A Sunday night shift in a NICU in south Brazil

Nursing in Brazil is so different in America! My experience on this one Sunday morning has stuck with me. Experiencing NICU in both countries really has given me a better perspective. Nurses Announcements Archive Article

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 transferred 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 were 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, post-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 CNASs 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 relieved 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 the 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 at 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 arrived 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 scheduled 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 girl was already going through 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 a better work environment, and fair ratios, for the sake of our patients.

caminb

About caminb

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Thank you so much for sharing your story!! You must be one heck of a nurse to manage what you managed, not to mention the skill your LPNs and CNAs must have had as well. One of the hardest things new grads face is either gaining enough confidence to do their jobs or having an over abundence of confidence and learning their limits.

I'm glad you're here - and anyone that has a problem with your English, just ask them to speak with you in Portugese. You are bilingual, much more talented than me. :)

Specializes in IMCU.

I can't imagine how you must have felt as a new grad having all that responsibility. It seems like so often things are thrust upon us that we are no where ready for. I was given 3 very ill patients to care for when first off orientation and I thought that was bad. Your situation was unreal. Did you have any LPN's or was it just CNA's working with you? Either way, the demands on you were horrendous. I think you must be one heck of a nurse and person. Forgive yourself for what happened to the child, you didn't cause it and it would have been impossible for you to have monitored everyone the way they needed monitoring that night. We are blessed to have you.

Mahage

You are awesome! Everything happens for a reason. You did your very best. Credo! Voce parece Mulher Maravilha! Hey, if you have an account on orkut, please let me know. I lived in Brazil for a year when I was in high school. Feel free to contact me directly.

Beijos,

Chris

Specializes in Maternity & newborn.

glad to hear you are in the US where there are better working conditions (better care for patients) than in brazil. please don't beat yourself up over a mistake any person could have made. you should not feel guilty. i hope you can move on and stop wondering "what if", because you did your best at that time. i wish you the best of luck thank you for the insight of being a new grad in brazil.

Thank you for sharing this. The nursing shortage may be bad here, but I have an idea that it is even worse in places like Brazil. Don't be too hard on yourself concerning what happened in that NICU in Brazil. You honestly did the best you could under the circumstances, and all who were involved were just that much more better off because you were there. In spite of all of the problems we have here in the U.S., we are still better off here in this country than in many other parts of the world. Your story helps put things in perspective.

I would like to thank you all for the words of incentive, I really appreciated!

I wish all nurses who work in US had a chance to go somewhere else to in the world to really see how people are treated around the world. I feel sad sometimes when people here don't appreciate everything they have. I tried to learn from my experience, I believe it's the best thing to do when bad things happen

Thank you all!!!

Specializes in trauma, ortho, burns, plastic surgery.

Camind you are a good nurse, never doubt about! An your english is better than mine, not doubt again about. Take day by day and smile. I know how is to work outside of US with goods and bads... is another life...I totally understand you, but even like that a nurse is a nurse wherever she will be!

Specializes in geriatrics, telemetry, ICU, admin.

Thank you; you are incredible.

Specializes in Ob/Gyn - NICU.

Just wanna make some points clear

It's complicated because what u call CNA and LPN here are very different of what u have there.

We do have CNAs working in NICU and PICU in some places but you can see that hospitals are replacing them for LPNs and in São Paulo and Rio de Janeiro top hospitals they're only hiring BSNs.

I'm a new grad nurse. Unlike most countries above Equador line, there are too many nurses here - BSN, LPN and all that jazz -. So, you can imagine how hard is to get a job. From the class I graduated, less than 10% got a job.. and I graduated almost a year ago. That said, I had the chance of getting a job in one private hospital but I refused. and you know why? because I knew that hospital, I knew IH rates are pretty high but mosly I knew that I would never feel like a nurse in that place. But like article wrote... I may not accepted that but someone else did. So, how is it going to end?

Article writer pointed out that she left Brasil 6 years ago. Well, nowadays new grads are not going to NICU, ICU or Cardio anymore... you gotta have at least 2 years exp. to try to get a job there. And a postgrad course and/or Nursing Residency. So, we are basically going to Med/Surg, OR,ER and Psychiatry.

Nurse/ pt ratio here is shame, I must admit . Once I read that in some countries ratio is around 6-1 / 8-1 . What a dream! When I was in my clinical rotation I had 5-1 . And I was just a student ! One day, in my Nursing Management clinical in Med/Surg we had 39 pts, 2 RNs, 4 LPNs and my friend and I . Awesome, huh?

I guess that's why when I meet some foreigners nurses in chats or skype they always say brazilians nurses are very good and can manage chaos well... you wonder why! hahahahahahahahah

There are very few hospitals that make me proud of brazilian health care system and I guess they deserve to be mentioned . They are : INCA ( National Cancer Center ... it's a whole complete new world there) ; INTO ( National Ortho Hospital), IFF ( Perinatology Center, Human Milk Center) .. not to mention some private hospitals.

About payment? don't get me started on that subject ....

Specializes in Cardiac surgery ICU.

You are a great nurse, excellent. Nurses should work abroad to appreciate their home. I don't work any more, I am retired, but I too started nursing school at 17 and worked for 40!! What you described in your post reminds me of what it was like here when I first started nursing. As third year students we were in charge of the evening or night shift, sometimes with one LPN nurse, no nursing assistants, in a medical or surgical ward of 40 to 50 patients, or even in the ER. Today it is different, thank God. Students have tutors to work with, they are not in charge even when they graduate, not to speak of different ratios of nurses:patients.

You have to be proud of yourself!!

Caminb,

I need some help if you can spare a few minutes. I am an american RN and I am needing to move to Brasil for personal reasons. My portuguese is not perfect yet so I will work on that but my other problems are that I don't know how to get a nursing license in Brasil. I only have an ASN, not a BSN. Will my ASN be good enough or will I absolutely have to have a BSN? I am assuming that there is a test of some kind that I will need to take to prove proficiency in portuguese. Can you tell me the name of it please? Also if you know anything about getting a VISA that would be helpful. Any help at all that you can give me will me most appreciated!!!!!!!