Really upset, bad shift last night - page 2

I'm sure all of you have had at least a few shifts during your time in the NICU that made you just want to chuck it all, the kind of shift that ends with you, in your car, crying too hard to even... Read More

  1. by   Gompers
    Thanks, you guys, for all your kind words and support. I love this board!

    I slept, fitfully, for about 3-4 hours today. I am just so depressed, you know? I mean, such a stressful night, and my life right now is completely stressful - getting married in 2 months, moving in with fiancee, dealing with our families and all the wedding stuff, not to mention money. What I need is a good rest, and tomorrow after work I think some Sleepytime Tea and a warm bath is in order. I was supposed to work at 7pm, but the charge nurse just called me and said I could stay home until 11 because we're slow right now. Instead of going back to sleep, though, I think I'm going to take a long bike ride around the neighborhood to get some sunshine and fresh air.

    When the charge nurse called, I just had to ask - did the baby die?

    No. Not doing very well at all, been having a horrible day, but is still hanging in there. I mean, they were pulling the crash cart over as I was leaving today, so I was kind of surprised. I wonder if they're going to give me the same assignment tonight. I don't know how I feel about that. I mean, I know the baby and that makes things much easier and more consistent. Plus, I have been supporting mom for the past few nights I've had the baby so if something were to happen I know it's better to have a familiar face around. But I'm just so down on myself and my abilities, even though I konw I shouldn't feel that way.

    I think part of it is that on night shift, even though we have a couple of doctors on call, actually in the unit - it's like pulling teeth sometimes to get things done. It depends on what docs are on - some are more aggressive than others, some are more clinically talented as well. I just felt like we did NOTHING helpful on nights, and then at 7am suddenly there were ten people at the bedside and tons of stuff is happening. I did the best I could with the support and resources I had available to me, I guess.

    Thanks again for all of your support, I really appreciate it.
  2. by   sddlnscp
    I hope your mind can be at ease because you truly are a wonderful person and your caring heart is going to be needed. Your work is so noble, it's too bad you have to take the pain with the joy, but I'm sure that is part of what makes you great at what you do.
  3. by   Gompers
    UPDATE: When I went to work at 11pm, of course I was assigned to that same baby. Well, I had a wonderful night with him! He's still extremely critical but at least he was totally stable for me with perfect labs and vitals. It's amazing what triple antibiotics, shock doses of hydrocortisone, dopamine, fentanyl, and pavulon can do, isn't it? So yeah, very very high level of support there, but it was finally all kicking in and WORKING. The surgical team that visited in the morning was so shocked and happy, they high fived me. I just can't believe it was the same baby that I left 24 hours before. Sometimes I forget how resiliant these tiny babies are, and it's good to see this happen once in a while - reminds me just why I'm so fascinated by neonates.

    I still haven't gotten over the guilt that we could have done more. Talked about it at length with some coworkers during the night - and we all feel the same way. We try our hardest to get everything we can for these babies overnight, but it never fails - we still end up looking like we were slacking off because as soon as day shift comes on, there are tons of new orders and interventions. Of course, they're the same orders and interventions we had been asking for all night, but didn't get. So we look like lazy chumps! I can only hope that the day staff understands that we did all we could with what resources we have at night. Most of them do get it, but not all!

    Thanks again for all your support, I really really needed it yesterday.
  4. by   BlueYYsRN
    {{{GOMPERS}}}

    I hope you did get assigned to that little one last night. That little one needed you as much as you needed him/her. Even if it wasn't the best of outcomes. It is so normal to have the kind of self-doubt you had. It is not only normal but it is needed to help us strive to be better...to learn more...to hone our instincts. Could another nurse have done a better job? Maybe...maybe not. Could another nurse have done a worse job? You bet. Imagine a world where we are not needed, a world where all babies are born healthy and go home fat and happy with beaming moms. We know that world doesnt exist but in our world we strive to make that happen in the end. Imagine a world where NICU nurses are born with the knowledge and skill to care for every sick child entrusted to us. :angel2: Aside from a few who would have you believe their incarnate ability...that doesnt happen. Every little one you care for depends on you for your knowledge and skill and every little one you care for teaches you, enhancing your knowledge and skill.

    When people find out what I do their reaction is usually to say they dont know how I can do it because it is so sad. I have to tell them that it is mostly very happy but when it is sad it is very, very sad. We see things that are so unfair and there is nothing we can do about it. But for every situation that is miserably sad there are probably twenty that we can say we made a difference. If it werent for our efforts it would have been miserably sad and thats the reason I go to work.

    When it is very sad then nurses and docs and RT's and everyone involved need to debrief. I hope you can do that. Most of us have been in your situation and trust me... we all have that self doubt when its over. Also keep in mind that crumping at change of shift is not uncommon. It was not a reflection of your care. I think it happens with all the activity that come with change of shift despite our efforts to keep the environment calm.

