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.
Thanks, everyone, for the support and great advice.
As an update, I've notified my educator and supervisor of the situation. My educator says she will focus on some pediatric education and better equipment availability next and my supervisor wants everything in writing so she can follow up with ICN. Some sort of system where a nurse could be on-call for true emergencies like this one is a great idea and hopefully will be arranged.
I'll definitely take your advice and get my PALS next. We do have S.T.A.B.L.E classes here - I'd never really considered them as applicable to me before but I'll reconsider that now. I'll take any training I can get so this is never so awful again!
The baby is still intubated and being oscillated (?) at a NICU at a larger hospital. I'm just happy he's still alive - they're querying aspiration pneumonia - and the feedback I've received from the nurses at the NICU there is that they were happy with the care he was given in our department (knowing how out of our league that was), although they felt the neonatologist failed to recognize the seriousness of the situation (he never did intubate - it was the transport team that did that). Either way, it was the neonatologist who ended up putting in the feeding tube that day so I'm grateful to him for that. I just didn't have it in me and I never could have justified it as the safe course of action.
So in conclusion, thanks again everyone. I was really feeling like a reject and you've helped enormously. I'll be sure to do my best to get some good now out of what was an ugly situation.
I disagree that the ICU nurse was out of line. Unless she works in a pediatric ICU, she may have no more experience than yourself as to how to put a NG tube in an infant.
Any nurse working in the ER needs to have ACLS, TNCC, PTNCC, PALS. If you had these credentials, you probably would have been a tad more comfortable with your near code. NOBODY is going to feel completely comfortable with a pediatric code - all of us would have our adreneline rushing like crazy.
I'm not saying you did anything wrong, no nurse knows everything, but having worked in a small community hospital in the ER for 8 years, I can say that the ICU nurses would absolutely stear clear of any peds patients on those occasions they came down to help, as they did ADULT ICU, not peds. The Peds nurse were helpful sometimes, with putting IV's in, but the more we did our own IV's, the better we got. We always tried before asking for help.
Try to get Pediatric Advanced Life Support and the Pediatric Trauma Nursing Core Course under your belt - this should help in the future (ACLS and TNCC as well).
I disagree that the ICU nurse was out of line. Unless she works in a pediatric ICU, she may have no more experience than yourself as to how to put a NG tube in an infant.
Any nurse working in the ER needs to have ACLS, TNCC, PTNCC, PALS. If you had these credentials, you probably would have been a tad more comfortable with your near code. NOBODY is going to feel completely comfortable with a pediatric code - all of us would have our adreneline rushing like crazy.
I'm not saying you did anything wrong, no nurse knows everything, but having worked in a small community hospital in the ER for 8 years, I can say that the ICU nurses would absolutely stear clear of any peds patients on those occasions they came down to help, as they did ADULT ICU, not peds. The Peds nurse were helpful sometimes, with putting IV's in, but the more we did our own IV's, the better we got. We always tried before asking for help.
Try to get Pediatric Advanced Life Support and the Pediatric Trauma Nursing Core Course under your belt - this should help in the future (ACLS and TNCC as well).
Good luck
OP stated that nurse came from an Infant ICU...so she would be more than qualified to help out....coming from an adult ICU...we used to have to respond to pedi codes and talk about a fish out of water!!
I see Penguin's point here..........and, from a little different perspective, perhaps the other nurse made that statement to cover the fact that she had never placed an NG in a neonate.
Anyway, kudos to you for performing so well under fire.
Calla: I beg to differ, no where in the post was it stated the ICU nurse was from a pediatric ICU.
Thanks
Your right, she did not say she called a pediatric ICU, she said in the orginal post that she called the intensive care nursery. In other words the NICU. The same NICU that sent a nurse to place the IV in a 3 lb baby. The same NICU that then wouldn't come down and place the ng.
A NICU nurse should know how to drop an ng into a neonate, it's done almost daily. Baby's love to pull them out.
It's almost humorous that she'd make the trip for the sticks to show off her "skills," but not make the trip for something just as essential, though less "impressive." Sounds like an ego issue. I'm sorry for you and for the baby. :/
We get calls every day from other units in our hospital...peds for a neo IV start, newborn nursery for an NG, SICU for a PICC, etc. Personally, I think it's kind of cool that we're a good resource for so many other departments, and I'm always glad to help when it's something within my skill set. I'm also not afraid to admit that I don't have a clue about how to do other things.
We've had similar poor communication issues, though, with other units. We have a lot of moms who end up in post-surgical or medical from complications. Typically, they are "dropped off" in our unit to spend time with their babies. I'll get a quick report from the delivering RN, and ask if there's anything I need to watch out for. One day, I got a lovely little story about another NICU RN who "was too stupid to run the wound vac," and this med-surg RN went on about how she returned to her unit and told everyone how the NICU RN's were "too scared" to touch the wound vac. Ha ha. "With what you guys do, I just couldn't believe she was SO stupid!"
"Yeah. ha. ha. Wanna Surf my 25 weeker? Maybe do her Art stick? No? You sure? Oh. You look a little green around the gills. Are you okay?" But that would be mean.
Anyway - the disrespect really bugs me. There's no reason that the RN's throughout the hospital should be so rude to each other. Everyone's job is just as important as the next. The goal for everyone should be the same - exceptional patient care, even when the patient makes you a little feel a little ooky. I get that sometimes people are super busy and just can't help out - but refusing to for their own egotistical reasons just stinks.
NRP might help, on the off chance you get a delivery of some kind, or a newborn who's having a tough time. STABLE would certainly help. But for the other daily care things like putting in an NG, I would maybe consider a day or two of cross-training. Those things are pretty basic, and would probably take 2 minutes to get over being intimidated by. No fear - just a much smaller tube. :)
OP stated that she called the "ICN"--which means "Intensive Care Nursery".
Dear OP: You did NOTHING wrong. Miss prima donna ICN nurse should have stayed down there after the IV start to help you in any way possible. Including inserting an NG/OG tube (very helpful for getting air out of the stomach after bagging baby or using CPAP).
I'd be safe in betting that there a LOT of skills you don't think twice about that she cannot do.
Erin 321
17 Posts
Thanks, everyone, for the support and great advice.
As an update, I've notified my educator and supervisor of the situation. My educator says she will focus on some pediatric education and better equipment availability next and my supervisor wants everything in writing so she can follow up with ICN. Some sort of system where a nurse could be on-call for true emergencies like this one is a great idea and hopefully will be arranged.
I'll definitely take your advice and get my PALS next. We do have S.T.A.B.L.E classes here - I'd never really considered them as applicable to me before but I'll reconsider that now. I'll take any training I can get so this is never so awful again!
The baby is still intubated and being oscillated (?) at a NICU at a larger hospital. I'm just happy he's still alive - they're querying aspiration pneumonia - and the feedback I've received from the nurses at the NICU there is that they were happy with the care he was given in our department (knowing how out of our league that was), although they felt the neonatologist failed to recognize the seriousness of the situation (he never did intubate - it was the transport team that did that). Either way, it was the neonatologist who ended up putting in the feeding tube that day so I'm grateful to him for that. I just didn't have it in me and I never could have justified it as the safe course of action.
So in conclusion, thanks again everyone. I was really feeling like a reject and you've helped enormously. I'll be sure to do my best to get some good now out of what was an ugly situation.