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my first day to come home and cry... little pt had an emergency trach change


Oh boy. I have such a long way to go! Being a nurse is harder than I thought and I feel a lot less capable than I thought I would be!

Background info: I am a pediatric homecare RN (what I do is a lot more like private nursing). I am working with a family who has twin babies, both trach/vented but only one on the vent 24/7. I work with one of the babies and there is another nurse for the other. Today marks the end of my first week off orientation.

So, this family has been hard for me to start working with - mom is kinda hard to please and very young. She openly has her favorites among the nurses and has given me the run around so far. I would do anything for her to think that I am a wonderful nurse for her baby.

Today, I had just run a neb for the baby and suctioned her and I went to go get her meds ready in the kitchen. I was going to pick her up and take her with me, because the couch blocked her from my view when I was at the table. Mom was nearby and insisted that I leave the baby on the floor in the living room (she could see the baby from where she was) Well, go figure, 2 seconds later the baby starts making funny noises. Mom looked over and she had her fingers in her trach nose. Mom picked her up and her trach was partially pulled out and she started turning blue and gasping. The other nurse and I started running over - the other nurse took over, grabbed the baby and started calling for supplies. I ran to the bedroom for supplies because I figured that was the fastest (not remembering that we had an emergency bag in the living room)....grabbed the smaller size trach by mistake, but it didn't matter because by the time I got back to the room Dad had already gotten the emergency bag and oxygen out. Before I could blink, mom and the other nurse had the trach out and a new one in. I did manage to grab the ambu bag and give a couple breaths with O2 ....the baby started breathing fine again, we weaned the O2 down and she was fine.

I was so scared. I still feel like crying and I wish to goodness that one of my nursing instructors was with me to tell me I did ok and to give me a hug. I feel like I didn't do much and also like I didn't have a chance to do much - I mean, I wasn't about to grab the blue baby from the other nurse (mom's fave nurse btw) and tell her she was doing my job... At home now, all I can think was - what could I have done better? I wish I would have been more on top of it. I still don't know what happened... the baby's lungs were so clear all day and I had just suctioned her.... We couldn't find a mucus plug in the trach that we pulled out... It must have obstructed from being partially pulled out? I wish mom and dad could have seen me respond better in this situation. Mom reported to the night nurse that the other nurse did everything and that I ran for the wrong supplies...

AHH! I just want SO badly to be a capable, great nurse. The kind that parents and coworkers can be confident in...

It's so different now than it was in school. In school and in my nursing internship, I was surrounded by instructors, classmates, and my wonderful preceptor who wanted me to succeed, who encouraged me and stood behind me and told me that I was going to be an awesome nurse! I did fantastic in school and always felt pretty capable. Now I struggle with critical coworkers and families and there is no nursing professor ready to back me up. Part of me just wants them to know that I can do this job and do it well! I KNOW I can!!! I am doing my absolute best! And part of me is scared, thinking - maybe I'm really NOT capable? I realize how little I know... How many hours I could and should spend studying up on things so that I would know them better...

But I guess the bottom line is, the baby is ok. And I will keep learning...

Anyone have any words of wisdom for me?

Hugs! Sorry you had a bad day. I'm a new RN myself and I asked myself if I would have done better but I don't think so.

Thank Goodness there was another nurse available to help.

I'm sure every new nurse goes through some kind of emergency situation like that for the first time and wonders the same thing"could I have done better". I think you did great! It 's got to be hard doing home care like that though because you are so much more alone than if you were in a hospital. :yeah:


Specializes in Emergency room, Flight, Pre-hospital.

I'm sorry you had a bad day, but you had another nurse with you and everything turned out fine. It is frusterating being new, and not knowing, but it gets better with time and experiance. Right now think about being a sponge and soaking up everything you can, if something scares you or doesn't make sense...ask another nurse, or even the parents. The parents of chronic kids know ALOT about their child and their childs illness. Don't be afraid to tell them that you are a new nurse. I belive that you will be a great nurse :)


Specializes in Home Health/PD.

I believe you did a wonderful job and I'm sorry that you had a stressful day. I too am an new grad (LPN though) and work in home care as a private duty nurse. I have a pediatric client who's trach has come out two different times while I've been on. It's very scary. I cried the first time it happened because I wasn't sure if I did everything correctly, but once I got home, I settled down and remembered that airway is first, I put the trach back in immediatly, and called his parents out of bed to check everything. The second time I probably should have grab new trach supplies, but I was nervous, and all of the extra trachs and supplies were pushed to the back of the changing table, not close to the bed like they should be, so just put the trach back in. The parent's were notified so that they could change the trach later if they felt it was necessary. Sorry for venting on your post, but I thought maybe sharing my experiance would help ease your anxiety about the situation.

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