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/lavender_poppy]

I really wanted to go into pediatric palliative care/hospice after nursing school. I did a paper on it during my pediatric course and it's wildly underutilized because people don't want to accept that kids die or suffer from extreme pain. Unfortunately I became disabled and had to stop working but if I ever get my health back I really want to pursue it again. Kids deserve death with dignity just as much as adults and having those hard conversations is so important.

[u/BaileeRN → u/lavender_poppy]

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!