Never Trust a Monitor

This is the best advice I have for new nurses. Often I see the new girls in our unit so concerned about the numbers on the monitor that they forget to actually assess the baby. Most of the time the monitor is not picking up the true heartrate or oxygen saturation because of a faulty lead, or a kicked off O2 probe. Always check the baby.

For instance,

We had a little one pass yesterday. She had Trisomy 13 which is fatal, but some children linger a while with this disorder. The mom spent great time with her. She was able to snuggle with her and love on her for a long time. Then she went home to hug her other children for a bit before coming back. It was in this time that her little one decided her fight was done. We knew mom wanted no heroic measures, so we just watched her, gave her a little oxygen, and waited. As other nurses were off calling the doctor and mom to come back, myself and the charge nurse waited with the baby. Then it happened... the monitor jumped, so we listened again. There was a heart beat. It was faint and way too slow, but it was there. Then the monitor started showing that the baby was fine. Heartrate in the 140s, O2 sat in the 90s. If I had been sitting outside that room watching a monitor I would have thought that child was fine. But indeed she was not. It is a phenomenon that happens at times with these infants at the time of death. She was able to hang on until mom got there and mom was able to hold her and say her final goodbyes, which I think was good. But we did just turn off the monitor completely because it was reading completely false.

Never look only at the monitor, it is only a tool. As one of our doctors says often, "The monitor is NOT your patient." Pay attention to what the patient is doing, what he looks like, what he is telling you a whole lot more than the monitor.

OMG, we are so slow!

Slow days. This is something I'd never say at work. Never utter the words "slow" or "I'm bored" or "we need to pick up." Or anything else like that. It is the kiss of death (literally for some of our little ones I think).

However, now that I'm home and not back for a while I'll write about it. We are so very sloooooow at work right now. All our poor PRN nurses haven't worked in ages. It is a little ridiculous at this point.

And this is where it gets a little hairy being a nurse in the NICU (or I guess I nurse anywhere). Saying things like, "Ok, we need more tiny babies" sounds pretty awful to anyone who doesn't exist in our world. But really, we need more preemies. Ok, I guess the thought is, we need more babies being born in general. Because even our well-baby area in our hospital is slow. Fewer and fewer people are electing to have children right now. I guess the economy and the uncertainty of the future employment plays a big role.

It makes my employment difficult too though. Everything really is very tied together.