New member

suzy253, RN · Aug 5, 2006

Hi & welcome to Allnurses. I just think it takes time to pick up all these skills and you're still considered a new grad. Hang in there. good luck.

mawjood · Aug 6, 2006

Thank you very much for encouraging me I really appreciated ...

So I went your opinion our any other member opinions, I will tell you the story of what happen for me...

On Tuesday , Our consultation passing only he saw in bed A, the RT with RT intern and nurse assigned in bed A doing the suction he told me he heat the crowded after that he pass in bed B the baby saturations in 80s, he ask how is the nurse her ,she was one of the senior I think maybe she had experience 11 years in NICU usually this baby the give most of the time one of senior nurse because he is very sick ,OK, so the consultation told her by looking only I can see that ET tube is out and the ventilator was alarming ,she replay to him that she was doing suction ,so he told her that after you do aggressive suction the ET coming out and at that time he said" say the saturation know 29 call one of resident to intubated '' so at that time I was looking and saturation was 31 he said I am sorry I will write incident report this time and every time when ET coming out after suction, so female resident come and told extubated and we will reintubated baby he complete his round and after finishing his round he told me to give him incident report paper ,I give him after some time our supervisor game she question assigned nurse she told her that it was not out and he and the resident don't examine baby by looking only he told that ET out ,So RT told the nurse to write that he is one doing suction and his intern because he is her friend , so our supervisor told her to write explanations ,after that the supervisor come to me and told me to be the witness in explanations without asking me what I saw I did not agree to sign because I saw the saturation 31,but I told her I am not there ,but this is not her first time that she want me in the front and there was two other nurses there that she did not told them , consultation write in the IR that the baby most critical baby in the unit.

In the afternoon the baby was transferred to other hospital to do ligation because baby have large PDA, the same nurse during transferred she was slowly not organized, the consultation was very upset from her.

At end of shift the supervisor told me that she did not submitted the IR, she told him that RT is good ,and he respect her opinion and never mind about IR.

Next day my assignment is other room with nurse intern 4 baby almost all stable, our consultation informed us that the did not do ligation and they want to bring patient ,our charge nurse she did not informed me that patient will be for me I know only when I came from break from our supervisor that baby for me with big smile in her face the baby according to consultation the most critical patient in the unit he is 33weeks in ventilator ,large PDA, cholestic jaundice , suspected NEC, suspected pulmonary hemorrhage due to Large PDA.

I told her I can't handle that baby because it is critical she told me "why you are afraid of him" she mean the consultation , she told me that she will disturbance me baby, but I refused to take that baby so she give it to senior nurse and you know if she told me that she want me to take that baby so I will learned or take experienced I will agree but she want me in the middle of problem because I am BSN and I am the one allegeable to be charge nurse espially that she still not official be the charge nurse and this is not the only time that she want me in the middle of problem but it is my first time to object and say no I will not be the victim any more... if I am write and wrong?

prmenrs, RN · Aug 7, 2006

You raise a number of issues, and it's hard to separate them all.

Are you asking for advice on taking care of the baby, or on the complicated situation between you and the charge nurse and whatever is happening to the other nurse?

It's really hard to say who is right or wrong. It would be unusual in this country for a doctor to interfere in the day-to-day unit management in the manner that this doctor did. You said he was a "consultant". In this country, that means he is not a neonatologist (they would be the doctors in charge of this baby's care), it would be someone from another specialty, like cardiology or surgery.

What is the proceedure for suctioning? Was the RT hand-bagging the pt. between passes? And doing it long enough to bring the sats back up? And I don't think he (the doctor) can really tell the tube is out just by looking. Does he have X-Ray eyes, like Superman?

How deep was the nurse suctioning? We had a card @ every bedside showing a drawing of how many centimeters we were supposed to suction so that we did not hit the carina. That hurts enough to cause the baby to desat more due to pain.

A pass w/the suction catheter should take no longer than a few seconds. Hold your breath--if you're out of air, so is the baby.

This baby sounds so sick. I wonder if he or she should just have comfort care. It certainly seems like a bad outcome that is only going to get worse.

I cannot comment on what is going on w/the other nurse in question as I really don't understand the situation.

Best wishes.

mawjood · Aug 7, 2006

hay,I will try to be more clear.

our doctors he is neonatology.

the other nurse I mean the nurse assignent for sick baby.

and about problemes between me and charge nurse I will give the hint in my hospitial you will see differents group of people according to there nationality,the charge nurse is phillipione so she take care of the phillipione nurse in the unit, our superivisior is indian with her group, Iam the only one different nationality among them .

and you know the nurse assignent to sick baby at the day that charge nurse told me she will give the sick baby ,in her other baby she pull out the uvc insited of uac so imagen how our doctors are angrey from here .

so my thinking only that charge nurse she want her to avoid another problemes,and my and consultation are the same nationality.

prmenrs, RN · Aug 9, 2006

ok. i have been thinking about how to answer this dilemma. i think there are 2 problems.

one is so many cultures working in one unit.

the other is mismatching skill levels.

every staff member must decide to become part of a team. the purpose is to take the best care of the babies as possible. that means learning about and accepting each others cultures. speaking the same language. whatever that language is decided to be, nobody should speak anything else. language can separate or divide you.

keep reminding yourselves why you are doing this: the babies!!!

the second thing is skill levels. education and practice standards need to be adopted so that every one does the same thing for any specific proceedure. for example, suctioning. the least amount of distress to the infant is the goal. no deep suctioning! consider going to an in-line suction system, like ballards. 2 people should suction in order to maintain sterile technique and to make sure the baby is adequately oxygenated. adequately, not over or under! don't forget that premies should not saturate 100%--too hard on their little eyeballs.

this would be a tough thing to accomplish, but if everyone wanted it to succeed, and everyone wanted to work towards it, it could happen.

a good nurse manager and a clinical nurse specialist/nurse educator will be very helpful. frequent communication in the form of staff meetings (w/the medical director and members of the respiratory therapy team) helps, too.

best wishes!

mawjood · Aug 9, 2006

ok.thank you for guided me I will try to discuses thes issue with our supervisior.............................. :nurse: