katierobin23 2,635 Views
Joined Dec 31, '12.
Posts: 147 (44% Liked)
This was a week I experienced not too long ago.
Night one: Decent shift, I don't remember the details...average night. Probably what most nurses think of when they think of working in the NICU. A few feeder/growers, maybe an IV or two.
Night two: I start with two babies, but the second one is given to another nurse two hours into my shift because baby #1 took a nose dive. The rest of the night was spent trying to make sure this 13 ounce baby was comfortable and mentally willing him to produce urine...any urine at all. He is so swollen that his skin is cracking and weeping. He is on 100% and maxed out on the jet, I have the code cart by his bedside. At 0600, he codes. Pulmonary hemorrhage worse than I've ever seen...blood shooting out of ET tube with every chest compression.
We lose him.
Mom says, "it's okay. I have eight more."
Night three (less than twelve hours later): My assignment is fine, but my friend has the baby next to me and needs my help. The baby is super sick (sudden overwhelming sepsis.) Had been doing beautifully the day before, but now is on 100% and maxed out on the jet. We code her five times in 12 hours, we give her just about everything in the book. The fifth time we code her, she doesn't come back, time of death called at 0700. Her mom falls onto the floor, yelling, dry heaving, and crying, "why god why? Why again?"
After that week, I had some time off and I very much needed it. This doesn't happen all the time, but it happens.
In my experience, nurses who come to work in the NICU that aren't passionate about it don't last long. It's not a place to work to avoid working somewhere else, it's a place to work because you can't imagine doing anything else, imho.
I work in NICU, one night I had the parents of a baby come in and the mom was really nasty at the bedside...to the dad and everyone else. Dad was really quiet but we knew there was a history of abuse there (from both parties, they just were toxic together and awful to one another).
About 15 minutes after they left, we heard from mother/baby that they went back to her room, where he shot her and then himself. Terrifying to know that he had just been in our unit with a gun. You just never know these days.
I can only imagine the horror of walking in on that scene. The nurse had to take a leave of absence.
We didn't use that room for a long time!
We try to limit popping the top, but it's not really a huge deal in most cases. If the baby's temp is stable enough, we can pop the top if we need a better angle or more room to accomplish a task. There is a radiant heat source when the top is up, so the babies really don't tend to get cold if it's only open briefly. If the bed is humidified, we leave the top down at all times except in emergencies.
Now, I will say that on admission little babies do get cold many times during line placement, but I feel like that has more to do with the lack of humidity than anything else and using a radiant warmer would likely have the same result.
We have a "golden hour" quality improvement initiative where the goal is to get all admission tasks finished within one hour of birth and get the bed closed as soon as possible...it's hit or miss whether it is accomplished or not.
I'm starting in the PICU at a large children's hospital on Monday and these cases are what scare me the most. I can only hope I am able to handle myself as you have.
^^Everything that they said! The best advice I can give is to be a sponge! Take advantage of every learning opportunity and ask questions. I've found NICU nurses tend to be eager to help out newbies as long as you're eager to learn. We are big advocates for the little people in our care, and part of that is teaching new people how to take good care of them
Best of luck and congratulations!
In my opinion, L&D will help you more. Mother/Baby is almost entirely healthy couplets, you'll need strong assessment skills to know when something is going wrong but for the most part your patients will be healthy.
L&D on the other hand, you'll see a wide range of deliveries... normal healthy babies to the sickest of the sick and everything in between. You also will get to see what the NICU team does for immediate stabilization of a sick baby. Good luck!
We have a policy that says we can choose not to use leads on micropreemies with significant skin integrity issues. Those babies almost always have a UAC which we use in conjunction with the pulse ox to monitor their heart rate until the skin matures enough to use leads.
In my experience, coban is much more abrasive to skin than the pulse ox sensor, we cover it with clear tegaderm to keep the adhesive off the skin, and wrap it gently with a posey wrap.
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