it's so frustrating..

preemieRNkate, RN · Mar 5, 2008

Or when all night long you're calling the docs in their call room, trying to get them to come out and look at a baby and they won't? And then at 6 am when they do come out, they start writing you a million orders and act like you didn't do anything all night long?? Yeah, that stinks. The only advice I have is to document, document, document! Write who you called, when you called and what was done. Also, keep going up the line. Call the resident, then the fellow, then the attending if you have to. Get your nurse manager or charge nurse involved. Sometimes they'll listen to them even if they won't listen to you.

It really stinks, and no matter what you always second-guess yourself.

Sweeper933 · Mar 5, 2008

This is definitely one of the most frustrating thing that us night nurses have to deal with!

I remember a baby a few months back... he had spontaneously perfed a few weeks ago and was getting better (former 24 weeker, was still on pretty high vent settings, but his belly was getting better...) His belly started blowing up (again) in front of our eyes. We call the resident (and fellow) in. We finally talked them into getting an x-ray. The x-ray did show free air in his abdomen. However... he had been having small amounts of free air in there for a few days. Our docs and surgeons knew about it, they were hoping it would resolve on it's own since it was such a small amount.

Well, his belly was still blowing up right in front of us, and he was quickly climbing on his oxygen requirements. The fellow actually said "this can wait till morning, I don't want to do anything about it right now"

Yeah... not so much. Mind you - this was the same fellow that couldn't intubate to save her life - anesthesia had to be called TWICE because she couldn't get kids intubated and were starting to code them. So we called the attending on call that night, filled him in on what was happening, he took a look a the x-rays from home, and said he was coming right in. He came in, and immediately angiocathed the baby and got 40+mLs of air out of his abdomen immediately. Yeah... the fellow got chewed out big time for that. After that night, she wasn't allowed to be on call w/o an attending in the building to back her up.

Always go with your "nursing 6th sense"... Just keep going up the chain of command.

acerila · Mar 5, 2008

Well, his belly was still blowing up right in front of us, and he was quickly climbing on his oxygen requirements. The fellow actually said "this can wait till morning, I don't want to do anything about it right now"

Exactly the same situation. Except that baby had no previous belly issues and was fine one day, going bad when I got him and dead when I was back for the next shift. He straight out said that he was not worried and that he doesn't want an x-ray at this point. He finally agreed to one a few hours later after I asked him for the second time. This was an attending that has been there for 20+ plus years like most of our docs. Some of them are great..others never listen and do their own thing and only agree to anything if the baby is right there about to code (or so it seems). In fact, after all this, I have heard from someone that this doc will never order anything if you suggest it even if he knows that it's something that should be done. He also kind of came across as not wanting to ordered anything on a baby that's not his because he wanted the baby's primary to come back and deal with all this and didn't want to step on any toes (common for the doc on call to write orders just to have the primary come in the next day, get mad and change everything).

hopinginlv · Mar 5, 2008

Acerila know that you did what you could!

This strikes me to my core because my son is only alive today because his primary went to another dr after railing for hours against the on assigned to my son. She could see the drastic change he made in ~4 hours and she was right. I wish more drs would trust the nurses who spend 12 hours with the patient...

Sweeper933 · Mar 5, 2008

I wish more drs would trust the nurses who spend 12 hours with the patient...

Seriously...

Especially when it's one of the primairies for the baby, and it's a moonlighter of sorts (or any doc who barely knows the kid). Thankfully 99% of our docs are really good about listening to the nursing staff when it comes to stuff like that. They trust our assessment skills and they know that when we are saying that our primary "just doesn't look right" - that we are usually right. They usually have no problem ordering an x-ray or getting a blood gas to see what's going on...

