Imafloat 6,766 Views
Joined Sep 24, '04.
Posts: 1,312 (16% Liked)
WeeBabyRN, I know it's scary the first few times you get a baby out. I found if I get all of my lines in position first and get everything set with mom or dad first, then I seem speedier in getting them up. We will usually disconnect them from the vent and inline suction before we move them over to the waiting parent, and in that cast, you can't be very slow. If the baby doesn't like being disconnected or has a high PEEP, then it goes a bit slower .
We encourage kangarooing, stable babies without umbi lines can kangaroo daily. They must be held for an absolute minimum of one hour, we prefer at least 90 mins. They go back when they start exhibiting signs they are getting stressed with their situation (as listed above by Prmenrs). I've had parents kangaroo for four hours. We have recliners and use the nursing stools that Prmenrs posted the picture of. If a parent decides to recline, then they get completely into position before the RT (in the case of an intubated baby) and I place the baby on their chest, and they stay reclined while we put the baby back when the session is over. We clip the vent tubing to the parents' gown or shirt in two places and check on the position of the baby and parent frequently (but quietly) to make sure they are not moving too much. We discourage talking at all during the kangaroo time, the whole point is for it to be very peaceful and I've seen babies get very upset if the parent speaks. I don't know if it is the reverberation or what, but many don't seem to like it. Also when most people talk, they have a tendency to move their arms or hands to express themsleves, it's an unconscious thing and then, whoops! There goes the ETT.
All of these things (parent in place first, clipping tubing in two places, checking on them frequently, discouraging talking) have helped decrease our unplanned extubations during kangarooing
I'm confused by this comment. This statement implies to me that your unit does not kangaroo unless the baby is really really sick? Or are you saying that you've found that when a parent is allowed to hold/kangaroo they have trouble grasping the fact their baby is a sick infant in an ICU and can still get very ill and possibly die. If the latter is the case, I kind of get what you are saying. It's like trying to tell a parent that just because the baby (possibly a 25 weeker) is here doesn't mean it is fine to hold and touch and stroke and give them a bottle right away. But I've found that if you educate the parents correctly about the concepts behind kangaroo care and it's benefits for ill babies, generally they don't seem to have unrealistic expectations. There are always those exceptions who think that no matter what or how sick the baby is, they should be able to hold.
I work NiCU.
...they are coding your patient in 34, don't worry about listening for report, just go to the bedside
...your patient in 12 has a sedated MRI at 0730 (it's 0710) he had a float nurse last night, I don't know if anythings been done, or if there's consent
....they say his abstinence scores are always high, but he was a perfect angel for me last night, he slept all 12 hours!
I am still in my first nursing job, as a NICU nurse. I love the babies and their families. I love that everything I do at work matters. I love that my population is vulnerable. I am detail oriented so NICU nursing is a perfect match. I have issues with poop and other body fluids, but when they come out of a baby, they aren't so bad (most of the time). I love the NICU because some of our families are there for a long time and we are able to develop relationships at work with them. I realize that people think NICU nursing is sad because it is sick babies. We all know there will always be a need for NICU's, there will be sick babies if I work there or not. I am glad that I am there to help parents through this dark time in their life. What an honor to make a parent smile during the most stressful and difficult time in their lives. I love that the families feel a connection with us and bring the kids back to see us for years and send us pictures every Christmas. It's incredibly rewarding to see the progress the kids make year after year.
Right now I'm not loving the hospital side of my job, we have been on a hiring freeze for a year, even though we have lost many staff nurses none have been hired to replace them. With H1N1 our hospital is busy and we are stretched too thin. I don't like being rushed and stressed all day, what if I mess something up? I know that this is a part of nursing. When I get really stressed, I go pick up a warm snuggly baby and rock them for a minute until everything feels a little better.
Black clicky pens so you don't have to worry about the lids. A black Sharpie to cross out patient info on any papers. I bought a nice clipboard that opens with a calculator at Walmart for $2.00. I keep all of my papers in it, it is even big enough to keep my stethoscope and clinical pens in while I am not in clinical. I found some small colored cards on a ring, they are about 2x3 inches, they are the perfect size to put in my scrub pants (carpenter) and I can study stuff when I have a few minutes down time. A good decent lunchbox, eating at the hospital can get expensive and fattening. I have a small 2 year paper calender in my purse, I have to see everything in front of me at once, it actually covers the entire time I am in nursing school, I got it at the one spot at target. I think it will be cool to look back at it when I am done. It is motivating now to look back and see how far I have come.
I've noticed that I have to pee at work but I can hold it. The minute I step in the door at home I practically have pee running down my leg....
January-I was thrilled to have my dream job in a Newborn ICU, I was making cold hard cash. I had an awesome preceptor for orientation. I was signing my name with RN behind it, I was giving meds all by myself, I was a nurse, woo hoo, life couldn't be any better. Everything I had worked so hard for the last 4 years had finally come to fruition. I got my first paycheck and my insurance cards, for the first time in my life I am a PROVIDER! I love being a nurse.
February-The newness has worn off, there is a lot more responsibility when you are the nurse and there is not a clinical instructor checking your work. The reality is starting to set in.
March- Night shift orientation; another fabulous preceptor. I am so tired, I scoured allnurses.com for threads on how to survive night shift. I bought Melatonin, an eye mask, and turned off my ringer. I lost a few pounds because of the nausea from staying up all night. I'm not so sure I can do this.
