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karnicurnc, MSN, APRN, CNS 3,909 Views

Joined Oct 20, '09 - from 'Virginia'. karnicurnc is a Neonatal Clinical Nurse Specialist. She has '19' year(s) of experience and specializes in 'L/D 4 yrs & Level 3 NICU 15 yrs'. Posts: 173 (30% Liked) Likes: 81

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  • Oct 31

    We do! The docs, NPs and the dieticians use it. It looks like the things they use to measure your feet in a shoe store lol. I will try and find out tomorrow when I'm at work which brand it is.

  • Oct 31

    I work in a level IV unit that has about 95 beds. For nurse to baby ratios, we do 2:1 for ECMO, 1:1 for titrating multiple drips or for just really sick kids and/or serious post-ops. Most of our babies are 1:2, and that covers most vents, all CPAP, and HFNC. We have a step down unit that is typically 1:3 but can be 1:4 if it gets crazy and usually if that happens you'll have discharged one by the end of the day.

  • Oct 31

    Level III NICU, 45 beds:
    1:1 patients are extremely rare (maybe a handful per year)
    1:2 or 1:3 for our NICU patients
    Step-down patients anywhere from 1:3 to 1:5 depending on staffing, most often 1:4.

  • Oct 31

    Where is this Shangri-La of which you speak? I wish to go work there.

  • Oct 26

    Another great legacy of our nursing heritage...ugh

  • Oct 26

    In a lot of states, it's not a protected title. In those states, employers can call anyone they want to a CNS, with or without certification, with or without a Master's.

  • Oct 26

    Depends on what state you're in. I"ve been places were CNS was a job title.

  • Oct 26

    Okay so you have your goal - I would choose the NP route.

    BTW though "some" organizations think DNP should be entry-level for APRNs, no one has enacted that legislation except for CRNAs.

  • Oct 26

    i liked the CNS and what they do but also i saw some of the restrictions they have in comparison with the NP. since there is a move to make the NP from a MSN to DNP. i thought it will better to get ahead of the new regulations. my goal is to be a nurse practitioner specialized in infectious diseases/tropical medicine and if possible some sort of public health degree.

  • Oct 26

    DNP is an academic degree that prepares people for a variety of advanced roles. CNS and NP are 2 different roles, both of which can be studied at the DNP level. (Though some MSN programs exist as well.)

    Which role (type of job) do you want to do in the end? If you want to be a CNS and do that kind of work, get a DNP focusing on the CNS role. If you want to do the work of a NP, then get a DNP with a focus on the NP role.

    Start by identifying what kind of work you want to do (what role you want). Then choose a program that prepares you for that. There is rarely a need to do both -- though some people may end up with both because they change their minds.

  • Oct 26

    The psych CNS credentials have already been eliminated. I don't know what's happening with the med-surg CNSs. I think this is a big loss for nursing. Once we're all gone, y'all will miss us.

  • Oct 26

    I worked in a NICU that used to check solely by auscultation and appearance of aspirate. We had a sentinel event, feeding the lung; the baby clamped down, coded, and didn't make it (the nurse was an amazing clinician, incredibly experienced leader/mentor on the unit, which made it harder). It's super-rare, but obviously can be catastrophic when it happens. Afterwards, we had a big initiative to prevent NG/OG tube displacement. According to our committee's research, auscultation is very unreliable, so we moved to a gastric pH system. If we placed the cath and couldn't get an appropriate pH, the provider would order an x-ray (which was pretty controversial, but I think the risk management department was a big proponent). Apparently many kids will get chocked up and brady if you insert into the lung, but not always (depending on disease status and maturity). It still freaks me out that my current unit doesn't check aspirate pH.

    I think one of the overlooked interventions that makes me feel most comfortable is ensuring the tube is taped down well, and that busy baby hands are adequately swaddled/secured. I think one of the biggest risks for tube displacement is when an active kid has pulled a tube halfway out, and someone comes by and shoves it back in (without verifying placement!) At my current facility, we use a 3M Cavilon adhesive barrier wipe (the kind used for stoma powder), then duoderm (heated with a heel warmer so it sticks really well), then another layer of Cavilon, a steri-strip chevroned around the tube to anchor it to the duoderm, followed by a layer of tegaderm (resulting in a duoderm-tube-tegaderm sandwich). I seriously did not think that the duoderm would stick, but it stays down (and is remarkably gentle).

  • Oct 26

    Like others have said, academic centers are generally Level IV NICUs and there are generally at least one in every major city. I would pick a few places in the country that you're interested in living and go to their websites. My experience has been that children's hospitals are always looking for NICU nurses, particularly experienced ones, generally short-staffed.

    For my part, residents are not in our Level IV unit and PAs are not even allowed to be hired in the hospital (which is a shame IMO but another topic for another time). They purposely placed us so that we wouldn't take care of only feeder/growers (we have a separate Level II in which we occasionally rotate) and take care of the sick babies, particularly CDH and ECMO babies. We have a transport team of RNs/RTs that go out and there is an algorithm for when NNPs go out- generally cardiacs, micropreemies, and otherwise very ill babies.

    Keep in mind that a lot of neonatology is just feeder/growers and what you get at a Level IV is not like most of the neo world so what you are getting is most of the norm for neo. What I take care of as a NNP is probably top 5% in regards to the sickness of babies. But you're right- it's better to start out with the sickest and have that skill set so that you can be a successful NNP most anywhere.

  • Oct 26

    I'd look into any university hospital or children's hospital. Our NNPs don't do transport, we ( the nurses) go with our fellows. Our NNPs take all the kids in the unit and the step down kids.

  • Oct 26

    The Children's Hospital at Vanderbilt University Medical Center (Nashville, TN) has a Level IV NICU that utilizes NNPs on all types of cases, as well as on transports. It's a tertiary referral center, so there are lots of surgical cases, as well as many preemies both born at the accompanying adult medical center, and transported in from around the mid-south region.


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