Scary baby near-code

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I work in a smallish (26 bed) community hospital ER that has the fortune/misfortune of being very close to a large specialty hospital. What this means is that trauma and peds go to the big hospital and not us, which is fine by me, but of course there's always the odd walk-in we can't predict and which is sometimes difficult to be prepared for since we don't see that stuff much. I've been an ER nurse for 2 years.

A couple of days ago, a mom came in carrying a mottled infant in respiratory distress and screaming "help me, my baby's choking!". The story was that the child was 7 weeks old, born premature at 2 pounds, 5 oz, recently discharged from hospital. At home, he'd had some formula and then taken a nap. When he woke up from his nap, he spat up and then seemed to choke. I was the resuscitation nurse that night so this baby was automatically my patient but as I'm sure you can understand, I was really scared. We managed to improve his sats and color quite quickly with a bagger and CPAP and a nurse from the intensive care nursery upstairs came down to help with the IV and drawing bloodwork. She left as soon as the IV was established but neonates are so out of my realm, I didn't even know how to follow the order NS TKVO (what is KVO if you weigh 3 pounds? Turned out be 2 cc/hr. Who knew?).

Anyway, things were starting to be okay when the neonatologist comes down to consult on this patient and asks me to put in an NG tube. Well, I gotta be honest, I would take my chances on the IV start any day over being the one to do the NG tube. I was trained on adults, all my experience has been with adults and while I'm comfortable with adults, I'm pretty sure things change when you're that tiny. Feeling out of my league and not wanting to harm this baby, I called the ICN back and explained the situation and here's where my issue comes in - the nurse who answered the phone laughed me and refused to help. She said (in that sarcastic, demeaning tone - you know the one), "You don't know how to put in a feeding tube?" and left it at that. Sick baby, a neonatologist looking at you expectantly and a nurse with the knowledge of how to help laughing at you on the phone.

So, I gotta ask - who's out of line here? How many of us (peds nurses excluded, of course) really would be okay putting in a feeding tube on a 7 week old preemie? I realize I'm an emergency nurse and that contributes to my dilemma. Technically, I need to be prepared to care for anything and everything (including the dog someone brought in last week!). However, I really don't know everything, and in a hospital that makes a point of sending out sick kids to other hospitals immediately for treatment, is it the best use of my time and resources to try to become proficient in this area? This is the first situation I've seen like this in 2 years. If I go out now and take neonatal resuscitation courses and the like, without the practical experience to back it up, will it really be of any good to me? Had this kid coded, I could have managed the basic ABCs, of course, but the rest of it is really beyond my training. I don't know. What do you suggest? I'd like to learn from this situation so next time it's not so horrifying but I have the feeling I'm never going to be comfortable with this sort of thing, and feeling like I can't rely on the nurses in ICN for help makes it so much worse.

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Specializes in Pediatric Psychiatry, Home Health VNA.

If protocol has not already been established, I think it's imperative for your nurse manager and the ICN nurse manager to sit down and develop one with the medical director. The ICN nurse should absolutely not have left you out to dry, you're a team. However, you really do need to be prepared for ANYTHING if you don't have a separate pediatric ED and your hospital carries a license for pediatric emergencies. I think your hospital should offer inservices and continuing education so you don't loose your pediatric emergency skills. I do think I'd let the nurse manager know that the ICN nurse refused to help just to CYA and because an attitude like hers doesn't do anything for team morale.

I commend you for keeping it together to care for an extremely difficult pedi. You're still a new nurse to the emergency field but to the parent you're the nurse that helped save their baby's life.

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I hope you got that nurse's name and employee# what a *****! Most peds nurse would even be weary of puting a NG tube down on an infant that tiny. While reading your post my heart went out to you-I had the same experience with a baby years ago, mom running in throwing her baby into my arms screaming he can't breathe-ugh don't these folks think of 911? Anyway that nurse was totally inappropriate-I would have put that doctor on the phone I bet she wouldve moved her *** then. People like that is exactly why nursing is in such bad shape:banghead:-I would never suggest or hope for someone to lose their job but that is just unreal her behavior. Regardless of what she thought you should have known how to do-that moment was not the time to dispute it or laugh about it:down:, she should've come and helped you for the time being. Sorry that you had to go through that, did the pt come out okay?

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Specializes in Advanced Practice, surgery.

We always have to have a paediatric nurse on duty in our emergency unit by law. That way situations such as your can be dealt with by a nurse who is trained to look after these little ones.

It sounds as if you handled the situation really well, sick kids are so scary I worked for a few years in PICU and I still find them really scary.

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Specializes in Emed, LTC, LNC, Administration.

I too think the ICN nurse was WAY out of line. Everything the other two responders said is how I feel also. You're a team as a nursing department in the hospital and should work together.

With that said, taking an NRP course (or similar) would be a good idea. Also, trying to get your hospital to sponosr one, based on this incident, would be better. As an ED nurse for 17 years and a paramedic for 12 before that, I can tell you that unless you work on peds all the time, it scares ALL of us. But, in doing it (working on peds) more, you become less anxious and more willing to do things. While 2 years in the ED is a good base, the longer you do it, the more comfortable you become (as with ANY line of work). But don't think you were wrong for requesting help. You were right in knowing your limitations and that you needed backup. I commend you for that. Now take that knowledge and make it a positive. Get some pediatric training (PALS, NRP, etc.), and talk with your department director about getting the same for the entire department and maybe even joint education with the NICU.

