Content That adpiRN Likes

Content That adpiRN Likes

adpiRN, BSN, RN 9,046 Views

Joined Nov 2, '08 - from 'South Carolina'. She has '3' year(s) of experience and specializes in 'L&D'. Posts: 375 (27% Liked) Likes: 210

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  • May 29

    Dangit, now I am watching several pairs of Danskos on eBay. Lol.

  • May 29

    Quote from adpiRN
    Thanks to this thread I just bought another pair of Danskos on eBay...

    I bought a pretty pair of handpainted Danskos on eBay a few years ago — they look like Starry Night by Van Gogh.

  • May 29

    There is no "average dollar amount extra" Depends on geographical location and the facility.
    Your main concern should be the orientation you will be provided with.

    What is each facility offering?

  • May 29

    Quote from Lisa.fnp
    Attachment 22322

    96 sets assorted and 10 royal blue 10 whites tops and pants not pictured. Funny thing is I haven't worn them in a few years now that I'm in primary care.
    (admiring lisa.fnp's collection and the fact that her hangers are all the same color and the fact that she has that kind of closet space to allocate to scrubs)

  • May 28

    Attachment 22322

    96 sets assorted and 10 royal blue 10 whites tops and pants not pictured. Funny thing is I haven't worn them in a few years now that I'm in primary care.

  • May 22

    I had been primary to a former 24 weeker who was now 9 months old and still in our unit. Despite everything he had been through he had a very sweet disposition. He loved to be held and rocked, esp during nippling. OT had beed teaching him basic sign lanuage. I would head straight for his crib as soon as I started my shift just to say hi. One day when I got to his crib he signed "Mama" and threw his arms up to be picked up. It was such a happy:heartbeat and sad moment combined. His Mom had visited 5 times in 9 months, it never crossed my mind that he would think I was his mother and it never crossed OT mind to teach him the sign for nurse. Sadly, he was not the only one in the unit who's mom did not vist, but some how he felt loved. That is what we try to do for our babes who don't get visits from parents. I still really don't know how former 24 weeker grasp such an abstract concept as mother. He went to a great foster family with a mom & dad, no other kids in the home, so he did not have to be 1 of 50 babies waiting his turn for a cuddle. I hear he is still signing, and Mama to his foster mom

  • May 21

    Welcome to AN! The site has a multitude of specialty forums, including one dedicated to NICU nursing where you may find some previous threads with the information you are looking for. Here's one of those threads to get started with.

    And here's one nurse's description of her shift:

    Quote from smilesweet
    A day in the life of a NICU nurse definitely differs...there's really no way to give you a good feel of what it's like because it can differ from minute to minute depending on the stability of your patients.

    Taking care of babies in a NICU is a very scheduled job though - on other nursing units usually night shift doesn't bother them much throughout the night and it's just giving them meds every few hours, but in the NICU we do a full head to toe assessment every 3 to 4 hours depending on what's going on with the patient.

    In my unit we admit any gestational age from 22 weeks (if viable and parents want to resuscitate) to sick term kids (the only thing my unit doesn't do is cardiac defects), but we do cooling, PPHN, ECMO, etc.

    So my shift goes like this...get report from day shift, scrub up (washing hands is VERY important), start my cares. "Care times" or "touch times" is when we go into each baby's bed and do their assessments, change diapers, feed them, etc. It's very important for premature and sick babies to sleep (aka their way of healing) so we cluster our cares. Either every three hours or every four hours depending on the needs of the patient.

    When we do our care times, I start by taking a blood pressure (with the teeniest blood pressure cuff you've ever seen), then I take an axillary temperature. Our goal temp is 36.5 to 37.5 degrees celsius. After temp I always listen to lung sounds, heart sounds, and bowel sounds. Then I feel the baby's head to see how their fontanels and sutures feel - we don't want the fontanels to be bulging (could mean increased ICP) or sunken (could mean dehydration) - we want them to be soft and flat. Sutures can be normal line, overriding, or separated - all of these can be normal at first but should go to normal line relatively quickly. After feeling the head I check pupillary response for PERRLA (especially if it's a baby with neuro issues). Then I go to the belly and make sure that looks and feels good. Premature babies are at a high risk for NEC (necrotizing enterocolitis - where part of the bowel basically dies - it can be fatal for babies). You need to watch the abdomen for loops - which are bowel loops visible from the outside - they feel like little lumps on your baby's belly. You also want to make sure the belly is very soft and the abdominal girth is stable. Measure abdominal girth around the entire abdomen near the umbilicus. Then I'll check residual via the baby's nasogastric or orogastric tube - we don't want more than 30% of the baby's feed to be left in the belly - this means the baby has not digested their food and maybe cannot tolerate the volume. Last (always last) change diaper. Makes sense why you would do this last - INFECTION RISK - but some people don't do that... make sure you monitor closely for any breakdown on the bottom. Take off gloves, wash hands, new gloves, feed the baby.

