I don't know how to feel about this

Nurses General Nursing

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Holy cow! What a night. I'm a newer nurse working in OB. I earned my RN license last October and have learned a lot since then, but I work in a small hospital so even in the time I've been there have not seen what many see in only a few weeks in larger hospitals. Anyway, last night I take report on a new mommy and babe just about 4 hours old. Beautiful story of an ideal labor and delivery with this wonderful babe who nursed within an hour, like a champ I might add. So we are all in awe of this mom who delivered a nine pound baby quickly, no intrathecal, (no side effects) and this baby who is a dream to feed. I was told in report he did have some facial bruising from coming down so fast so not to be alarmed when I see him. I go to retrieve this baby from mommy, notice that he does indeed look bruised, and proceed to the nursery to assess him. I immediately notice his little feet are pale, he has acrocyanosis of hands, and I think, "okay well I don't see this a lot, but he's only a few hours old so acrocyanosis is WNL for his age." I take his temp and he is 98.8 axillary. I then think, "no, babe's I've cared for who are still having acrocyanosis are not usually this warm. Something is not right." I do a pulse ox and get 66%. I about $%#@. I pulled aside the other nurse working with me and said, "That number better be wrong." She said that it HAD to be. He looked totally relaxed, breathing normally with NO signs of respiratory distress. I changed probe location several times, changed probes, change oximetry machines, and promptly placed blow by to his nares. He pinked up (in his "bruised" face) and hands very slowly and his pulse ox rose VERY slowly. I then placed him under oxyhood since oxygen was what he apparently needed. I was not impressed with the slow response to O2, and the fact that he never got in high 90's like most babies. I called his doctor, informed him of the situation which he had a difficult time believing. He gave orders for a chest x-ray and said he'd be in. It turns out this kid has cyanotic heart disease and was shipped by transport team to a children's hospital to see a specialist. I got a call later in the shift from the transport nurse saying that if I had not detected the problem, acted when I did, that baby would have died in our nursery. She said that when he was declining when she and her team were there it was due to his ductous arteriosis (ductous venosis?), I can't even keep my terminology straight at this point, closing. This was the only way his lungs were getting any oxygenated blood so if it had closed he would have died. Since the transport team was there and had time to confer with the neonatologist they had determined what the suspected diagnosis was, had a drug available to open that back up, and had placed the UVC and UAC. They pushed the drug, which slowly worked, stabilized him and transported him. I was the hero of the unit with all singing my praises. I was flattered and appreciated the recognition. I even felt a surge in confidence that I met the challenge and made the right call with a baby that needed more than routine care. So, now that it has all sunk in, why do I feel so bad. By the time I had been patted on the back for what seemed like the hundredth time I wanted to scream, "what the &%#$ does it matter, the kid may die anyway!" I didn't feel like I saved his life, if anyone did him any favors it was his doctor who doesn't have one of those big egos that make them decide that they are going to keep the kid here and provide care themselves, or "watch them" for awhile. It was the transport nurse who was a pro at what she does. She was so calm, methodical, and reassuring to the parents. She's the hero. The call we got back says this kids heart is a piece of junk. He's got multiple defects that make it a very complex case. If they can save him he will have to survive at least 2 or 3 surgeries which are risky at best. So, everything that was done may be worth nothing. I'm sorry, I know I did my job and I have nothing to feel guilty about if he doesn't survive, but my efforts are worthless to his parents if that boy dies. They aren't going to be comforted by the fact that "that nurse made a good call, she caught on early on that something was not right. " Woopee, I really don't care how good I did. If he doesn't live what value did my actions have?

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Specializes in Day Surgery/Infusion/ED.

I understand feeling conflicted about this situation. However, your skills at least gave the baby a chance. You also must have been good enough at communicating your assessment to the doctor that he took your assessment seriously.

You do need to feel good about what you did. One of the problems with nurses is they often devalue their worth or credit others. You need to take credit when it's appropriate...and this is more than an appropriate circumstance.

