Okay, here's the deal. Most of you know by now that I graduated in Jan. and started right away in the NICU. I have worked very hard trying to learn as much as possible, but I'm running into a problem with some members of our respiratory team. In my hospital, the RT's are on the unit 24-7 with their own assignments. We are supposed to work together, and they basically handle all the vent settings, cpap, nc's, and drawing/interpreting blood gases. The past couple of days (an example...this is a daily occurance) I have worked with 'Sam', an RT on night shift. Sam is..well...a bit of a character, but I had never doubted for a minute that he was experienced and capable. I had a baby on an oscillator, who was tolerating the settings well and was being weaned down from 70% fiO2. The baby was on the second day of a three-day course of Dexamethasone, and had been weaned down to 40%. He was satting high, nearly 100, and appeared to be quite comfortable. No flailing, jitteriness, etc. Relaxed, sats high. Sam was doing blood gases q4 hours, and each time they came back, he would tell me how they were and give me a printed report. I am still learning to interpret these effectively, and so am somewhat reliant on the RT's expertise to assist and guide me in my decision making. If all else fails, I ask another nurse or three, but opinions vary, etc. Sam tells me all night that the gases are good, no problem. I look at the reports and everything was good, except the pCO2 seemed to be sloooooooooooooowly rising. I ask him about this, he says it's not bad, nothing to worry about, not high at all. Because this infant appears calm and comfortable, I used minimal sedation- q 4-6 instead of q2 hours (Versed was the only thing ordered). I was also concerned about over-sedating this baby, an ELBW infant who was three weeks old (gest. age 24 3/7). At about mid-shift, I became a tad bit concerned that the baby wasn't moving at all (had gotten three doses of Morphine on day shift) and decided not to sedate for the rest of the shift unless I had to, and would report all to the incoming RN, who could then use her own judgment regarding additional sedation. Okay, day shift, here comes the day RT, and he literally *****es me out for not sedating the baby q2 hours, telling me very loudly that I am trying to kill the baby, I am making him have to work harder during the day shift, etc. He asks about the gases, and I say that they were not bad all night, and look to Sam to back me up. Well, dontcha know that Sam decides to do a bit of hemming and hawing, and he says, 'Oh, the gases were crap all night long, the PCO2 was horrible, etc.' and my jaw just hit the floor. I mean, I LOOKED at each and every gas, but I do admit that I am still learning, and I'm wondering if I missed something!!! I would never EVER do anything to the detriment of these babies, and so I now look to you nursing goddesses for some advice! If I am wrong, I humbly stand corrected! Of course, the second the day RT comes to the bedside, the baby begins to move around a bit and opens his eyes. I decided that it was the noise of all the shift change brouhaha, etc., and the fact that the sedation from earlier in the day had finally begun wearing off, but of course the day RT starts wailing about how active the baby is and how could I let him get this way etc. Explaining was pointless, because as he said, Look at him! Doesn't matter what happened all night, the baby is moving his legs for three minutes and all of a sudden I'm the angel of death! Okay, that's situation number one. Second one is this: I had Sam last night again, same baby, and I suggested that we turn the baby and reposition his head. Sam says okay, and then decides he can't turn the baby without jostling the tube yadayada, so I finally say, okay, let's just reposition using positioning rolls and we'll explain it to day shift. Well, the new day RT comes on, this time a very crabby woman, who proceeds to curse at me and accuses me of trying to break down the entire right side of the baby's face by not turning him overnight. I tried to explain, looked at Sam yet again for back up, considering that it was SOLELY him who decided not to turn the baby, and he hems and haws. I walk away, turn around, and hear him saying to the day RT that every time we turned the baby on his stomach he desatted and didn't tolerate it, so that's why he didn't turn the baby all night. WHAT? That was a blatant lie!! He told me that oscillator babies don't like the stomach, he couldn't check for chest wiggle that way, etc. and here he is just telling her this and basically making me look like the wicked witch who lives to torture innocent children! For the second day in a row, I got a drop-dead look from the RT and I got so frustrated I was about to scream and rip Sam's hair out at the roots. Anyone? Please tell me what I'm doing wrong here! The ONLY thing I am concerned about is the baby's health and well-being. I need advice. Thank you!
