Emotinally Draining

prmenrs, RN · Aug 1, 2006

When you feel like this, you need to go to the area of your unit where you can hold and feed a baby who's been sick and is now getting ready to go home. Sit there, hold and rock that baby.

I worked in a unit where we all worked in both the ICU and convalescing areas--so you could balance the adrenaline w/the nurturing. Nurturing goes both ways!

Also, make sure you're getting enough "fun" stuff to do in the rest of your life!

Gompers, BSN, RN · Aug 1, 2006

Our NICU is set up so that one night you could be taking care of a very critical baby, and the next you might be caring for 3-4 "grower-feeders" instead. It does help do spend time with those kids, I agree with prmenrs. You need to remind yourself that most of these babies DO get better and most DO survive. When you're in the ICU area all the time, it's easier to get burnt out and forget why we're doing this.

Some units have debriefing sessions set up after a traumatic patient death. Mine doesn't, but we spend time talking about it amongst ourselves and support each other that way. There are some deaths that were so traumatic for us that we still talk about them years later. We also let ourselves cry whenever we need to, whether it's excusing ourselves for a few minutes or to just cry right then and there with the family. If I've had a REALLY stressful night, I will go to my car after work, get inside, and proceed to scream and cry until it's out of my system. THEN I start the car and drive home. It helps relieve some of the tension, both physically and emotionally.

We go to a lot of funerals. Management tries to accomodate this as much as possible, changing our schedules at the last minute so we can attend. Some places don't encourage this, but I'm glad that we do. Formally saying goodbye to the baby and family really helps with closure, and it helps the famlies too. Sometimes we're the only ones there, besides the parents, that even got to meet the baby.

The first few years are the hardest, I think. It doesn't get easier, exactly, it's just that you find ways to deal with the pain. It will never stop bothering you when you lose a baby at work. If it does, then it's time to get out of the NICU. The death of a child is always going to be traumatic. But after you've been in the NICU for awhile, you start to understand the fact that not every baby can and should be saved, and that there are worse things than death.

I'm so sorry that you're having a hard time. Come here anytime you need to talk, okay?

prmenrs, RN · Aug 1, 2006

When you have a baby who dies on your shift, hold that baby and say good-bye. Never be afraid to cry in front of parents--it means a lot to know that their baby was loved in the NICU. Years later, families will comment that "even the nurses were crying". (That's true for any pt's family, not just babies.)

If a baby is going to be taken off of support and the family is not there, hold that baby. Try to take him/her to a private spot, off the monitors, and just check the heart rate w/your stethescope. Yes, you'll cry. It's ok.

The point of going over to the convalescing side once in a while is just what Gompers said--to remember why you're there.

RainDreamer, BSN, RN · Aug 2, 2006

Thanks prmenrs and Gompers.

I think you're both right that it would help to comfort a dying baby, to cry with the parents, etc. I wasn't there when these kids died though, well I was there when they took the ECMO kid off .... but I was in a different pod. I just keep thinking about those parents of the gastroschisis baby ...... they're in my thoughts and prayers.

So many people say not to get attached and blah blah blah ..... but I think that's pretty much impossible. Yeah you don't get attached to every single baby you take care of, but I got pretty attached to that one kid because I formed such a bond with the parents. It was impossible not to. Is that bad? It sounds like you two think it's not bad, so that's good to know .... I know you're both great NICU nurses that have done this for a long time.

Going and feeding a big feeder/grower would indeed help when feeling down, I'll have to keep that in mind.

Thanks for listening, it really means a lot. I'm so glad I have this site to come to and know there are people that know how I'm feeling. Thanks again.

BlueYYsRN · Aug 3, 2006

Our unit is very sad right now. One baby we had with us for over five months and had been discharged home a few weeks ago came back through the ER coding and was later taken off life support. Another we have had for six months was set for discharge on Friday but started getting sick a few days ago and ended up reintubated on nitric and not expected to make it.