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Specializes in CRNA, Finally retired.
Holy cow! What a night. I'm a newer nurse working in OB. I earned my RN license last October and have learned a lot since then, but I work in a small hospital so even in the time I've been there have not seen what many see in only a few weeks in larger hospitals. Anyway, last night I take report on a new mommy and babe just about 4 hours old. Beautiful story of an ideal labor and delivery with this wonderful babe who nursed within an hour, like a champ I might add. So we are all in awe of this mom who delivered a nine pound baby quickly, no intrathecal, (no side effects) and this baby who is a dream to feed. I was told in report he did have some facial bruising from coming down so fast so not to be alarmed when I see him. I go to retrieve this baby from mommy, notice that he does indeed look bruised, and proceed to the nursery to assess him. I immediately notice his little feet are pale, he has acrocyanosis of hands, and I think, "okay well I don't see this a lot, but he's only a few hours old so acrocyanosis is WNL for his age." I take his temp and he is 98.8 axillary. I then think, "no, babe's I've cared for who are still having acrocyanosis are not usually this warm. Something is not right." I do a pulse ox and get 66%. I about $%#@. I pulled aside the other nurse working with me and said, "That number better be wrong." She said that it HAD to be. He looked totally relaxed, breathing normally with NO signs of respiratory distress. I changed probe location several times, changed probes, change oximetry machines, and promptly placed blow by to his nares. He pinked up (in his "bruised" face) and hands very slowly and his pulse ox rose VERY slowly. I then placed him under oxyhood since oxygen was what he apparently needed. I was not impressed with the slow response to O2, and the fact that he never got in high 90's like most babies. I called his doctor, informed him of the situation which he had a difficult time believing. He gave orders for a chest x-ray and said he'd be in. It turns out this kid has cyanotic heart disease and was shipped by transport team to a children's hospital to see a specialist. I got a call later in the shift from the transport nurse saying that if I had not detected the problem, acted when I did, that baby would have died in our nursery. She said that when he was declining when she and her team were there it was due to his ductous arteriosis (ductous venosis?), I can't even keep my terminology straight at this point, closing. This was the only way his lungs were getting any oxygenated blood so if it had closed he would have died. Since the transport team was there and had time to confer with the neonatologist they had determined what the suspected diagnosis was, had a drug available to open that back up, and had placed the UVC and UAC. They pushed the drug, which slowly worked, stabilized him and transported him. I was the hero of the unit with all singing my praises. I was flattered and appreciated the recognition. I even felt a surge in confidence that I met the challenge and made the right call with a baby that needed more than routine care. So, now that it has all sunk in, why do I feel so bad. By the time I had been patted on the back for what seemed like the hundredth time I wanted to scream, "what the &%#$ does it matter, the kid may die anyway!" I didn't feel like I saved his life, if anyone did him any favors it was his doctor who doesn't have one of those big egos that make them decide that they are going to keep the kid here and provide care themselves, or "watch them" for awhile. It was the transport nurse who was a pro at what she does. She was so calm, methodical, and reassuring to the parents. She's the hero. The call we got back says this kids heart is a piece of junk. He's got multiple defects that make it a very complex case. If they can save him he will have to survive at least 2 or 3 surgeries which are risky at best. So, everything that was done may be worth nothing. I'm sorry, I know I did my job and I have nothing to feel guilty about if he doesn't survive, but my efforts are worthless to his parents if that boy dies. They aren't going to be comforted by the fact that "that nurse made a good call, she caught on early on that something was not right. " Woopee, I really don't care how good I did. If he doesn't live what value did my actions have?

You do deserve credit for showing good judgement - which is a gift that a lot of experienced nurses never develop for such a subtle set of symptoms. Sick babies are a part of obstetrics - fortunately a very tiny part, but you'll mourn this little guy and you'll move on. You can't judge the "value of your actions" when you have no data like this unusual case. You're entltled to be saddened by this, but the pain you're feeling now will evolve into the acceptance that nursing sometimes makes your heart hurt.

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Having children myself I would have to say you arean angel. Any amount of time you have to spend with your child is wonderful, and to think you gave these parents more time than what they might have had. You deserve a pat on the back. At least now the parents know they have a sick child. It would have been horrible if that baby died and they were left to wonder what was wrong. You did a good job!:nurse:

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Specializes in Emergency Room.

