Bad night in the NICU

prmenrs, RN · Mar 19, 2015

Sometimes, you gotta say, ya know, I have a bad feeling about this, and I need your help! Whatever the outcome now, if you had left a kid w/ a blown belly for the next shift, it would have been worse. And every one would have turned and said, why didn't you tell us? All the "but I did!" wouldn't help.

I think it's ok to push a little harder. "Please give me a hand--this kiddo is headed for the drain or the OR, not sure which!"

And, lastly? IMO, you did a good job. Your co-workers, not so much!

RNjazzie12 · Mar 25, 2015

Hey OP,

First, you did what you had to do to advocate for your patient. That being said, I think you're being hard on yourself. I, too, am very hard on myself and tend to over-think things at times. But one thing I have grown to learn in my nursing experience is to never be too shy to ask for help. If I am very behind (which has happened to every nurse possible) I would want someone to help me as well.

Where I work, our shift has a very good rapport. We help each other out and look out for each other. We are a smaller unit so if someone gets behind, you'll have at least 2-3 RNs willing to help. I almost never have to ask because they can see when it gets tough, especially if we have a new admission. Not every unit is like ours, however, I still feel it's necessary to be proactive and ask for help when needed.

You did what you had to do. Nursing is tough at times but remember why you became a nurse :). Don't let the small stuff like gossip and work drama hinder your reasons for doing what you love. Hope this helps!

J.

mskangaroo · Apr 2, 2015

You did the right thing! Good job! Your coworkers, however, are terrible teammates and I'm sorry they weren't as helpful as they should have been.

tallynurse · May 7, 2015

You did good. Don't beat yourself up over it. NEC (which I'm assuming is what your baby has) can seem to pop up extremely quickly and make a baby sick quickly. So while you may think you should have noticed it sooner, there might not have been much more to notice sooner. I think most nurses I've worked with would have done the same thing, watch it for a little while first unless it was a large jump in girth or there were other symptoms. As for feeling like you shouldn't be asking for help, get rid of that idea. Everyone needs help sometimes and especially as a new grad and when one of your patients gets sick suddenly. I'm sorry the nurses weren't nice about it. Hopefully it was just an off night for them. But never be afraid to ask for help.

R1515J · May 9, 2015

I wouldn't beat yourself up. Gut issues are hard because all you can do, really is watch and wait. As the bedside nurses we definitely know our babies better than the docs lots of times because we are there constantly to see the subtle changes. But, I have also had patients who I was sure were headed in THAT direction (you know where) that wound up being benign symptoms. It's our job to advocate for your patients and honestly, you'd be scrutinized even harder if you didn't and something happened. Also, you should be able to count on your co-workers. The NICU is a 24 hour operation and the next shift should be able to pick up where you left off. We don't just wrap up our days with 100% of our tasks completed like an office job. When we get a sick kid in our unit, that baby becomes everyone's priority. Everyone pitches in. Same with an admission. They shouldn't leave you drowning. I'm sorry you had a bad day, but good job on catching your baby's issue! That's a sign of a good NICU nurse!

LisaNICUrn, BSN · May 14, 2015

I read your comment a few weeks ago and remembered it after a night I had about a week ago and wanted to respond to your post. I've only been in the NICU for 6 months, a nurse for 2 1/2 years (but the 1st two years was in a psych hospital) I absolutely love working in the NICU. Our hospital is wonderful, doctors are wonderful, co-workers are great. We are a level 2 and 3 unit, with a newly added 12 bed unit where we now have our most critical babies. It's great because newer nurses are able to be in level 3 and gain experience. That was me last week. I always ask to be in level 3 if possible for the experience. I was admit 1, very excited. About 830pm (I work night) we got a call for a transport from a hospital 10 minutes down the road for possible seizures. Sounded fairly simple and not too complex that the coordinator let me keep the admit. When she got to us she was clearly in seizures, we hooked her up to EEG, started an IV, antibiotics, phenobarbital, and 2 fluids. a few hours later, no change, gases showed major acidosis, our PA put in lines. I was getting so overwhelmed. but I had 2 nurses in the room with me that just jumped in and started doing things for me. This was my 2nd admission, and I was lost, but they helped without me even asking. The doctor and PA helped me, explained things to me, and was very patient with me all night long.

She was in no respiratory distress but was grunting. The doc said it wasn't respiratory related though. All that we were doing did nothing to help her, We all felt a little helpless, didn't really know what was going on. Well I had to wait each time I needed to do something because by this time she was so critical I didn't know how to do things. I felt bad, but no one complained or anything. They finished their 400 assessments on their little ones and started helping me. None of us had charted since about 11pm. We did all we could until day shift arrived, I gave report and then we all started charting. The other 2 nurses didn't leave till about 830 almost 9:00 when we are generally out about 7:45 at the latest. The day nurse picked up where I left off, did the admission history for me, did the Kardex for me, all the little things I didn't have time for. My admission was now a 1:1.

I came back the next night and was waiting for huddle. We are all sitting talking and one of the nurses mentioned a code earlier in the day. Someone mentioned it was my admission. I was very shocked, as when I left my baby was on RA, no respiratory support at all, sats were 100%. Now she was on an oscillator, had coded, respiratory system completely shut down. She was on the brainz monitor and the monitor was flat, her brain was extremely swollen, fluid around her lungs. She was now the sickest kid we had in the unit. Doctors finally figured out she had HIE. The hospital she was transferred from thought she was having seizures but still fed her twice, and just said they were going to "monitor" her for the entire day before they called up. If we would of received her within 6 hours our cooling team could have cooled her and possibly had a different outcome for this little angel.

I wrote all this to say I know how you feel. I left her with sats of 100, no respiratory support, possible seizures, and thought we would figure out a cause and start treatment. When I returned she had coded, on an oscillator at 55% o2 and our sickest baby in the unit. I felt like a failure. Was there something I could have done, something I should have noticed? I felt so bad but everyone has stressed by the time she came to us it was too late, she was already 12 hours old and the swelling was already taking over, and we couldn't have realized it at that time. It was a horrible night for me, I went and checked on her whenever I had a chance and she looks like a totally different little baby. Thankfully the mother and father still thank me every time they see me for giving such good care when she arrived and I try to just comfort them as much as possible. It is really hitting me hard because it was only my 2nd admission and it was just really rough.

Also, I would talk to a coordinator or someone about others not helping. That is horrible that they would not help. It is ok to leave things for day/night shift because it is a 24 hour revolving unit and you can not finish everything, but there are things that you should do. Your co-workers should also be willing to help you, especially in a situation like you were in. I'm sorry that happened to you.

Trauma Columnist · May 14, 2015

Just a quick and gentle staff reminder - the internet is not private. Revealing too many details and possibly using your real name as your user name could make you very easily identifiable.

Please be cautious.