.

Thanks for those kind words, I really appreciate them. It does help to put things in perspective, that is for sure!

[cherokeesummer]

Going from adult care to NICU is about the steepest hill you'll ever climb. You might not ever reach the summit either, because neonatology is one of the fastest changing fields there is, with an enormous knowledge base. (Oh, and by the way NOBODY knows it ALL!) As the previous posters have said, being safe is far more important than being fast. Competence comes with experience, and you can't get that if you don't do the job. An OT told me that it takes a minimum of 1000 repetitions for a task to become automatic. Turning a vented baby six times a shift will take 167 shifts for it to be familiar enough to be considered automatic. Maybe you could cut yourself some slack? Worrying about having to attend emergency deliveries right now is about the same as worrying about the supply of fossil fuel drying up. It will happen someday, but not today. Keep your ABCs in mind and you'll get through. Airway, breathing, circulation are essential. The rest is less immediately important. You can find a way to deal with the stress you're feeling. Maybe you could do a little debriefing at the end of each shift with your preceptor. Tell her how you feel about the events of the shift, how you feel about your responses to them and see if you can pick out one triumph every shift. There will be at least one! Ask for guidance on what you could be focusing on for your next shift. It will get better... and it won't take 1000 repetitions, either!

I agree totally with you about safety over speed. Unfortunately (and not with disrespect) our hospital seems to want speed and safety all at the same time and I just don't think its a good idea. I know that many new nurses would be apt to take it as slow as they can to avoid facing their fears but I truly feel that sometimes they push tooooo hard toooo fast. I will continue to keep doing the best I can. Thankfully I have had some great preceptors that understand. They want me to be fast but they remind me to take my time at the same time.

Thanks again for the kind words!!!!!!!!!!!!!!!!

[NotReady4PrimeTime, RN]

The old Catch 22. "Take your time and think about what you're doing. Now hurry up!"

[Imafloat, BSN, RN]

You're still using the NeoBar? We got rid of them about 8 years ago. They're prone to failure so much that unless they've been completely redesigned, I can't imagine us every using them again. The bar would detach from the Duoderm base patch on the baby's cheek, which was still adhering nicely, but the tube would be free-flying.

This is the only place I have ever worked so neobars are all I have been exposed to. The RTs don't use duoderm patches, they use some sort of iodine colored liquid to help hold the neobar on.

[NotReady4PrimeTime, RN]

This is the only place I have ever worked so neobars are all I have been exposed to. The RTs don't use duoderm patches, they use some sort of iodine colored liquid to help hold the neobar on.

That iodine-looking stuff is probably tincture of benzoin (Friar's balsam). Stinks like crazy, gives me a rash. The NeoBars we used back in the old days had the Duoderm already attached. There was a layer of Duoderm on the winged parts that was stuck to the baby's cheeks; the end of the bar was sandwiched between that and the top layer of plastic.( http://www.dhmc.org/dhmc-internet-upload/file_collection/neobar2.jpg ) Our experience saw the layers delaminating so that the end of the bar was not attached to anything. Now maybe the manufacturer changed the way they were making them because of that, I don't know. I just know we hated them. In our unit here, we only ever use tape. Even on our adult sized patients, who could quite nicely use a Hollister ETAD. But then of course, we use nasal tubes almost exclusively. (Bring on the sinusitis!!)

We've derailed this thread again... sorry cherokee!

[Mommy TeleRN, RN]

The old Catch 22. "Take your time and think about what you're doing. Now hurry up!"

That sounds familiar! Critically think constantly about your patients but do it fast...and juggle 6-7 in your head and keep it all straight...ack!

[longjourneydream]

Hello,

I am not a NICU nurse;but hats off to all of you that are...

I cringed when we had a 4 month old die of respiratory arrest, in our trauma room, I did not get near it, due to my weakness of infants, I will have to get over it because, that is our jobs, we get no choices when we have a life to save...

I share in your feelings of being overwelmed.

If you read some of my threads you would know why.

I work in the ER,and have asked for more orientation after my 12 weeks, because I did not feel competent enough to survive season in SW FL. We have very sick patients, that need admissions,tx,etc...

To make a very long story short, it seems at times it is a damned if you do and damned don't.

I have been told:

Worry about assessment,blood,IV if needed, EKG, and stat tx

Then worry about tx, that can wait. Get patient up and out to unit or floor. Hurry,Hurry, Hurry.

Then I'm told I'm not initiating things that patient needs to have done before the Dr. sees them.

the list goes on and on.

I do get better every day.

In the beginning I felt like I was not obsorbing what I needed to learn, but now it seems to be clicking, the bulbs are now going off!

When I go home I review what I have learned that day, write it down in this notebook that I keep each day, jut to reinforse my learning. If I need to understand it further, I look it up in my nursing books, then if I'm lucky enough to be exposed to it again in the near furture, I feel so darn smart.

Yes, I AM GREEN. AT TIMES I AM SCARED. BUT I CAN NEVER SAY I AM BORED.

There are days when it all seems to run smooth and I am proud of myself, and other days that I wish I was in another profession, and that I hated my job that day, but all in all I cannot see myself doing anything else at this point, maybe later.

I will see how I feel in a couple of months...

Good luck to you, I know it will come to you, you will absorb it and you will be very competent as a NICU nurse. You are all a special breed, and I look up to all of you;helping maintain a new young life, as well as saving them!

Any way

Hi there,

Another new NICU RN feeing very overwhelmed here!

In August, I started my position in a level 3 NICU after one year of Med-Surg nursing. After the last few shifts I have worked, I am wondering if I am cut-out to do this type of Nursing. I dread having to attend emergency deliveries and I have not had a vented baby yet.

Every time I drive to work I want to turn around and go back home! The stress is overwhelming. So many things can go wrong instantly. I just pray I will be able react quickly with the appropriate interventions.

I tell myself I will wait one year to feel comfortable in the NICU, but I hate leaving work feeling incompetent.