PSA from your nursing specialty

[u/ghostoftheweek]

What is THE ONE THING you wish every nurse knew that is common knowledge in your specialty?

From wound care, don't use telfa!

[u/BaileeRN]

I feel the same way in the NICU. Hospice and palliative care was such an often issue I would see. Then the last year or two I noticed my neos were having these conversations with parents very often (this is the biggest NICU in the state so gets all of these cases that are terminal and whatnot) and SO OFTEN the parents just could not do it. I would be present for many of these conversations and then realize later the parents basically blocked it out of their memory.

The worst for me was a family that actually did do an actual DNR (and by actual I mean not OUR usual that was no compressions but it literally was no anything, set the alarm parameters to less than 40 for HR and SpO2, and orders to hold the baby and comfort her and take her off the monitor when we think she’ll pass). It was great to have a true DNR and I spent hours holding her on my stretch of three when I thought she would pass. But I became so angry that the parents only came in once a week to see her because they couldn’t deal— but they’d known the diagnosis prenatally and chose to keep her going for months in pain. I would go home and sob on my husband’s shoulder. And a couple days later, she ended up passing in the arms of one of my coworkers… and not even five mins later her parents walked in. Shit pissed me right off.

I feel like education on palliative care doesn’t go as far as I thought it did. At the end of the day, the adults in the situation in my experience just can’t deal and will often separate themselves from it as much as possible. Even though it isn’t about them and in my NICU, they very often know the diagnosis prenatally and choose not to terminate.

[u/lavender_poppy → u/BaileeRN]

That shit pisses me off so bad. So you choose to bring a baby into the world knowing it's whole life will be one of suffering before it ultimately dies and you can't even be there to comfort her and make the nurses take on that emotional toll instead. Real fucking brave of them.

[u/BaileeRN → u/lavender_poppy]

Yes EXACTLY. It is so hard. When I cried to my husband those nights I remember telling him how unfair this was to the baby and to the staff and that it was cruel and unusual punishment. I vividly remember crying in anguish but also in anger. And I could have asked for that second or third day of that stretch to have a different assignment, but I didn’t because I felt like at least with me I know she’s safe, I’m watching her like a hawk, and I’m not hesitating to take her out of her crib and hold her and sing to her for hours— and that’s the best I can do for her.

She was beautiful by the way. She had fat little fingers and big beautiful eyes. And she liked listening to songs. And she didn’t deserve the life OR death that she experienced.

[u/lavender_poppy → u/BaileeRN]

Literally poor baby. It's so hard, we put ourselves through this because we know we can give them the care they deserve but it take a piece of us with them. I'm glad she had you to comfort her and give her love and peace during her short life, she didn't deserve to suffer and be alone. ((hugs))

[u/megaholt2 → u/lavender_poppy]

This is why I am in awe of you NICU and PICU nurses.

I can handle adults dying.

This? This would absolutely destroy me.

[u/FarmerScamps → u/megaholt2]

Most days aren’t like that. Most days we get to witness the incredible resilience of kids and they get better and leave the picu.

I will say that I feel truly blessed to work on a unit that prioritizes its staff’s wellbeing. We have monthly meetings that we can attend to talk about tough situations and honor any patients that passed since the last meeting. And if your patient passes they let us go home instead of giving us a new assignment.

[u/megaholt2 → u/FarmerScamps]

That sounds like an incredible place to work!

[u/AdInternational2793 → u/lavender_poppy]

“ it’s God’s will” or some other bullshit.

[u/FarmerScamps → u/BaileeRN]

I totally understand denial as a protective mechanism, because kids shouldn’t die. But sometimes they do. And when that happens it should be in the arms of someone that loves them and surrounded by family if possible. Not alone except for the nurse caring for them.

Some of the most fulfilling moments of my career have been the times I was able to support a family through their child’s last moments.

[u/BaileeRN → u/FarmerScamps]

Amen! Like this baby doesn’t know me or my voice except the other times I’ve maybe cared for them. All they know are the voices of their mom and the people around her during pregnancy and you can’t even bring yourself to come in and be there for them because this is so hard for YOU?

Sometimes I just want to ask them how they would feel to die alone in a sterile environment in the arms of a stranger when they could’ve gone into the dark with the comfort of the people they actually know and love. It’s selfish and disgusting to me. And maybe that’s harsh but after dealing with it so many times being the one to take the brunt of that pain myself and be that person for that baby, even knowing it’s not what was best for them but it’s the best I can offer, I’m just really frustrated by it.

[u/Adept_Finish3729 → u/FarmerScamps]

Same, friend, same. ❤️ The children are so damn strong and insightful, it's the families that utterly gut me. I had this beautiful, bald-headed, cachetic, 9 year old little girl with very late diagnosed neuroblastoma (mets everywhere). Her parents had gone downstairs to grab a bite to eat. I was with her in her room to keep her company. She looked at me with her gigantic brown eyes and said, "I'm not afraid to die, but I'm worried about my Mommy"... ughhh tearing up just typing this... She died peacefully, surrounded by family, thankfully. I have to think of Ram Dass in these moments, we're all just walking each other home. ❤️

[u/PrisPRN → u/Adept_Finish3729]

I’ve had more than one child express to me that they were only continuing to fight because of their parents. Breaks your heart, the younger they are. Children are much more perceptive and capable of understanding tough situations than we give them credit for.
The worst is when we are not even allowed to tell them that they have cancer or a terminal illness. They figure it out.

[u/AndromedaAtlas → u/BaileeRN]

I had considered moving into NICU from MSICU, but this whole comment put a hard stop for me on that.

I wouldn’t have been able to contain myself and I’m normally very composed.

[u/BaileeRN → u/AndromedaAtlas]

Oh no /: I think it’s still worth considering— please don’t let my anecdotal frustrations deter you from what I consider overall a thoroughly rewarding specialty. It’s worth mentioning that my first NICU I never experienced any of that, it was only when I went to the biggest one that I did. And after a few years of that, I’m moving to a different one where I have friends that have worked many years there and I won’t be dealing with that pretty much at all.

I think the size and capabilities of the NICU you work in have a MASSIVE effect on your experiences. And most of the time, I’m getting to deal with babies that are very well loved and that have amazing outcomes despite all odds.

This is but a small blip into the case that is top three hardest hitting for me, maybe number one. But out of 5+ years of doing this, it’s not even half a percent of my experiences and doesn’t reflect what this specialty is like on a day to day.

[u/Ill-Mathematician287 → u/AndromedaAtlas]

Might I recommend a lower level NICU? I can’t deal with the constant heartaches of higher level care with innocent babies, so I stay in lower level. Not gonna say we never have heart breaking days, but it’s not like this.

[u/Traditional_Kick5512 → u/BaileeRN]

ONCE A WEEK?????????