New Peds Nurse Struggling

Nurses General Nursing

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Hello,

I am a (sort of) new nurse, I completed a New Grad Program in December and have been working on my own with pediatric patients since January. The hospital I work at doesn't see a lot of pediatric patients, so my training and experience has been somewhat sporadic. Last night I experienced the first shift where I left wondering if I should be a nurse or not. I had a 3 month old baby who was born 4 weeks premature in with RSV. After hand off his respirations were in the 70's, he was severely retracting and obviously in respiratory distress. Collaborating with RT (which was like pulling teeth) I ultimately placed him on a Blender, he was receiving 1.5 liters flow and 40% Fi02. His saturations never went below 90 and his respirations did decrease, and his retractions became much more mild (but never fully went away) and it seemed he had turned the corner. I also performed a lot of suctioning and let my charge nurse know as we don't do intermediate care and any increase in flow would mean a possible transfer. I utilized RT so much that the therapist actually complained, and when the doctor came in and assessed him in the morning she left a note that stated that he seemed improved and she wasn't concerned. So, logically I know that I did all of the right things and notified all of the right people, and I kept a very close eye on him and charted accordingly. Suctioned and assessed at 6 am, and at 7 am when we went in to do change of shift he was retracting severely, wheezing and his respirations were back up in the 70's. He looked like crap. For some reason I am having so much trouble with feeling guilty, like I missed something or that there is something I should have done differently. RT gave an albuterol treatment which improved him remarkably, we also suctioned a few more times. But I left with a pit in my stomach and tears in my eyes. It is also the first time I had seen a baby that sick. Any input would be greatly appreciated. Sorry for the novel!

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Specializes in Geriatrics w/rehab, LTC, hospice patient.

I am not experienced with pediatric patients. However, I will say that it's very likely that his condition changed rapidly before change of report. With very sick patients, that happens. Babies are fragile and as long as you documented all your interventions, which it sounds like you did, you should be okay. There have been times that I have given report on a patient, only to found out on my next shift that the other nurse sent them into the hospital. The other day, I found out that a patient had passed away an hour after my shift had ended. In all of these cases, I do wonder myself if there was something that I missed. I even wondered how long the deceased patient had actually been gone. But, I knew, and my charting showed this, that I had done what I could for my patients during my shift, and reminded myself that the deceased patient had been alive right before change of shift. So, I do understand feeling guilty, but have to remind myself that patients can decline very rapidly.

As for the RT complaining about how much you needed him, don't let his complaints let you feel guilty about asking for assistance. It is frustrating when a patient continues to need assistance, but that is what we are there for. Also, don't let his complaints make you hesitate from asking for assistance in the future. You are there to advocate for your patients, not the RT.

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Specializes in NICU, ICU, PICU, Academia.

I think you did great! Kids with RSV can turn on a dime- and you kept advocating for your patient and getting appropriate interventions.

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It sounds like you aren't struggling at all and made all the right decisions. RSV is not to be messed with. Especially with an ex-premie. Small babies with this virus can and do turn on a dime...and they die. Oxygenation is important but with this virus ventilation really becomes the issue and a pulse ox does not monitor that. These babies can and often do go into respiratory failure. Frankly, with his history he probably should have been transferred to a tertiary center by a pediatric CCT. I think you did fine in what must have been an extremely stressful situation.

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It sounds like you did a great job. Realize that your mind, body, and emotions are recovering from being on alert all night (or on and off throughout the night). It's okay to just rest now.

I think during our careers we experience things we didn't quite understand before, and it can be a bit jarring:

It is also the first time I had seen a baby that sick.

These things don't leave the mind quickly, or ever sometimes, they become part of who you are and what you know about the world.

It's good that you have a mind to review your actions for appropriateness, but there is a limit to the usefulness of that activity. Train your mind that when you have done what is appropriate and prudent it's okay to let it go (and actually harmful to perseverate on a fantasy where everything would've been different if only you'd somehow done better).

Kudos to you - you did great - now get some rest. :)

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Former peds nurse of 16 years here. You did fine. Peds, especially former preemies with RSV, can turn on an absolute dime. You sought out your resources and used them correctly. Crap happens and when it happens at shift change, it's normal to question yourself. But it really sounds like you did everything properly.

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Specializes in LTC.

wth is the RT complaining about? Having to actually do their job?

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Thank you all for your input and kind words, I do feel much better after some sleep and reading your comments. I am really glad I signed up for this website! I am thinking about an e-mail to my supervisor about the RT, as this is not an isolated incident with this particular therapist. But seeing how quickly this baby changed and how sick he got made me realize it's important to be able to collaborate without having to argue and try to convince her (RT) to come up to the floor. Thank you all again, I will be focusing on trying to turn into a learning experience rather than questioning and blaming myself, and will always be on alert with a premie with RSV :p

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