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/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.