Really upset, bad shift last night

[Gompers]

I'm sure all of you have had at least a few shifts during your time in the NICU that made you just want to chuck it all, the kind of shift that ends with you, in your car, crying too hard to even drive home.

You all know I love my job. LOVE IT. I can't imagine ever LEAVING it. Maybe the hospital someday, but never neonatal. NEVER.

But, damn it, there are days when it becomes too much to bear. The immense responsibility that comes with this job is something that is always on my mind. Usually, I'm very proud of my work and the babies do pretty well in the end.

I just had one of those shifts...post-op gut baby...gasses sucked...vitals going downhill...looked bad...got worse...finally started to crump as I reported off to the next shift RN. I just feel so guilty, like I failed the baby and its family. Why hadn't I pushed for more labs, more meds, more intervention? The doctors were up all night long, often at the bedside, and I was constantly talking to them, but maybe I wasn't saying the right things? I keep trying to figure out what I did wrong. Maybe if I had not cared for that baby and someone else had, it would be doing much better right now. If only I had not worked last night, would things be different? Or would they just be the same, but I wouldn't feel so awful, so guilty, so heartbroken. I keep kicking myself and just can't believe it was all hitting the fan within minutes of me signing off to the next nurse.

I love this job, but sometimes I just wonder what in the world I can be thinking by working where I do. Being a Wal-Mart greeter sounds pretty good right about now. You turn your back for a second and someone has to grab their own cart - no biggie. As a NICU nurse, you overlook tiny things here and there and a baby can die on you. Why am I doing this?!?!?!?

[Gompers, BSN, RN]

Gompers, you talk about it looking like the night shift is slacking when things don't get done on your shift then the day people come in and all of a sudden its all action....

This brings up an interesting point. Some nights, doesn't it seem that the NICU is really an ICU from 7AM to about 5PM. Once the attendings are gone and it's just the residents, the attitude is one of just "getting by" until the morning. I love it when we have an NNP there for the night. Most of them appreciate that babies can't always wait until morning to get a septic work-up. It aggravates the stew out of me when I know a baby is getting sick--maybe it's poor feeding, distended belly, increase in apneas/desats-whatever, and the resident looks at me and says "babies do that sometimes." :angryfire Then I have to persist and nag until something happens. Thankfully our charge nurses are great back-ups and will join in the persist/nag routine until we wear one of them down. Luckily, our nighttime coverage has improved alot over the past year and this becomes an exception instead of the norm. My concern now is the nurses that will let things slide until morning.

Most of our nurses don't let things slide, but there has definitely become a "getting by until morning" kind of a mentality on our unit for awhile. We used to have NNPs at night, who only worked 12 hour shifts - therefore they didn't sleep at night and were available all shift to us. Since we stopped doing that, it seems like we get nothing done on nights sometimes! I hate the old, "we'll talk about it on rounds tomorrow" argument - when it's 11pm and rounds aren't for 10 more hours, but RIGHT NOW the baby is white as a sheet and is in a constant state of apnea, things like that!

Hopefully it well get better over time, not worse. Also depends on the docs who are on call, and just how sick the baby actually is.

[Gompers, BSN, RN]

I was just reading the post about how to deal with the hard parts of NICU nursing and felt like reading this post over again. That night still comes back to me whenever I read my first post in this thread. I had kind of a similar night a few weeks ago, but I felt a lot better about it. There have been three or four times since that night that I've asked for Dopamine all night long, only to have them finally order it at 0730 right in front of my face when I'm giving report to the day shift RN. :angryfire

Oh yeah, and an update on that sick little baby from this thread...

Had a few more surgeries and lots of issues, but finally made it to full feeds and room air. He had a very nice personality, even though he was pretty "chronic" and was a very nice little guy to take care of. Didn't PO feed very well, but mom learned to do NG placement and feedings and will continue to work with him on PO feeding. She wanted him home for Christmas, and there didn't look like there was any way to honor her wishes because he had so much going on and so many setbacks.