Imafloat, BSN, RN · Mar 7, 2008

We are lucky in that our residents will pretty much write just about any order we ask for. This came about because last year we had a resident who blew off a nurse who has been on our unit since 1977 when she told him the baby's BPs were dropping and the baby just didn't look right. After a few hours of this the nurse went over his head. The attending ordered a septic workup, but the baby died by the end of the shift, she was septic. The resident was like, oh but her temp was fine...I wanted to choke him. The situation may not have had a different ending if he had acted in a more timely manner, but we will never know.

wensday, MSN, RN, APN, NP · Mar 19, 2008

It's the same over here in England. You know your baby and you know your baby is not the same as he was when you arrived. You tell the docs and they give you the 'ah look at the nurse thinking she knows something' look. :madface:

elizabells, BSN, RN · Mar 20, 2008

This happened to me the other night - li'l 25 weeker on vent CPAP (we usually use bubble, so vent CPAP is for kids with apnea issues) with a big, but soft and otherwise benign belly. Failed ibuprofen for his PDA. Had a PRBC transfusion in the afternoon. Has his bradys and desats, so I go through the routine each time, stim, aspirate his OGT, bump the FiO2 a little, and all is well. Then, one time when I'm aspirating his belly, I get this BLOB of dark yellow/green ... snot. With blood in it. Call the resident, she comes over along with one of our NPs who is NOT taking care of this child, and is also one of the most dismissive (of nursing input) providers we have, and also often wrong. The NP just LAYS into me for aspirating the kid's belly! Excuse me? It's part of the algorithm! So after she has the resident convinced I'm an idiot, she finishes with "You only aspirate it if the baby has a bad spell!" THAT'S WHAT I WAS TELLING YOU! But by this time it's too late, the resident thinks I'm a nut, and anyway the baby had a belly film earlier that day... blah blah blah.

0655: We have another brady/desat. I aspirate the belly. GREEN. Not a lot, but dark. I turn to show it to a senior nurse near me, she says call the resident again, I turn around... HR is 35. In there like a flash, bagging and flicking and rubbing. By 0659 (yep, ONE MINUTE BEFORE SHIFT CHANGE) I'm on the code button. End up intubating the little booger when we'd normally be giving report.

To her credit, the intern did apologize later. Don't think she'll be listening to that NP anymore, which is fine by me.

acerila · Mar 20, 2008

I had another baby getting sick today. I was proud of myself because I feel like with each day I work there I begin to notice the little signs of a baby going bad more and more. I was worried about his tummy from the start based on that past experiance I posted about in here so I was definatly keeping an eye on it. I knew that this time I was going to have to be more persistant with the doc as well. Thankfully, the doc that was on call was amazing. Everyone there hates him and thinks he is mean but he does listen (unless he feels like you complain about something that is a normal part of prematurity) &will always write orders and is really on top of things. He was worried about the belly as well and a really bad blood gas had us convinced that that might be the issue. We took x-rays and he was on the phone with the radiologist and the surgeons right away and was in there checking on the baby a lot in addition to all the times I was calling him. Lets just say I know who I want taking care of my baby if I ever have on in the NICU.

It's weird because we are such a big NICU but we don't really use our NPs or residents. The residents really don't do much on their own and the NPs area always on the computer but they never look at a baby (&no one trusts their opinion and goes to the docs anyways regardless of what they say).

preemieRNkate, RN · Mar 20, 2008

It's weird because we are such a big NICU but we don't really use our NPs or residents. The residents really don't do much on their own and the NPs area always on the computer but they never look at a baby (&no one trusts their opinion and goes to the docs anyways regardless of what they say).

We LOVE our NPs! We always go to them for their opinions, even on babies that they are not caring for. The residents only spend a month out of each year here, so they don't always do a whole lot. There are some fellows I like and others I can't wait for them to leave! We also have an attending in house 24/7, but they sleep at night unless something big is going on.

SteveNNP, MSN, NP · Mar 20, 2008

Here, we use our NNPs all the time. They are assigned to the DR/ORs, round on their own pts (including pre/postop cardiacs) and are always getting bugged by the residents and fellows for their advice and technical skills.