I'm at a loss for words and feel so discouraged and like a complete failure as a NICU nurse and am doubting myself as a nurse right now, wondering if I'm really capable of doing this job. I work in a level III NICU, our acuity right now is through the roof. About my background, I've been in the NICU a little over a year. I have taken care of a baby on a vent 1 time about 3 months ago, I've never taken care of a critical unstable infant, never had a micro. I've dealt with the normal a/b/d episodes but that was it. I've never even bagged a baby. I've seen it done 100's of times. I have a seen 1 code since Ive been there and was able to do chest compressions but that's about the extent of my experience. I watch and observe, try to learn at every situation available so when it comes my turn, I know what to do. Even with the code I attended, I wasn't even suppose to be there but I asked if I could observe because I don't want to freeze when it happens to me, with my baby.
That being said, I was taking care of a chronic ex 24 weeker who's been through the ringer a dozen of times, but nothing in the past month 1/2 or so. He was doing great, down to 5L. A coworker and I were putting his ND tube back in and the unexpected happened. We think he just vageled but he completely checked out. Once we realized his sats were in the 50's, hr in the 70's and not coming up, I called for RT as were bagging. After another 30 seconds I called the doctor. He told me I needed to call the NP. I work night shift and we always have a Doc and NP here, it's great. Doc's are on until 0300 (I work nights) and then the NP takes over till 7. I called the NP but her phone was going ringing busy. I tried about 5 times before calling the doc back. At this time it's been about 2 minutes. I called him back and gave the situation and he said he was in a delivery and couldn't come. Someone ran to find the baby as we are continuing to bag the infant. It was me, a RT that was from a our Peds, not the nicu, and another nurse who's been here about 8 months now.
Within about 4 minutes our NP showed up. I don't know if she did something because I couldn't see, but after 20 minutes his hr came up, slowly followed by his sats.
I feel horrible. His HR was under 50 for probably more than 4 minutes. He made a few agonal breaths but other than that, not a single breath. He was grey, completely unresponsive to anything. I feel like such failure, like I completely froze, forgot the basic of NRP, and just basic resuscitation. We should have started compressions within 30 seconds, and no one did. We were all focused on bagging and trying to find someone (NP, doc) anyone. I never thought the first time I would need to bag and (should have) code a baby I couldn't get a doc or Np when I needed them the most.
I didn't start cpr, it was my infant, my responsibility. But no one else did either, not the other nurse, the RT. I had 2 very educated nurses standing right out side the door (he had a private room) no one said anything about it. No one has mentioned it that I know of (like to our coordinator or anything,) 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.
Sorry so long, but I just needed to vent my frustration with myself with people who know and understand. I don't want to talk about it to coworkers because I don't want everyone to start doubting me. Thanks for listening.
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.
From experience, it frequently feels like nothing goes right during a code, even if you have everyone and everything there. It sounds like you did things as best you could given the circumstances. Those ex 24 weekers frequently have issues like that.
Although we seldom do it, you can always call a code in the NICU, and that will get you people there to help, who even if they are not familiar with NICU can still help. It'll also get you people who may have down time elsewhere on your unit. There should be a dedicated code blue line on your hospital phone, or my unit has buttons on the wall that trigger a code blue.
Rather than beat yourself down, use this as an opportunity to grow and learn and also benefit your unit.
Jokerhill
172 Posts
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.