    I hope your little one pulls through ok. If they do then I know they will have a special advocate...Gompers . If they dont then Gompers has many cyber shoulders to cry on :icon_hug: .
  5. by   sddlnscp
    Quote from Gompers
    UPDATE: When I went to work at 11pm, of course I was assigned to that same baby. Well, I had a wonderful night with him! He's still extremely critical but at least he was totally stable for me with perfect labs and vitals. It's amazing what triple antibiotics, shock doses of hydrocortisone, dopamine, fentanyl, and pavulon can do, isn't it? So yeah, very very high level of support there, but it was finally all kicking in and WORKING. The surgical team that visited in the morning was so shocked and happy, they high fived me. I just can't believe it was the same baby that I left 24 hours before. Sometimes I forget how resiliant these tiny babies are, and it's good to see this happen once in a while - reminds me just why I'm so fascinated by neonates.

    I still haven't gotten over the guilt that we could have done more. Talked about it at length with some coworkers during the night - and we all feel the same way. We try our hardest to get everything we can for these babies overnight, but it never fails - we still end up looking like we were slacking off because as soon as day shift comes on, there are tons of new orders and interventions. Of course, they're the same orders and interventions we had been asking for all night, but didn't get. So we look like lazy chumps! I can only hope that the day staff understands that we did all we could with what resources we have at night. Most of them do get it, but not all!

    Thanks again for all your support, I really really needed it yesterday.
    Yeay for your little one and for you!

    About your predicament, I am not a nurse yet, only pre-nursing, so I don't know how any of this works, so bear with me if I ask a stupid question. Do you guys have to document when you ask for things - even if you don't get a response? If you do, then the day shift will see that you did ask for interventions and just were not granted them. Does your department rotate shifts? If so, then probably everybody knows that things operate differently on day-shift than on night-shift because they have been there. I'm sure people understand why things happened the way they did and I highly doubt that anybody judges you negatively. If it's really bugging you, maybe you could talk to some of the day crew and see how they feel and if they know the situation - maybe that would ease your mind.

    Of course, given my limited knowledge of all this, perhaps all of my suggestions should be discarded or ignored. Either way, just remember that you did the best you could with the resources you had and you will continue to do so. Best of all, your little one had a good night with you that you could enjoy!

    ((((((((HUGS!)))))))))
  6. by   Gompers
    Quote from sddlnscp
    Yeay for your little one and for you!

    About your predicament, I am not a nurse yet, only pre-nursing, so I don't know how any of this works, so bear with me if I ask a stupid question. Do you guys have to document when you ask for things - even if you don't get a response? If you do, then the day shift will see that you did ask for interventions and just were not granted them. Does your department rotate shifts? If so, then probably everybody knows that things operate differently on day-shift than on night-shift because they have been there. I'm sure people understand why things happened the way they did and I highly doubt that anybody judges you negatively. If it's really bugging you, maybe you could talk to some of the day crew and see how they feel and if they know the situation - maybe that would ease your mind.

    Of course, given my limited knowledge of all this, perhaps all of my suggestions should be discarded or ignored. Either way, just remember that you did the best you could with the resources you had and you will continue to do so. Best of all, your little one had a good night with you that you could enjoy!

    ((((((((HUGS!)))))))))

    Well, you have to be careful when you do your documentation. You can write, "MD aware of decreased urine output" but not "MD aware of decreased urine output, no new orders received." With the former, it shows that you were aware of something abnormal and reported it to the docs. With the latter, it implies that you THINK there should have been new orders but there weren't any, therefore it makes it look like the doc is doing something wrong. NOT GOOD in a legal situation. I'll sometimes write, "Will continue to monitor" if I don't get any new orders.

    Yes, the day shift can see that I was reporting everything to the docs all night, but there is more to it than that. During the day, you get more orders, more procedures, just get more aggressive treatments because there are so many more doctors around. At night, you get the necessary stuff, but it's not like it is during the day. Like, all night long, I was hoping for an arterial line so I would have arterial blood for blood gasses and constant BP monitoring. The docs on that night weren't good at art lines, so I didn't get one. But first thing in the morning, there was a nurse practitioner and a different doc at the bedside right away to try for a line. It's stuff like that that I'm talking about. Things are just busier on days, so it sometimes looks like nights is lazy and slacks off.

    We do rotate the day shifters to night shift - but one night shift a month isn't enough for them to really get how hard it is for us to get as much done at night. Most of them have worked nights at some point in their careers, but it's easy to forget that you don't have the resources at night that you do during the day.