    That's basically a set of cares for a typical baby. Of course each baby is very different - if you have an intubated baby you'll have to do oral care and suction out the mouth and ETT, and ensure the ETT is in the proper place. You'll also want to check your ventilation settings to make sure the baby is getting the proper amount of pressure and support. You also want to wean the FiO2 (oxygen) per protocol. Premature babies less than 36 weeks gestation have oxygen saturation parameters of 85%-93% and babies over 36 weeks have parameters 88%-95% (but those can also change per baby). You do not want your baby to self-extubate on your shift so you need to make sure you monitor the tube positioning VERY closely and make sure it is safely secure on the baby's face.

    Feeding the baby can differ too - we never try to PO feed babies who are less that 33 weeks gestation as they physically do not have the suck/swallow/breathe reflex - which means they'll aspirate when they try to suck on a bottle. For these babies we feed them via an NG or OG tube (which is something I mentioned previously). Always check the placement of your NG/OG tube! If the tube is even a few centimeters out - it can be in the trachea rather than the stomach - and you would be pouring food into your baby's lungs!! This happens more often than you would think And this then causes aspiration pneumonia, which can also be fatal.

    IV's are another thing you'll have to check if your baby has one. Little baby veins can blow and become infiltrated VERY easily. If your IV has continuous fluids running through them you need to be putting your eyes on that IV every hour. IV's, if infiltrated, can burn babies depending on the fluids going through.

    Those are some of the basic things I can think of right now - The NICU is a great place to work! If you have any more questions feel free to ask I'd be happy to try to answer/help!!

  • May 16

    I would never risk my job or license for something so trivial.

  • May 12

    I second everything NICUNurseEliz said.

    Another thing that's unique to NICU that you might not find anywhere else in the hospital is the continuity of care. With adults, as their status changes, patients move to different units. For instance, a traumatic brain injury MVA patient might go to the ED, then Trauma ICU, then step-down, then a neuro/rehab unit. When you take care of a sick ED/ICU patient, you probably will never know what happens to them. In NICU, we take care of our kids from the minute they're born in the delivery room until we walk the patients and their parents out the door. You may take care of the same baby from the time they're 1 lb and vented until they're big enough to take a whole bottle themselves. It's incredibly rewarding to watch them get big and strong, and to celebrate as they achieve their milestones (i.e. coming off the vent, coming off oxygen, coming out of the incubator, etc.) You may or may not get that continuity of care in your PICU, depending on whether it's integrated into your Peds unit or if it's its own unit with separate staff.

    In NICU we have moments of joy, which I believe is uncommon in acute care. Helping parents do skin to skin, putting a baby to breast for the first time, giggling when a pooping baby makes a goofy smile. I absolutely love it.

    To be honest I don't know if anybody feels competent when they start in NICU, but you'll learn. The same can probably be said for PICU! I actually think adjusting to PICU would be much harder because the norms are so different at various developmental stages. I am in awe of the PICU nurses who know a normal/abnormal assessment findings in a 17 year old as well as they know them in a 1 year old. My hats are off to them!

  • May 10

    Speaking to those saying that midwives carry resuscitation equipment; just a bulb syringe or even a canister of O2 is not enough. If they are not NRP certified they are not qualified to be resuscitating an infant and will not be doing it most effectively. They certainly aren't going to be able to intubate which is necessary in some scenarios and they aren't going to be able to start a line for fluids. I can't tell you how many YouTube videos I've seen where the baby clearly needed some form of resuscitation. Midwife was torn between helping mom or helping baby. Ineffective bagging with no chest movement, blow-by O2 being given by nasal cannula when baby was clearly blue and not breathing - these are not the "professionals" I want resuscitating my baby if/when he needs help. And according to NRP guidelines 10% of babies WILL need help breathing at birth. Proximity to the hospital does not appease me either; you try going without oxygen for even 5 minutes, it's not going to be a good outcome!

  • May 10

    Quote from hayleyh31
    Watching parents who are unable to let their baby go and die a peaceful death, so we essentially torture the baby by trying to keep alive a 25 weeker with a belly full of dead bowel.
    This. It's not the babies that die that get to me. It's the ones that no one will let go.

  • Apr 3

    Do you understand that FNP scope includes pediatrics?

  • Feb 21

    Adult Med-Surg has nothing in common with NICU. In fact, I think starting in med-surg is only going to make things more difficult for me as I have to practically erase everything I have learned in my first job.

    Two years or even one year wouldn't have helped me in the slightest in NICU and just about every single NICU nurse I know who has made the transition from adult med-surg to NICU agrees with me.

    Quote from Ruby Vee
    A solid two years -- or even one year -- in Med/Surg would have been better.

    I took the "Princess attitude" comment to be reference to new grads who don't want to put in one to two years at the floor which first gave them their chance to show what they were capable of. Those who want to get the "dream job" without having to put in their time learning the basics. People who were sure they were being victimized if someone else got the job they were convinced they "deserved". We see a lot of that here on AN.

  • Feb 21

    I've worked as an RN for 17 years. Not once have I had to write a nursing diagnosis.

  • Oct 30 '15

    If you are going to have an asthma attack, what better place to be around (hospital) or people to be surrounded by (nurses and doctors)??