A Sunday night shift in a Nicu in south Brazil

( My english it's not 100%, thank you for your patience. )

I was young, that was my second job. I had graduated from nursing school a little more than a year before that night, I was 20 years old.

Ever since I pass my initial exam to enter nursing school (I was 16 years old when I started) I've dreamed of working in that hospital. It's one of the best hospitals in our city, big, well equipped, and the nurses were well paid, at least for our culture.

My supervisor only worked days, and they were short on the night shift, so a little after a month of training I was transfer to the Nicu/Picu RN position. I was the only RN in the unit, and during weekends, the only RN to answer for NICU, Cardiac ICU and ICU. Yes, 3 units, 1 RN.

I had several CNAs under my watch, actually the ratio for the NIcu was 1 RN for 15 patients + 6 CNAs.

That night we were full. For some reason women were giving birth exactly that night, mostly preemies. I remember having 5 preemies, 3 on ventilators, 1 on cpap, 1 stable and 1 woman on the birth center with severe eclampsia, which was almost always equal to one more baby for us...

On the other side of the unit there was 5 pedi patients. For some reason I don't remember much of those patients, except for one little girl, about 2 years old, with Down syndrome, pos-op for a cardiac defect, with 5-6 IV infusing pumps, ventilator and all the other stuff that cardiac patients have post-op.

By the middle of the night, 2 out of my 6 CNAs were resting (Brazilian protocol stands you get 1 hour break every 12 hours shift) and I was in the unit with the other 4 CNAs when the phone rang, our next patient, another preemie, was on the way.

I ran to wake up the doctor on call, got everything I could think it will be needed, call for two of my cnas to help me admitting the baby, and left the other 2 taking care of the other 10 patients.

Usually I was able to admit one baby and keep him stable in a matter of minutes, but that little guy was really struggling, and we had a lot of work just to keep him breathing.

After close to 2 hours working on the little guy, he was finally stable, my other 2 cnas were back from break, and I was relief that our 11 patients were alive. It was close to 5:30 in the morning, and I had only 1:30 hour left on that shift. I still had sooo many things to do, the unit was a mess, and I was late.

I stop to think what should I do first and right on that moment I notice the little post-op girl becoming more and more restless. I got closer to her bed when I noticed the K IV site was infiltrated, her hand and arm were bigger than her thigh and she couldn't scream in pain because of endotraqueal tube. My heart stopped at that moment. I wanted to cry, but I had to keep working. I pull the IV off, began every measure to relief pain I knew. I couldn't stop looking to her face and trying to imagine how much pain she was feeling. I asked the doctor to sedate her, it was inhuman to let her awake that moment. I kept thinking "how did this happen? ", "for how long iwas that IV infiltrated?", "Why I didn't notice before?", "Why nobody noticed before?"

In a matter of seconds my shift was over, the morning shift team had arived but I just couldn't leave her bedside. I kept working on her until my supervisor came and sent me home, that was nothing I could do to change what had happened. She had second and third degree burns from the K solution in her arm, she was schedule with plastic surgery to work on that arm, but the scars will be there forever.

I got home that morning feeling a complete failure as a nurse. That gril was already going trough so much in her life, she did not deserve a gross error like that tho happen. I thought I should quit, and never came close to a patient again.

After talking to my supervisor I notice that what happen was not so uncommon under the circumstances. I was the ONLY RN signing for 3 ICUs that night, it's impossible to do it, and the worse part is, my boss knew it!
It's sad to admit that in my country ratios are not followed as it should. I believe the fear of unemployment, and the excitement of a new grad didn't helped me see that. I accepted that position, I agree to work that shift, I wanted to proof I was a nurse, and I was wrong.

A few months after that, my husband got a job opportunity in the US and we moved. After coming here I was able to see another world, a different way of nursing. Sure there are still many things to change here, but I'm grateful to God for this place.

It has been over 6 years since that night, and I don't know what happen to that little girl, much less to all the other patients. But I do know what happen to me. I learn my limits, I know I can only do so much, and I don't have to prove anything to anybody. And if you can learn something from my experience, please learn to say no and learn to ask for help when you feel you need.

Many things have changed in Brazil in 6 years and I hope Brazilian nurses learn to fight for better work environment, and fair ratios, for the sake of our patients.