Preceptor woes

[aerorunner80, ADN, BSN, MSN, APRN]

I don't know if the title of this thread is exactly appropriate but it's the best I could come up with.

Here's the situation:

One of the days I worked this week, my preceptor and I took on a very sick 1:1 baby. I had asked her the day before if we could take this baby on because I am the last of the orientees (there are 4 of us) to have any sort of high acuity and I was getting scared about being behind and not learning what I need to learn.

So I pushed her that day to see if we could take this baby on the next day and we did.

When I came onto shift and got report, my preceptor just looked very worried and she started to cry a little at the beginning.

The middle of the shift came and went with no problems that I could see. My preceptor was fantastic at helping me learn all the new things I had to learn about having a baby on vasoactive drips.

What got me was at the end of the shift. As things were winding down and I was doing my last little bit of charting, she started talking to me.

The conversation started off with her asking me what my dream job right out of nursing school would have been. I answered her, without hesitation, ICU, specifically cardiac ICU (we don't have a specific CVICU but we have a nice mixed one). I like having low patient ratios, being super involved in what is going on with my patients, having the autonomy that we do. Plus I'm a type A personality that doesn't mind speaking up when I don't agree with something. I just really like the ICU environment and now that I am in the NBICU, I feel I've found my home.

From there, the conversation started in on ethical issues. She asked me how I felt about the things that we do to our babies. While I agree that we can, and do, some bad things to our little ones, I really have a neutral position on all of this.

My view is that when I am at that bedside as a nurse, I am there to keep the baby as stable as possible and alive. I can't stop and think about what we do to these babies and all the ethical issues that surround our type of work. I feel that it isn't my job to judge what we do to babies has "mean, harmful, terrible" or any other word that can be used in negative terms. My job is to keep the baby alive and as comfortable as possible while delivering the most compassionate care that I can while also not getting too emotionally involved.

I am well aware that we can, and do cause harm to some of these little ones but without us, I feel that a good majority of our patients in the NBICU unit would not have lived past birth anyhow. It's a good and a bad all mixed in one.

I feel that I give care full of hope.

I just feel like my preceptor is second guessing herself and then trying to put it on me. She told me that the adult areas have all this shiny technology and all that. I told her that I agree with her but that I like this environment better for many reasons (if I go into it here, this post may never end. )

I feel like my preceptor was trying to turn me away from the NBICU and into the adult ICU world. I stood my ground and said that I have no plans of leaving the NB world no matter how enticing the "other side of ICU" may seem.

I've now had experience in both areas as a nurse and have made my decision. I'm staying.

I'm just concerned because this is not the first time my preceptor has talked about this to me. Each time I give her the same answers. Still it bothers me.

She is a fantastic nurse and is super smart about the ways of the NBICU. She has taught me a lot and I love her for that.

Because of the conversations we've had, I'm just questioning myself about her. I wish I could find the right words to say what I'm feeling about the situation. I almost wonder if she wants out of the ICU area (she has been there for quite some time) but feels stuck and doesn't want me to fall into the same trap.

Any thoughts?

[TheMiss]

Maybe she does have troubles with the ethical issues she faces and "uses" you to sort out her own issues.

But maybe she just believes that "not thinking about" such issues will get you in a lot of trouble down the track.

During our postgrad NICU studies we had heaps of time dedicated to ethical dilemma - and it's well worth it.

Our patients are humans who can't fight for themselves. And many times you will have to fight for them. One day you might hear a mother (whos last chance of having a child is the 23 weeker in front of you) asking you "should I sign the DNR?"

You write " I can't stop and think about what we do to these babies and all the ethical issues that surround our type of work." - I believe you will have to. I believe you will be made to. A NICU nurse is not a robot - you are guiding babies and their parents through a nightmare rollercoaster of emotions.

When stating that " I feel that it isn't my job to judge what we do to babies has "mean, harmful, terrible" or any other word that can be used in negative terms" inexperience guides your words. Yes you will have to judge, yes you will have to do things you find utterly wrong - and yes, you will have to fight to lessen the horrible things medical staff does to these babies.

Most of all you will get overwhelmed with ethical issues, you will need to know where you stand in order to allow others to have their standpoints. The NICU is one of the most controversial areas when it comes to ethics - and it's all too easy to hide behind all our fancy equipment/medication/procedures.

It may well be that your preceptor isn't sure herself anymore - but maybe she is just very smart and knows that you can't be a good NICU nurse without considering those challenges.

[kids]

I can't stop and think about what we do to these babies and all the ethical issues that surround our type of work. I feel that it isn't my job to judge what we do to babies has "mean, harmful, terrible" or any other word that can be used in negative terms. My job is to keep the baby alive and as comfortable as possible while delivering the most compassionate care that I can while also not getting too emotionally involved.

I disagree. Part of the "job" of giving compassionate care is recognizing an ethical issue and advocating in the best interests of the patient. Sometimes that means NOT keeping them alive.

[BittyBabyGrower, MSN, RN]

I agree with kids....sometimes death is not the worst thing that can happen. You are speaking purely from inexperience. Once you have taken care of a kid for several days who is being kept alive and has no real future not matter what happens, you will feel different. You will question what we do and why we do it many times in your career.

[IvoryLena]

Sometimes preceptors views are different from yours, no need to question yourself. My preceptor was horrible, so much so I had to ask to be switched half way in my training. Afterwards I found out I was the 4th person who asked to switch from her. So if you don't feel the same way, no biggie. However as far as ethics are concerned, they play a huge role in the NICU. Here are some examples I have had...

1. Baby born with omphalocele, now has trach, frequent infections, bilateral grade 4 w/ PVL, seizures, desats to 20's every other hour. Saw doctor walk in and tell parents "Your baby is fine, he's going to walk, talk, and be completely normal." Parents turn to you....Will my baby really be okay? What do tell them?

2. 19 week gestation baby, doctor says your baby is doing well to teenage mom. Mom asks you why babies legs are turning black and if they'll be able to fix them? What can you say knowing that the doctor should have never even put the poor mother through this. A 19 weeker? I dont even know how he intubated.

3. 23 week gestation, kidney failure among everything else going on. Baby has swollen so much, stool is now bursting from it's umbellicus to the point we had to put a ostomy bag on it. Mother doesn't come to see the baby says it's too sad to see. It's your turn to take report and you have this child. You feel guilty moving the poor thing, you wonder why ethics committee is doing nothing. I wanted to refuse this child, but then you run the risk of being fired. Mentally you want to call the mom and say "Get in here and end the suffering!!!!" but again you get fired and lose your license.

I came from MBU, GYN, Lev 1 NICU and believe me, I never faced such ethical issues like these anywhere but the NICU. I find one of the best ways for me to deal with situations like these is refering the parents to speak with a doctor who you know will be truthfull in a nice way like... "Doctor XYZ knows alot about long term outcomes with children who suffer from XYZ, I would suggest speaking to him/her." And if it's a situation I can't explain or give off to the doc, I simply do the best I can as a nurse for the child and pray. But sometimes you will still have ethical dilemas and have to live with them. I dont think I will ever forget these children.

[mauigal]

I agree!

[mauigal]

I agree with BittyBabyGrower! The things these poor babies go through sometimes is FAR worst than death.