serenitymmason

Wow, the nursing community never seems to fail me, I am always surprised by the wonderful support we offer each other every day. Thank you all for your wise comments and suggestions, I needed that little boost of morale as well. My unit has been wonderful about this, the event was brought to the hospital safety huddle and I think we are all learning from it. I am appreciative for the event because looking back on it I see now how much I learned from my mistakes! And I am amazed by how apologetic my unit as been for 'putting me through that' as they say. I have great a great support system there I just need to take more advantage of it and learn my boundaries, I can't expect so much of myself right now. I watched a 35 wk scheduled section yesterday and it was wonderful to be able to step back and incorporate everything without really being involved. So that was very helpful. Thank you everyone:)

So I am 4 months into working in the NICU as an RN with 6 years adult experience and no ped/baby experience. I have been off 'official' orientation about a month now in my level 3 NICU, yesterday we had multiple deliveries and I was asked if I felt comfortable going to a delivery and admitting a 28 week twin. This was my youngest admit so far, and might I add FIRST delivery, I love what I do and am eager to learn and get as much experience and practice as I can, so I said I felt I could do it as long as I had help, which I knew I had as everyone has been wonderful in teaching and offering assistance. I told the NNP when mom was at 4.5cm that I would be delivering with her and that when the time came, I needed her to tell me what she needed of me and to help guide me through the process. She was appreciative and agreed. My kid ended up breech while mom was in active labor so they called a stat section. Charge nurse told me to hang back a bit while the other twins admitting nurse checked the section room. There was miscommunication between charge and the other RN, she did not check my bed, only hers we found out. The section room was a cluster to put it nicely, during the time the incision was being made the NNP I was working with was looking over the bed and noticed multiple things missing and I did not know where to find them, I think she was also upset things were not set up appropriately, and the other girls from the L&D and the floor did not know where to find them either (I think they must be newer too), so my NNP had someone run back to the unit to get me help. Baby came out after my help arrived, baby was dried, stimulated and put in bag, no breath or tone, PPV was immediately started, I counted 40HR, baby was intubated and I started chest compressions, we still did not hear respirations and the suction was not working (not checked prior because of the miscommunication between my unit and also missed by L&D who sets up and checks before us)so NNP retinubated, I counted 50HR and continued compressions. The fourth or so time counting respiration I think the adrenaline and everything together got to me and I kind of mentally froze and could not concentrate or hear enough to count confidently so I requested my help to count. HR was then 100 just over a minute later and we had a sat of 70%. We brought baby back to the unit and started lines and the admitting process. The other twin did not have as rough a time as my kid, I'm beating myself up because I don't feel I prepared myself appropriately and think I jumped the gun on this one. My baby was down to 25% FiO2 when I left him and I had him already titrating down on his dobutamine drip that we started 6 hrs after birth because his art line BP MAP was fluctuating between 23-27. We had a de-briefing between myself, the NNP and my RN help. We discussed what went wrong, how I did, how we communicated and what we could have done and what we learned to improve future deliveries. They all said I did great for where I'm at, I kept calm, despite freezing up in the DR and being very unorganized, I feel I did my very best and they felt that I did too but then I got so emotional I started to cry and I am just so embarrassed. I'm upset I did not respond to these events quicker and in a more organized/appropriate fashion. Many of the girls came up to me throughout the night to offer support and one girl even texted me this morning, I feel I have the support and resources I need to be successful but can't get over how poorly I feel I performed! Does anyone have any similar experiences and what did you learn from it? Do you have any suggestions on how I can improve myself? Thanks in advance for your responses.

I see your concerns and often wonder that myself, however I am fairly new to our unit and seeing as they have been doing this for decades I just assume it works best for us. 1. We make a point to wash our pitcher every shift (BID or even QID depending on staffing). 2. We do of course see feeding intolerance as does every unit but I think our kids do fairly well. 3. I would be very interested in what you find out about nutrient damage though! Thanks for sharing!

We warm up our milk in a hospital pitcher of hot water, works just as well as milk warmers!

I feel very fortunate after skimming through these posts, I live 5 miles down the same street as the hospital I work at. But I'm in a smaller city (Green Bay, well I live in a surrounding suburb and work in Green Bay), I work at one of the best hospitals in the areas and live in one of the best cities as well! I plan to start biking to work next spring, love the close proximity!!