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

First off, I'm so sorry this happened to you. There is no excuse for her actions. Her immediate response should have been one of two things: either 1. "I'll be right down!" or 2. Calling your charge nurse to make sure you got the help you needed pronto.

Some people just amaze me. I agree with October. Get together with your NM, the ICN NM and the medical directors to establish protocols. Everyone needs help at one time or another, and that certainly wasn't the time or place for the ICN nurse to snicker. She was called to help as a resource and it sounds as if she completely failed at her task.

To answer your question: yes, take the courses...whether it's NRP, PALS, PEARS, or another course, anything that will help you to deal better with just such a situation is going to help. The one thing that is better than anything else, though, is experience. Try to gain some experience with the little ones any way you can.

Find your educator and tell them your experience. Ask them to go over things with you, too. It is intimidating doing things when you're unsure or haven't done them before. Even harder when the only time you've ever done a procedure is on a 130 kg diabetic, and now you've got a 1.2 kg ex preemie.

Sorry, but that nurse would have needed a gluteal transplant after I was done with her. When are they going to figure out that we're all in this together, and any help we can provide one another is going to help the patient get better sooner??

vamedic4

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Specializes in Maternal - Child Health.

As a NICU nurse, I thank you for your efforts, and agree with the previous posters.

The NICU nurse was out of line.

Did you have the opportunity to ask the neonatologist for help, or was he already gone? As a rule, neos are usually pretty willing to help out with procedures.

Your hospital needs to provide PALS training for ER staff. NRP is pretty useless outside of the delivery room, so I'm not sure that would have helped you all that much. In addition, running "mock" codes, delivery scenarios, etc. is very helpful, and your clinical educator should be able to arrange this.

Thank you from the bottom of my heart for all you do to care for adults. I am quite sure if I ever called you for help with a grown-up, you would respond!

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I am going to take a slightly different view on this situation. I agree that the NICU nurse was completely out of line. That unit had someone who was skilled enough to assist in that situation and should have sent someone down to the ER to assist. (As a pediatric nurse, specifically adolescent, when I get pulled to the NICU, I cringe. I'm not at all prepared to work in the NICU. I haven't taken NRP and I don't plan to, as the chance of me ever needing it when I float does not make me want to spend the time taking a course for something I might need in less than 1% of my work time.)

Like most nurses, I am not a huge fan of floating, but I do it to help other units out. When I worked in a Children's Hospital, floating wasn't a big thing, as we went to other peds units that were similar to ours (adolescent med surg was where I worked, and I floated to heme/onc, renal, community peds, and inpatient surgery, to name a few). It really was a matter of just being in a different area, as I knew what was expected of me.

Where I work prn now, I am expected to float to all peds areas (PICU, NICU, heme-onc), without the benefit of orienting. Orienting nurses and their preceptors do not float, so how can we be expected to even get ready to float? I signed up to work prn (once a month or however much I can, as I have another full time job) on the general peds floor, and it was getting that every time I worked, I was floating, because it was my turn on the list. Not at all safe. Even if I did orient to the areas, I wouldn't be able to remember it months from then when I needed it, and some things change constantly that I cou;dn't possible keep up with.

To get to the heart of my rant here, I don't think that nurses should have to be the jack of all trades and be able to float to any given unit. We all know how unsafe that is. If I took ACLS, I'd forget most of it after I left the classroom, but I'd still have that card. Does that make me capable of applying ACLS during an adult code in the next two years? Nope.

In the poster's situation, I'd suggest having a peds or NICU nurse on-call from the units in the event that a situation occurred that required their intervention. I'd also recommend that the neonatologist assume some responsibility in the situation and implement some procedures. Adult nurses should not have to be peds nurses!

No one expects a medical doctor to practice outside their specialty, so why should nurses have to know everything and be ready for everything? Seems like a huge, and dangerous double standard.

:D

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Shame on that nurse! It wasn't about helping any other nurses, it was about helping that baby!

She should be reprimanded at the least.

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Specializes in PICU/NICU.

So sorry this happened to you...... and yes, this ICN nurse should have helped you! (I would have). Let me play devil's advocate here and just assume that the ICN nurse was maybe busy with her own patients, or it may have been just that she did not really want to be in the ER again as she probably had to change clothes and rescrub- the ER is considered "dirty" you know.... it is not a good thing to be exposed to RSV ect and then carry it back to the NICU. But I am making no excuses for her as we all should just be there to provide the best care for that patient! However, I really cannot believe that you do not have a Peds RN on duty each shift for these instances- maybe this is something you should bring up at your next staff meeting.

As for NRP- it is geared toward rescusitation in the delivery room and would not be much help for you I'm afraid. PALS would be a much better choice. Also, if you could find a S.T.A.B.L.E. class, I would HIGHLY recommend it! It is geared for preparing a baby for transport- simple instructions on how to manage blood sugar, temp, airway, labs, ect. Nurses who do not usually care for babies find this helpful.

I hope this never happens to you again!!

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Specializes in LPN, Peds, Public Health.

I think the nurse that laughed was way out of line! No one feels comfortable doing anything that they are not trained to do. She should have at least come down and walked you through it or just BEEN there in case you needed the help! Isn't that what nurses are for??

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Specializes in Med-Surg/Tele, ER.

Hope you follow-up on this. The NICU nurse's behavior was unprofessional at the least, and dangerous at worst. Scratch that, it was both.

Great job with a difficult situation.

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