I'm never primarying again, y'all - page 2

This is so awful. My primary is six and a half months old. He was a CDH-er, was on ECMO. He almost got better in August and September, got him down to 30% CPAP, but went into respiratory failure at... Read More

  1. by   MA Nurse
    I understand what you're going through. I've taken care of babies like this in the past. I know it's sad, but I really think he's suffering, even with pain meds. After all these hypoxic episodes, his brain is probably not doing well. It's hard to let these babies go, but I also think it's wrong to allow suffering. We can give the best care we can give, but we can't cure babies like this, and we shouldn't feel bad or guilty if it's time to let go.
  2. by   MA Nurse
    Quote from elizabells
    In all honesty? Not always. This is a child with terrible bronchospasm - the moment he starts fussing you MUST fix whatever the problem is or you will find him with sats in the 40s and HR in the 60s. More than once I (and his other primaries, as we've discussed among ourselves) have gone to break having given a full report to the covering nurse, with very specific instructions as to how to get him back, and come back to an empty pod and a blue baby. His parents actually asked to have him moved out of one of our private rooms (normally a very hot commodity) because he was basically being ignored if one of his primaries wasn't there.

    I do know that I need help. I'm even thinking of EAP, at this point. I know this isn't healthy. I know he's not my baby. I just don't know if I could face his parents (who have noticed and pointed out the days I and his other primaries have taken "breaks" to take care of other kids - they actually went to patient relations when a few weeks went by with no primaries) if I just stop.

    You made very good points, llg. I'm so new at this. I guess I just have to do it and stop overthinking it.

    This is not right for nurses to treat him this way. have you thought about reporting them to the manager and maybe having a staff meeting about him and how these nurses treat him? Sounds liek you need to bring this up to management.
  3. by   MA Nurse
    Quote from elizabells
    This is so awful. My primary is six and a half months old. He was a CDH-er, was on ECMO. He almost got better in August and September, got him down to 30% CPAP, but went into respiratory failure at the end of September. Several runs on the oscillator later, he got trached last week. It's made him worse. He's barely double his birth weight. His head is enormous, and he has these skinny chicken legs. His SVC seems to be failing him, and his entire chest is covered in petechiae and burst capillaries. He's suffering. My unit (as Steve and I have been very vocal about on this board) undersedates ridiculously. The fact that I secured standing orders for q12 Ativan and q6 MSO4 last night is a sign of how bad it's gotten. He's so labile we don't even change his diaper unless he's sedated. They're tolerating PCO2's in the 100s. I bagged him for 25 minutes last night and counted a victory when his sats held above 75. His parents, who are the loveliest people I've ever met, are also members of a religion that doesn't hold with DNRs, and certainly not with withdrawal of care. I truly think they'd let him go if they wouldn't be ostracized from their close-knit community. He has four primaries, and all of us are losing our minds. We're all crying during and after work. The other nurses are starting to talk about us, and not in a good way. I don't know how much longer I can do this. We're talking about calling the Ethics Committee, which I have not seen done in the 18 months I've been on the unit. We're all talking about quitting, which we won't, really, but it is coming close to burning us all out. I've gone from 2 cigarettes a day to almost a pack. We can't not take care of him, though. His parents need nurses they can trust. Most of the other nurses can't stand the baby because he's so needy. We refuse to let him die with someone who doesn't care about him.

    Thanks for reading, if you made it this far. I should sleep, because I have to go back and do it again tonight. May God forgive us.

    This is very hard when the parents have a religion like this. It's sad for everyone involved.
  4. by   MA Nurse
    I read their religion part after I posted about letting him go, sorry. I just think babies like this need to be in a better place. Hope I haven't been too harsh.
    also, maybe you could get the primaries together and just go out and talk about him...maybe if you get together and vent, that would help.
    Don't be too hard on yourself.
  5. by   RainDreamer

    I'm so sorry you're going through all this Gosh this sucks big time. We have a kid like this in our unit right now .... well he's similar in the fact that he's over 6 months old, he's going to die, but the parents are refusing to sign a DNR. They just called the Ethics Committee on it last week. I don't primary him so I'm not his nurse often, but I had him recently and it was SO DRAINING ..... I left the unit in tears that morning. So I can't even imagine doing that shift after shift like you're doing.

    I wish I had some words of wisdom or something to say to make you feel better, but I don't. I will keep this whole situation in my thoughts and prayers.

