Utter failure with my first baby that should have been coded

My initial impressions of your post leave me to wonder what kind of training or support you've gotten during your residency. If you've seen a kid being bagged 100 times, has no one let you/made you do it before? Also, what were the other nurses doing during this time (the ones that were outside the door)? Was the RT bagging effectively? Yes, you should start compressions after 30 seconds of effective ventilation, but I'm wondering if it was truly effective? In our unit, we have no one at night so we have to make the best of it -- I'm wondering if the nurses in your unit are too reliant on the NNP? I guess I would be kind of ticked at the people who have more experience that didn't step in to help. At only a year of experience, you still need back up -- heck, after 16 years there's still some days I need back up if I can't figure something out!

I think you did what you could - you called RT, tried to call the NNP and then back to the doc, etc. Sometimes these chronic kids can be really hard to bag.

I'm not going to critique your performance as you have already done that, and continue to do so. Stop beating yourself over this; learn from it and move forward. Many do not realize how stressful their first code situation will be until it happens to them. It is not uncommon to have difficulty remembering NRP (ACLS, PALS, etc.).

…I had 2 very educated nurses standing right out side the door (he had a private room) no one said anything about it…

This is unacceptable behavior, which I find very concerning. In addition to being a lack of support for you, this showed a complete disregard for the patient.

…but I know we screwed up, and now I'm doubting myself.

I Have asked and asked for harder assignments, more complex and acute infants. I had a chronic but stable infant who just stopped breathing and I couldn't even do what I needed to do with them…

Stop this! Have you taken NRP? Even if you have, if you don't routinely use these skills they are quickly forgotten. I find very little of concern in what you did. You recognized the problem and attempted to get help. In my opinion, your unit deserves most of the blame for this. If you have been there for over a year, and only care for a ventilated baby once and performed chest compressions in one resuscitation, how in the world do they expect you to function independently during a resuscitation?

If this is typical for your unit, and not an isolated incident, I think that you are in a toxic environment, as well as one not supportive of new nurses. If this is an isolated incident, you should schedule a meeting with either your nurse manager or unit educator (if you have one) and discuss your concerns. Together, you should develop a plan to expose you to sicker babies as this is the only way that you will become proficient in caring for sicker babies. If it were me, and they are unwilling to do so I would begin looking for a new job, immediately.

Best wishes in whatever you decide to do, and again, quit beating yourself over this.

Ok, a few points I want to touch on:

1) You are in a level III but your last vent was three months ago? That absolutely needs to change, so you are right to ask for more complicated assignments. You will never get better unless you do it more often!

2) Were you all able to get a good seal on your mask while bagging the baby? I'm unsure from your post. I am guessing not since it took so long for your baby's vitals to improve. Sometimes it does take a while for kids with chronic lung issues to saturate, but I would have expected the heart rate to improve faster if you had good ventilation.

3) Did you get any help from anyone experienced there? Did the charge nurse come to help you? I'm getting the feeling that you were kind of fed to the wolves here. You're just past your first year and had a rough situation and it sounds like you had very little help. Do you have a staff assist or code button that you can press in an emergency?

Please don't beat yourself up for feeling like you struggled with a "stable" ex-24 weeker. He doesn't actually sound that stable with your description of his having been through the ringer, having been a struggle to get him down to 5L on his flow, and that he checked out for so long, including just gasping for a few minutes.

I am so sorry about your rough shift. For what it's worth, I don't think that you are a failure as a nurse at all!

Did the baby survive?

I am not a NICU nurse so I have no constructive advice. I just wanted to add that you clearly care deeply for your patients and take responsibility for your nursing practice. We all make mistakes, sometimes really, really big ones that negatively impact our patients. I hope your patient is okay, and I am sure you learned a lot from this experience that will make you a better nurse.

I agree with the previous posters who expressed concern about your unit. I can't IMAGINE being in a level III for that long and only having one vented patient, and it is seriously upsetting that you have seen 100s of codes and were only able to participate in one of them. Your unit should be invested in helping you develop the experience necessary to be competent with these highly complex patients, and it doesn't sound like you are getting the mentoring and support you need.

I have been in more than a few scary emergent situations, and EVERYONE reacts like you when it is their first time. It is impossible to describe the panic that comes when someone is trying to die in front of you and you can't even remember where to start. You can be NRP certified all day long, but unless you use those skills ALL THE TIME, that little piece of paper might as well be your kids school ID. It is really unacceptable that your unit isn't making sure you are getting this type of practice.

ETA- the first time I had to resuscitate a newborn, I was so freaked out I couldn't get the bag to seal and ended up doing mouth to mouth on this freshly born, slippery little noob. Baby did fine, but talk about a wake up call. I still get chills.

This is my reality as well. I work in a Level III NICU were the majority of vent, cooling, 30 weeks and under pt are given ONLY to experienced nurses (5+ years). I had to leave my unit for a level IV to get any experience. Then upon returning I was allowed more complicated patients. The problem is, now it's so boring. I'm already looking for a new NICU experience. Even with all this I've been in 1 code situation. ONE. I've been a NICU nurse for 3+ years. I worry every day I'll be placed in an NRP situation. The unit I work in is kind and helpful, but it's not conducive to new RNs who need to learn through experience.

Was bagging working? Chest rise? Air flow? If not then ABC, you have no airway and have to address that before compressions. It sounds like he needed intubation and I'm guessing no one qualified was there yet? Also, sometimes, we keep thinking that a little more bagging and he'll come up...

Don't beat yourself up. Absolutely those more experienced nurses should have stepped in to help. It sounds like your entire unit would benefit from mock codes.

Like the others have pointed out, I question whether the bagging was done properly. And that isn't a fault of yours alone...the RT, other nurses, etc. should be able to all do this. Sometimes it is hard to get a good seal, but if you can't and have already removed any prongs, etc. that may be blocking your seal, get someone to help. You can have someone focus on just holding the mask on correctly, while someone else bags. Someone should be able to do all of this alone, but in a pinch you can.

If the bagging was done correctly and just not enough for the baby, the baby should've been intubated way before the NP finally was reached and came down. In a lifesaving situation, you don't need an order to intubate. The RT (should) knows that and should be capable of doing so. Do you only have one RT available? We always have at least 3 that are in our NICU and the NICU alone. They don't round in any other units for the night.

I'm sorry you had such a terrifying experience, but you did what you knew to do. You got help instead of just watching it. And it really is different when it's your baby verses watching it happen to others' too. It's easier to freeze or feel put on the spot. Part of it is just something that comes with experience.

Did the baby survive?

We may never know....

I don't know if you'll ever see this, but yes, the baby did survive. He's doing great now, I see his mom on FB all the time.

I don't want this to seem like an attack on you, but learn from it. Sounds like the outcome was okay, baby lived, I'll point out that babies have decels in utero for just as long and live normal lives after. To learn you need to recognize the problem, it seems there was a communication problem most of all. With a years experience I would not expect you to run a code but I would expect you to communicate with the others. Others don't always know your skill level and expect you to tell them what you need, as you identified your lack of experience with experience as what you needed, you sometimes have to tell others that. Take it and learn from it, identify what went wrong, believe me I rerun every one I have ever been on over and over, in my head, trying to find what could have been done better. The result may have been good, but I want to learn and be better next time. Take the gilt your feeling now and use it as motivation to learn more, no one says you can't take NRP again with a years experience I will bet you learn a lot more as you now will understand things better. I can take a textbook and read it cover to cover and not learn a thing, but when something is new and I have a motivator like you have I will learn it and more. Have a good day and better tomorrow.