Be proud of yourself!! So many new nurses take the word of a more experienced nurse (he looks great.....that is normal, etc) over their own gut feeling. What is important here is that you felt like something wasn't right, and you acted on that. Many nurses would have just said "okay, a little acroscyanosis is normal, and a temp of 98.8 is normal too, so the baby must be normal; plus, the nurse I got report from said he's doing great and looks perfect, so he must be okay." You listened to your gut and followed through!

Don't dwell on what might happen next to this kiddo....at least your quick thinking gave him a chance he might not have otherwise had!

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Specializes in Assisted Living Nurse Manager.

SweetCheekers,

I would say the value of your actions made a world of difference to that mother and father. If you had not used your knowledge and skill to know when something was not quite right, the little baby boy would have died, leaving the parents wondering "what just happened". By your quick thinking you gave this little boy a chance at life, a chance that he would have not had otherwise. But you gave this little boy a chance to fight a chance to be able to grow up happy and healthy. If for some reason he does not make it, always know in your heart you gave him a chance and his parents a chance to say "goodbye". Thank you for becoming a nurse and thank you in advance for the many lives you will save!!!

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Yes, the transport nurse was a pro, but so are you.

You're right, the parents probably won't remember that you made the discovery, regardless of what happens, but you did exactly what you are supposed to do and you absolutely deserve a big pat on the back for your efforts.

What this little guy will have to endure is heartbreaking, even if the outcome is the best possible. You must be a very caring person to be concerned about it, even knowing that you did your very best.

As a new grad, I hope that I am as perceptive as I begin my career.

Amanda

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I'm sorry, I know I did my job and I have nothing to feel guilty about if he doesn't survive, but my efforts are worthless to his parents if that boy dies. They aren't going to be comforted by the fact that "that nurse made a good call, she caught on early on that something was not right. " Woopee, I really don't care how good I did. If he doesn't live what value did my actions have?

But thinking positively, what if he does survive??? Because of you, he will have a fighting chance.

And if he doesn't, you did the best you could do and that is all anyone can ever ask for. If you didn't do everything you did, the parents would always be questioning what could have been done differently??? I think that would be a big burden to bear.

You did good, just keep reminding yourself that.

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As a parent of three, I can tell you that every moment with your child is precious. Even if, and I hope it doesn't happen, the child passes, you gave the parents an opportunity to know that their child lived for however long he did. You gave his parents the knowledge that a nurse was able to notice that something wasn't quite right. You gave the parents the knowledge that because a true professional was on the ball, their child had a fighting chance. You gave the parents an enormous gift no matter what the outcome.

I don't know of any parent who would have said "I'd rather my child died in the newborn nursery." Regardless of the outcome, you gave the parents the gift of time. And that, for what it's worth, cannot be matched by anything else in this world.

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hi sweetcheekers,

your judgement was commendable and your perception and empathy, inspirational.

i'd be darned proud to work with you.

and yes, it is potentially a very sad situation; that he might die anyway.

yet i agree w/the others, that you saved further heartache and trauma to the parents, r/t a probable, spontaneous death because of his pathology going undetected.

my premie sons' prognosis was very bleak, w/all of the docs anticipating his death.

but he showed them all and has thrived beyond anyones' wildest expectations.

and it was your perseverence that afforded this beautiful baby his own fighting chance for life.

even if you don't feel good, i hope you feel at peace.

leslie

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Worst case, baby dies. You gave the parents more time with their child, and they'll at least have the comfort that everything possible was done. Best case, baby has a long happy life. More than likely, it will be somewhere in between.

Remember, it's teamwork. Sure, the transport nurse is brilliant. But she wouldn't have been there to do that terrific job if you hadn't called the doctor. Sure the doctor's great, but wouldn't have known to call for transport if you hadn't made that call. You set things in motion. You did good. Sadly, even when we do good, it doesn't always lead to miracles. But at the very least, that baby has a chance, because of you.

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GREAT NEWS! The baby in my post had open heart surgery yesterday and did well. He may only need one more surgery instead of two more like they originally were thinking and he goes home this coming week if all goes well. (To wait for his next procedure.) I am sooo thrilled. Thanks for all your support.

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