In need of some support - absolutely devastated

[The_Muffintime]

Hi everybody, I've been a long-time reader of this board and I want to first off say that I love this forum very much. It has been amazing for learning new things about my future profession and seeing different perspectives on many subjects.

I am an RN student in an ADN program (I'm going to get my BSN right after I graduate and get licensed, while I'm working as an RN). Right now I'm in my maternity course, and I just had my first clinical experience in a NICU.

A little bit of background information to correctly frame my feelings: I have seen death during school, but never before. The first time it happened definitely took me by surprise, and I experienced emotions that I never expected to feel. I have finished Fundamentals, Med/Surg 1, and now I'm in my third nursing class.

All of the horrible, gut-wrenching emotional upheavals I have experienced so far, though, have NOTHING on what I'm feeling right now. Our instructors prepare us well in the area of grief/loss and have supplied me with useful coping mechanisms that I feel have made me a much better nursing student/future nurse, and I have been able to separate those sad feelings from other aspects of my life. In other words, I believe that have the tools necessary to cope with most things I come across.

Today was different. I saw my first NAS baby today. The details aren't so important - you all know what I saw and what it was like. The mother was in and out all day, and I am doing my best not to judge her ability to be a mother for her beautiful new baby girl.

I can't seem to get a grip on my emotions right now, however. I have been home for a few hours now, and I can think of nothing other than that little baby girl: her horrifying cry, the way she went as stiff as a board while she writhed about in her bassinet, the look of sheer terror and pain in her eyes...

I have been crying off and on for the past few hours, ever since I got home. I'm not ashamed to admit it. I'm not a guy who normally cries about most things, but I like to think that I am sensitive and in touch with my emotions when necessary.

So, fellow student nurses, new grads, NICU and neonatal nurses - I have to ask you this question. How do I get past this? How do I stop seeing that baby's face and big brown eyes every time I close my eyes? How can I remain professional when faced with people who appear to feel absolutely no remorse or caring for an infant whose intense suffering is a direct result of their actions???

I am going to talk with some of my teachers and the school psychologist tomorrow, but I was hoping some of you could lend me your insight and experience. What do I do? I don't think I have ever felt so broken inside.

With lots of love,

Muffin.

[adventure_rn, MSN, NP]

I'm so sorry about your difficult experience yesterday. In nursing, it can be jarring to face the pain and suffering that our patients experience. It's especially hard to make sense of cases in which the patient's own lifestyle choices aren't to blame for their misfortune (i.e. a drunk driver hitting a healthy young adult, a child getting cancer, an NAS baby going through withdrawal).

I'm sure you already know the textbook answer: Addiction isn't a lifestyle that most people choose, nor is getting pregnant while addicted to drugs. It's quite possible that the mother avoided being in the room because she feels overwhelmed by guilt when she sees her baby in pain that she feels responsible for causing. Neonatal drug withdrawal is a difficult situation for everyone involved, including the infant, family and staff. The care and management of NAS families tends to be a hot-button topic that causes interpersonal and moral distress and frustration for many neonatal nurses.

Perhaps I'm reading too much into your post, but it sounds as though part of your inner turmoil results from feelings of helplessness: that this poor, sweet little baby was in pain by no fault of her own, and that you couldn't fix it. The good news is that for many of these kids, we can fix it: we give morphine (on a weaning protocol), and we swing, rock and cuddle. In general, we don't let kids get to the point that you're describing for a prolonged period of time; if they're so miserable and can't be consoled by non-pharmacologic methods, they get morphine to keep them comfortable and to prevent seizures. I wonder if your day would have gone very differently if you'd had the chance to sit with that baby, rock her, and help her settle down ('therapeutic touch' is the official nurse-y term).

In nursing, regardless of the specialty you choose, it is frustrating and even painful to feel helpless to improve your patients' quality of life (even if they're responsible for their own suffering). When you feel this way, I'd try to focus on the tangible, positive steps you can take to help these patients: for the nurses of this baby, it would probably include advocating to start morphine therapy, and therapeutic holding.

Best of luck with your meetings. The fact that you are so emotionally invested in the wellbeing of your patients (especially those that can't advocate for themselves) is a testament to your empathy as an aspiring nurse.

[jennylee321]

If you ever have the opportunity to really listen to a drug addicted mom's story, it will help you deal with the feelings of judgement that you are trying to deal with. PP has answered really well, when you spend extended time with these babies you will probably feel less helpless because you will be able to advocate for pain control and learn what comfort measures works best for them.

[adventure_rn, MSN, NP]

If you ever have the opportunity to really listen to a drug addicted mom's story, it will help you deal with the feelings of judgement that you are trying to deal with. PP has answered really well, when you spend extended time with these babies you will probably feel less helpless because you will be able to advocate for pain control and learn what comfort measures works best for them.

