Week from Hell

[Kattabba]

Okay -

I am a recent grad and have been on the job in a Level 3 NICU for 6 months. Most of that time was spent in our Level 2 nursery. I functioned independently for about 3 months handling 4 feeder/growers. I am now beginning my orientation on the level 3 side of the nursery. Well --- I screwed up big time on Monday. I hung an IV med without checking it with my preceptor (long story short I had checked it earlier in the day with my preceptor - but the pharmacy sent up half of the needed volume - my preceptor clarified the order with the Neos - finally several hours later I hung the med). Well I forgot to change the rate since the new order was twice the concentration I should have 1/2d the rate. It hung for 45 minutes before my preceptor noticed.

No ill effects - but I have been beating myself up all week -- I know better. My professors taught me better, how could I screw up so badly?

Well I filled out an incident report and the Unit Educator sat down with me today. She asked me what happened. Of course I broke down in tears as I explained the day. She said my preceptor has said that even before this incident I seem to have poor time management and am easily distracted.

Wow! Am I that bad of a nurse? Is this typical new grad behavior? I am a second career adult and these two statements seem very atypical of my past performance in corporate America.

Any advice at all is appreciated --

:-)

[elizabells, BSN, RN]

Our ECMOs are usually rock stable unless it's cannulation/decannulation time or they've decided to seize or go into SVT. Also since we barely sedate them at all, sometimes there are tense, hold 'em down while someone runs to they Pyxis moments.

[MA Nurse]

Our ECMOs are usually rock stable unless it's cannulation/decannulation time or they've decided to seize or go into SVT. Also since we barely sedate them at all, sometimes there are tense, hold 'em down while someone runs to they Pyxis moments.

You barely sedate them at all?! That's not good medical practice to have a baby on ECMO not sedated. They should have a drip of some kind to keep them calm, or Q4 ATC sedation.

[elizabells, BSN, RN]

You barely sedate them at all?! That's not good medical practice to have a baby on ECMO not sedated. They should have a drip of some kind to keep them calm, or Q4 ATC sedation.

Dude, I hear you. There's a reason I get called the "druggie nurse" and why the perfusionists are always happy to see me. The rationale (and I'm not saying I agree with it, just saying what it is) is that continuous sedation makes it more difficult to monitor for seizures, and that sedation increases V/Q mismatch, which is like the biggest drama on my unit. My feeling is that the kid's not going to HAVE a neuro status to monitor if they decannulate, and nothing makes worse V/Q mismatch than bucking the vent. The attendings can be as mad at me as they want for "oversedating", but they'd be a lot madder if the baby exsanguinates.