April- I'm on my own, holy crap! This is so scary, I'm the NURSE, I'm supposed to know all this stuff! One of my patients required an emergency procedure at the bedside, thank goodness for my coworkers at my side supporting me. I am starting to doubt my choice, NICU is too stressful and too much responsibility, maybe I should have done that year or two in med-surg before choosing a specialty. There is a negative nurse on nights who might be a problem, she never has anything nice to say about anyone. I find advice on allnurses.com on how to deal with toxic coworkers. It could be worse, I won't take her behavior personal.
May- I have definitely made a mistake by becoming a nurse. There is too much responsibility for too little money. I had a baby self extubate and I was so freaked out by it. I have made the decision to stick this job out for a year so I will be more marketable, then move on (how am I going to make it 7 more months!!!). I am finally able to eat at night, and I am getting some sleep during the day. Toxic coworker made a not so nice comment about my assignment being undesirable that I overheard, why are some nurses so nasty? Gah, I hate nursing, what have I done with my life!?!
June- I took the NRP (newborn resuscitation) class. Another patient self extubated, this time I knew exactly what to do, that felt so good. I got nominated for outstanding new grad (me???). I got my 6 month evaluation, I am a "strong performer" and I am getting a good raise. I can do this for 6 more months. I got my first primary patient. Her dad asked me if I would be her nurse, he could tell I cared about her the way I talked to him on the phone about her. Aww, I loved that baby and I felt honored that someone wanted me to care for the most precious thing in their life. I am feeling a smidgen better about my career.
July- The May/June new grads are starting on my unit. When I get report from them I begin to realize how far I have come since I started. My family took a week long vacation at an ocean front house that we would have never been able to afford before. The student loan payments are due now, holy cow, this degree was expensive, I can't quit my job to work in a doctor's office for less pay, I won't be able to afford my student loan payments. I think I might be able to work in the NICU for longer than a year.
August- My primary went home, I cried tears of joy and sadness. Words can't express the joy of being a part of nursing a tiny, sick baby to health and sending them home to a happy life. Sadness because I have fallen in love and will selfishly miss that smiling face loving me back everytime I work. There is a dayshift position opening up, I think I may put in for it, I still can't sleep soundly during the day, getting 4-5 hours of sleep a day isn't working for me. I scour allnurses.com for day versus night shift threads to help make the decision. I love the extra money of nights and I LOVE my coworkers. The people I work with on nights have taught me so much, I will carry some of the lessons with me forever. I start questioning myself, am I a strong enough nurse to deal with the hustle and bustle of days, can I emotionally deal with the drama of days? I talk to my nurse manager and decide to go for it, if days doesn't work out she said I can go back to nights. I just realized that I am 3/4 of the way through my 1 year commitment to this job.
September- Dayshift, what was I thinking, families, doctors, rounds, families, social work, nutrition, families, students, LESS MONEY ahhh! One of the June grads had a baby self extubate, she was paler than the baby, I jumped into action and helped her out. After it was over she thanked me and told me that she isn't sure this is for her, too much responsibility, would she ever know how to handle a crisis. I told her to relax, she was being too hard on herself (I can't believe that I actually told someone that, me THE queen of being too hard on myself). I am dealing with the hustle and bustle of day shift just fine. When I do get behind, my dayshift coworkers are always willing to lend a hand to get me back where I need to be. I LOVE my coworkers. Sometimes I am all caught up and I have the opportunity to help someone else get caught up. This time management stuff is starting to click.
October- Day shift is smoothing out, I am adjusting and things don't seem so bad anymore. I think I was getting depressed from lack of sleep on my night shift stint. I like most of the families and there is a rhythm to the business of the day. I don't have that dread feeling when I go to work anymore.
November- I don't know what has happened to me or when it happened, but I like my job. I like the challenge and I like taking care of the sickest babies. I sometimes leave work worrying that I forgot to do or chart something and I fear getting a nasty gram in email over it. I decide that I am a big girl and if I get a nasty gram, so be it, it will only improve my practice.
December- I feel confident some days. I still suck at starting IV's, but I am an expert at developmentally appropriate positioning. I still get little inklings of worry that I forgot something at work but I have made the decision that I am not going to worry. I do the best I can every day and I am only human. My primary from the summer came to see me and bring me a Christmas card, she is a chubby bundle of smiles, I wish I could kiss her fat little cheeks. I was so touched that her family made the effort to come to my job on a day I was working to be sure I could see their child. How wonderful is that, what a gift, it may have been the best Christmas gift I received this year. Our breakroom has been transformed into a cookie and candy palace. Every surface is covered with treats brought by current and past families. It is overwhelming, both emotionally and on the waistline. It is hard to believe that this job has such an impact on people. I guess it isn't just 'a job.' I can't imagine leaving this magical place. I became a nurse because I love people. There is no way I am leaving. If I leave and go work somewhere else how will I know how all the babies are doing? I love being a nurse.
The biggest lesson I learned this year is that being a good nurse doesn't mean you have all the answers or know how to do everything. Being a good nurse means that you care about what you are doing, are courageous enough to own your mistakes, and humble enough to ask questions when you don't know something or for help when you need it. The ability to leap tall buildings would be a plus, I plan on working on that during my second year of nursing.
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