Awesome point: you just reminded me of an article posted on AllNurses a while back that I found really enlightening. This post was by a mom who became pregnant (despite birth control use) while she was in a methadone recovery program, and it provides some thoughtful insights.

https://allnurses.com/nicu-nursing-neonatal/methadone-and-nas-459804.html

[NicuGal, MSN, RN]

It is gut wretching to watch. But, each mom has a story and after listening, sometimes it is easier to put that aside. Heroin and prescription drug addiction are so widespread, and many of these moms could have been you at some point, or your daughter or sister. It is easy to judge them but you have to put it aside.

You sort of grow a bit of a shell after awhile and it helps you focus on what matters...helping that baby thru the withdrawal process. Hang in there.

[NICU Guy, BSN, RN]

It is a shame that you could not witness the techniques that calm the NAS babies. We use stretchy blankets and swaddle them into "baby burritos", pacifiers, and the greatest invention on Earth- the Mamaroo rocker. Along with Morphine and Clonidine protocol, we are able to get them through the withdrawls. We also have volunteers that come in a help hold and rock them.

[The_Muffintime]

It is a shame that you could not witness the techniques that calm the NAS babies. We use stretchy blankets and swaddle them into "baby burritos", pacifiers, and the greatest invention on Earth- the Mamaroo rocker. Along with Morphine and Clonidine protocol, we are able to get them through the withdrawls. We also have volunteers that come in a help hold and rock them.

This is exactly what we did :) and she got a 16 Finnegan score so we gave her some phenobarb on top of the morphine and clonidine. That was the only thing that finally put the little angel down. I must have spent half the day holding her binky for her and letting her grasp my finger. That calmed her down too.

Thank you everyone for being so helpful. I think I played up the judgmental thing in my post more than I really felt at the time. I was just emotionally cracked, and looking for someone to blame. I am definitely not naive to the disease of addiction.

My heart still breaks for the little one, but time, talking, and your posts have afforded me some much needed perspective. In a way I'm glad that I care so much. I wouldn't much like the me who didn't care.

Love,

Muffin

P.S. I forgot to mention, along with the comfort measures you listed above, guy, we also placed her in a rocking bassinet. The rhythmic motion seemed to be very good for her. I am so grateful that the nurse I was assigned to yesterday was so caring and concerned for baby's well-being. She and I truly did all we could to help baby get through the day.

[The_Muffintime]

I'm so sorry for the double post, but guy I just looked up that Mamaroo bassinet. That was exactly what we put her in! It truly is a marvelous product. I'd say it did as much for the baby as the drugs did (OK maybe not the morphine)!

[wensday, MSN, RN, APN, NP]

Sorry you had such a rubbish day, we've all had babies we struggle to forget for one reason or another.

I think as the others have said, you can't presume to know the back story, but it's so hard to look at that little one and feel completely at peace with it.

I think when sad or difficult things happen, you have to be hard-faced. You have to push it out. You get better at bringing up that wall. I cry on the way home and then when I get through my front door I try leave it behind. I know someone else is there on NICU doing an amazing job for them. The other thing is remembering the happily ever afters. Those babies you never, ever thought would get out of the front door. Those babies so tiny and fragile or post-op and full of stitches, or suffering from things caused by others- intentionally or otherwise...then seeing them going out of the door all cosy in their 'going home' outfit and smiles and hugs and tears and love.

Thats what I push into my mind at the end of the day. The happy. Sometimes it's the only way x

[prmenrs, RN]

That is a REALLY tough deal this early in your career. You won't have this much drama most of the time. Narcotic w/drawal babies are always the neediest, crabbiest babies of all, but they don't always get this bad. Mostly, it's a lot of cuddling, rocking, meds to control the w/drawal, skin care issues (they have diaper rashes from diarrhea) and abdominal pain as well. Then, there are the social, i.e., parental needs.

Look @ it as a learning experience. Research the signs/symptoms/medical intervention/nursing care involved, so you can get a better handle on all that you saw and experienced. Take care of yourself physically right now, because such an intense experience can take a toll. And, use that school psychologist as much as you need. S/he can be a big help.

My hunch is that you will do well in your future career, even after this rough episode! Hang in there.

[NICU Guy, BSN, RN]

...then seeing them going out of the door all cosy in their 'going home' outfit and smiles and hugs and tears and love.

I discharged a set of twins whose "going home" outfits were handmade Thing 3 and Thing 4. I took them out to the waiting room and was met with their older brother and sister dressed in their Thing 1 and Thing 2 outfits. Those are the Things that make your day (pun intended).