    Hang in there, and please do like everyone else has mentioned and try to get some help. Do something for yourself, please.
  6. by   elizabells
    Thank you so much for all the advice and support, you guys. I go into work every day now telling myself "This is it. Today is the day you tell the charge nurses you need a break." And every day I see my name next to his on the assignment sheet and I can't do it.

    I'm starting to feel like a horrible nurse. I know, I KNOW I can't fix this baby. But all I do is put out fires now. I'm just chasing my tail. It doesn't help that one of his day shift primaries is the Monday-morning quarterbacking queen, so whenever I give report to her it's like "why did/didn't you do that? Oh well, I'll fix it later." I'm impatient with my coworkers. The other baby in that pod is not so sick but is a boatload of work, and that's really not helping.

    It's almost funny - I feel like I'm watching myself burn out. Like it's an out of body experience or something. I see what's going on and I think "this is how it happens." I'm really, really considering at least a change of specialty, if not a change of career altogether, once this little man dies.
  7. by   canoehead
    He has GOT to get more pain control.

    I wonder if the other nurses feel strongly that he should be allowed to die, and they don't respond to his moniters as quickly as they should?

    I agree that a staff meeting needs to be held to see if any issues are under the surface, and to give you support (big time).
  8. by   DDRN4me

    I think you need to ask for a STAT team meeting with docs and nurses to look at this baby's future ( or lack of such)

    You are torturing yourself into overthinking. You need to let the NM know NOW how you are feeling before it gets any worse. Let her be the bad guy and take you off the case so you dont feel as guilty.

    and know that you have done everything in your power for this baby; but you are human too!!!! Mary
  9. by   rehab nurse
    I don't have any idea what NICU is like, but I do know what it's like to feel how you are feeling now. I've been where you are, and the others have given you better advice that I can. I just wanted to say that you ARE a good nurse, please don't think anything less. Words can hurt, as evidenced by what mom said to you. I just wanted to send you my support, and to tell you that I think you are one GREAT nurse. I wish I could fix this for you, cause I can *feel* the anguish you are feeling. Tomorrow is Monday, so please talk to someone in charge about this. Don't put it off. You have so much to offer, it's not fair for you to burn out now. I am crying for you right now, that's how much I feel your pain. Hugs to you. I wish I could do more.
  10. by   BabyNurse513
    Sorry about your situation. I used to work in that unit and unless it has changed drastically in the last couple of years I know how frustrating it is. They are horrible about pain management and there is no teamwork and a serious lack of support from the managment. I don't have any new advice, just know what you are going through. Remember, take care of yourself first, and don't let this situation turn you off from NICU nursing or nursing all together. I've been there, it's that unit environment. I could go on but feel free to PM me if you want to talk about it.
  11. by   Imafloat
    Quote from elizabells

    It's almost funny - I feel like I'm watching myself burn out. Like it's an out of body experience or something. I see what's going on and I think "this is how it happens." I'm really, really considering at least a change of specialty, if not a change of career altogether, once this little man dies.

    NOOOOO!!!!! The babies need you...Sure, another nurse can fill your shoes, but that nurse won't be you. I know how much you care about your patients from your posts, you are where you need to be.

    You defenitely need to take a breather. You appear to love being a NICU nurse, you even state that you are an ECMO Junkie, this baby is burning you out and you need to take a breather.

    I had a similar experience. There was a baby on our unit with a 1 in a half million syndrome. He had congenital anomalies out the wazoo. His issues weren't compatible with life, but his mom couldn't accept that, she wanted everything done. Some of the other nurses didn't want to take care of him. I took him on because I felt sorry for him. I felt like I had to protect him from the nurses who were rude about him. He wore me out, he burned me out, and I had to ask for a break from him before he left our unit. My charge nurse told me that it didn't make me a bad nurse, it actually made me a better nurse to realize that I needed to step away to do the best for both myself and him. He has left our unit and this world and I am left with the fractured relationships with a couple of coworkers. I can't say if I would have done things differently if I had to do them over again. I did my best for my patient, but it really took a toll on me.

    I guess I am not giving you any wise words, but I just want to let you know that I know what you are going through.
  12. by   RainDreamer

    I really have no words of wisdom or any advice that can fix this. Just know you and this whole situation continues to be in my thoughts and prayers.
  13. by   prmenrs
    Liz--can you think of a way we can help you not burn out? You're too valuable to waste, girl.