    You'll see, when you start working, that the dynamics are totally different between day and night shifts. Both with the workload and the staff.
  7. by   sddlnscp
    I see, that makes sense. See, all this stuff is going to be brand new to me. But, at least I am learning. Thanks for the info. Are you feeling better today?
  8. by   canoehead
    Quote from rn/writer
    False guilt comes from the illusion of having control.
    This sums it up I think. You did everything you possibly could, and that baby was lucky to have someone that cared so much at his side all night.

    Cry, but get back in there- we need more people like you.
  9. by   Gompers
    Quote from canoehead
    This sums it up I think. You did everything you possibly could, and that baby was lucky to have someone that cared so much at his side all night.

    Cry, but get back in there- we need more people like you.
    Thanks.

    I know it wasn't under my control, but all the interventions they started at 8am as I was leaving...they were things I could have been doing but didn't get the authority to on nights. I think that is what bothered me most - like I didn't convince the docs well enough that the kiddo need more help. But then again, I know that the baby's decompensation had more to do with nature than with me, and that I am really not responsible for that. I realize now that I probably did the best I could. And the baby was doing much better the next day, though not nearly out of the woods. I'm glad I had the same assignment the following night - gotta face those demons.
  10. by   Mimi2RN
    I'm glad the baby is still hanging in there, and you took care of it. Some docs will never take suggestions, no matter what you ask. It's a shame that you have to wait until dayshift, or the next doc, to get anything done.
  11. by   sparkyRN
    Gompers, you talk about it looking like the night shift is slacking when things don't get done on your shift then the day people come in and all of a sudden its all action....

    This brings up an interesting point. Some nights, doesn't it seem that the NICU is really an ICU from 7AM to about 5PM. Once the attendings are gone and it's just the residents, the attitude is one of just "getting by" until the morning. I love it when we have an NNP there for the night. Most of them appreciate that babies can't always wait until morning to get a septic work-up. It aggravates the stew out of me when I know a baby is getting sick--maybe it's poor feeding, distended belly, increase in apneas/desats-whatever, and the resident looks at me and says "babies do that sometimes." :angryfire Then I have to persist and nag until something happens. Thankfully our charge nurses are great back-ups and will join in the persist/nag routine until we wear one of them down. Luckily, our nighttime coverage has improved alot over the past year and this becomes an exception instead of the norm. My concern now is the nurses that will let things slide until morning.
  12. by   Gompers
    Quote from sparkyRN
    Gompers, you talk about it looking like the night shift is slacking when things don't get done on your shift then the day people come in and all of a sudden its all action....

    This brings up an interesting point. Some nights, doesn't it seem that the NICU is really an ICU from 7AM to about 5PM. Once the attendings are gone and it's just the residents, the attitude is one of just "getting by" until the morning. I love it when we have an NNP there for the night. Most of them appreciate that babies can't always wait until morning to get a septic work-up. It aggravates the stew out of me when I know a baby is getting sick--maybe it's poor feeding, distended belly, increase in apneas/desats-whatever, and the resident looks at me and says "babies do that sometimes." :angryfire Then I have to persist and nag until something happens. Thankfully our charge nurses are great back-ups and will join in the persist/nag routine until we wear one of them down. Luckily, our nighttime coverage has improved alot over the past year and this becomes an exception instead of the norm. My concern now is the nurses that will let things slide until morning.
    Most of our nurses don't let things slide, but there has definitely become a "getting by until morning" kind of a mentality on our unit for awhile. We used to have NNPs at night, who only worked 12 hour shifts - therefore they didn't sleep at night and were available all shift to us. Since we stopped doing that, it seems like we get nothing done on nights sometimes! I hate the old, "we'll talk about it on rounds tomorrow" argument - when it's 11pm and rounds aren't for 10 more hours, but RIGHT NOW the baby is white as a sheet and is in a constant state of apnea, things like that!

    Hopefully it well get better over time, not worse. Also depends on the docs who are on call, and just how sick the baby actually is.
  13. by   Gompers
    I was just reading the post about how to deal with the hard parts of NICU nursing and felt like reading this post over again. That night still comes back to me whenever I read my first post in this thread. I had kind of a similar night a few weeks ago, but I felt a lot better about it. There have been three or four times since that night that I've asked for Dopamine all night long, only to have them finally order it at 0730 right in front of my face when I'm giving report to the day shift RN. :angryfire

    Oh yeah, and an update on that sick little baby from this thread...

    Had a few more surgeries and lots of issues, but finally made it to full feeds and room air. He had a very nice personality, even though he was pretty "chronic" and was a very nice little guy to take care of. Didn't PO feed very well, but mom learned to do NG placement and feedings and will continue to work with him on PO feeding. She wanted him home for Christmas, and there didn't look like there was any way to honor her wishes because he had so much going on and so many setbacks.

    Well, by some miracle he was discharged on Christmas Eve and hasn't been readmitted so it looks like all is well!

    It's all about happy endings in the NICU.


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