Well, by some miracle he was discharged on Christmas Eve and hasn't been readmitted so it looks like all is well!

It's all about happy endings in the NICU.

:)

[sddlnscp]

That's wonderful Gompers - it just goes to show that you are so right to never give up! Glad your little one has pulled through so well and that you are doing well also. I only hope that one day I can be where you are (NICU) and learning to do as well as you have done. I'm sure I will have days of heartache and hardship, but hopefully I will learn to be as strong as you are and to keep going back, day after day, in order to ultimately make a difference in those lives that we can.

Thanks for all you do!

[dinkyandzen]

Why am I doing this?!?!?!?

Because those babies (and their parents) need you worse than any other patients. Because they don't all get worse. Because more often than not, you are the reason they get better and get to go home!

Keep your head up. My thoughts are with you!

Courtney

[Gompers, BSN, RN]

Thanks again, everyone!

When I went to work last time, there were some Polaroids of this baby and his parents up on the unit. They were in for a doctor's appointment and stopped by to say hello. He's been home four weeks, and he looks great - mom already got him transitioned to full PO feeds and was able to pull the NG for good. His parents look so happy in the pictures, I just about cried.

I'm glad I have this thread to come back to after a hard night, to remember why I do this job!!!

[prmenrs, RN]

:balloons: :flowersfo :icon_hug:

[rafael80]

All I Can Say Is That I Am Proud Of You For Feeling Guilty Because That Proves You Care!!!

[Coley'sMom]

Ok - I just lost a really big post I made...and don't have the time to retype it.

I just wanted to say, as a mom of a 28wkr & now 3yo, that you guys ROCK!

I honestly can't imagine going back to the NICU day after day, the way you do...even the idea of going to give thanks rocks my emotional core.

To answer your question from the first post, you do what you do because you are good at it! You give families hope & inspiration, and most of the time are able to send a bundle (yes sometimes with issues) home. The fact that some of these kids have issues, certainly gives families grief - but without a doubt, we are VERY appreciative that we have our bundles! And in no way are these issues a reflection of your abilities! The fact that they are able to overcome them and come home is!

I have never met a more resiliant bunch - and they teach us more than you could ever know. Not one of us (moms) takes even the tiniest milestone for granted...they bring us joy beyond belief...and there isn't a day that goes by that we don't thank god, the angels, and any other mystical power that you do what you do.

Yes, sadly, some don't make it - that is without a doubt beyond your control, and I imagine gut wrenching for you all - but know, I mean really take it to heart - regardless of the outcome...we appreciate every speck of effort, care, tough love, compassion, fight, teaching, thoughfulness and understanding that you provide...I just couldn't leave my baby a night, or even to pump, if I didn't trust you all...and I am not alone in that.

When you have a bad day, try this:

follow this link: http://preemiegroup.1.forumer.com/

Spend a couple minutes giving a new mom some comfort, some 'inside' knowledge to feel better or just poke around and see what we've been up to since discharged. Yup, the fight continues...but it's ALWAYS worth it!!!!!

Hope this helps some!

KJ

[Gompers, BSN, RN]

Thanks again, everyone!

When I went to work last time, there were some Polaroids of this baby and his parents up on the unit. They were in for a doctor's appointment and stopped by to say hello. He's been home four weeks, and he looks great - mom already got him transitioned to full PO feeds and was able to pull the NG for good. His parents look so happy in the pictures, I just about cried.

I'm glad I have this thread to come back to after a hard night, to remember why I do this job!!!

I was just going through some old NICU posts when I stumbled upon this thread that I started last September. I went to work the other night and there was a new picture of this new little guy posted on the unit - he's a year old now! He looked amazing and was smiling and grabbing for the camera. I know he has some developmental delays and that his eyes are very very bad from ROP - we actually had to keep him at a 45-90 degree angle for the last month he was on the unit to decrease pressure and bleeding in his eyes - but he's alive and happy. Rereading the first post of this thread still takes me back to that night and I can remember it like it was yesterday, but at least I can remind myself now why I'm doing this crazy job we all love.