Sometimes it seems so unfair to work so hard and invest so much in the babies and the parents just to lose the baby months down the road. Sometimes the sad things feel like too much to bare. But I think God was looking out for us this time because before everything started happening the other night a familiar face peeked through the door. She asked if I remembered her and I told her her face was familiar. Then she said come here I have something to show you and she said her son's name and I knew right away who she was. There in the hallway was a perfect 3.5 year old boy who had been the first child I had ever cared for on a jet vent. He was standing there holding a teddybear smiling and talking...just perfect except for the small scar on his neck where his trach had been. She had been a very nervous mother and I had been a very nervous orientee back then. I have seen and done so many things since I started this job...good and bad...but there standing before me was the reason we do it. That mom will never know how the timing of her visit helped us with our perspective in dealing with the sad part of our job.

prmenrs, RN · Aug 4, 2006

Sometimes, I get the "why's", too. Why did we care for this baby for all these months, only to have it taken from the parents (and us)? Why was this child born to these parents and that one born to those parents? It all seems so unjust.

In this case, it helps to be even a little bit religious. It helps to be able to say, OK, God, I know you have a plan. I don't know why this happened, I have to trust that You have a reason, even tho I will be unlikely to know that reason. I will choose to believe and trust in Your love and in Your plan.

There are those who will scoff @ that reasoning. For me, this is what works. I could wear myself out railing @ all the "not fairs". I don't want to do that. This is my solution.

leslie :-D · Aug 4, 2006

In this case, it helps to be even a little bit religious. It helps to be able to say, OK, God, I know you have a plan. I don't know why this happened, I have to trust that You have a reason, even tho I will be unlikely to know that reason. I will choose to believe and trust in Your love and in Your plan.
There are those who will scoff @ that reasoning. For me, this is what works. I could wear myself out railing @ all the "not fairs". I don't want to do that. This is my solution.

i have to agree with this.

as a hospice nurse, all my pts die.

some have better deaths than others.

but rather than question "why" in spite of aggressive interventions, it always helps me to 'know' that God has His plan; even if it's not readily known to man.

it calms me to know that i can leave the burden w/Him, and He will take care of my pts who suffered at the end.

leslie

TennRN2004 · Aug 4, 2006

I posted a thread on my nephew about his passing today (27 weeker). It is very ironic that when I started as a new nurse 2 years ago, I interviewed and had a job in the NICU. I loved it, loved the babies, but it was a level III where the sickest of the sick end up. The NM told me in the interview they have grief counseling for the nurses to help deal with the babies who don't make it. I had a month before the position was going to be officially open, really thought hard about it and I decided I just could not deal with taking care of these sick little ones emotionally and be able to support the families the way the need at this desparate time in their lives. I am very thankful for those of you who do it day in and day out. When you feel down, just remember that the babies all feel and hear your love and the parents do too. Even though every baby may not make it, it means a lot to know that you all tried and you care, and it makes it easier I think for the parents to let go because they see how vested you are in these babies and really want to do everything reasonably possible to save them. I sincerely think this is one of the hardest jobs in nursing, and I admire each of you for doing it and making a difference.

leslie :-D · Aug 4, 2006

i remember my son being in the nicu, just as if it were yesterday.

for 2-3 wks, we weren't even allowed to touch him: the nurses said he wasn't feeling well.

i remember looking at ea nurse as my sons' mom, dad...even as GOD...that is the depth of gratitude and safety i felt as i watched my son struggle to survive.

there's something so gut-wrenchingly personal about helping one so frail and sickly, to either survive and live, or to help them peacefully die.

both of these scenarious typically present themself in nicu and hospice.

it's a privilege to assist in either.

so while it's perfectly appropriate to experience such intense emotion, coping strategies must be in place, or we will all burn out...some, never bouncing back.

for as passionately as i love the specialty of hospice, nicu will always elicit the humility and awe that can literally bring me to my knees, in reverence and admiration.

i would have left hospice yrs ago, if i never found ways to deal w/those who suffered before they died.

talking with God has helped me enormously.

i talk to Him dozens of times daily.

and as much as i hate it, exercising, running was always a saving grace.

be kind to yourself; to your body, mind and spirit.

we need you today and forever.

leslie xo