Are we tyrants?

Specialties NICU

Published

The other night, our RT was orienting a new guy to help cover NICU. He was taking him from bed to bed, showing him around and explaining things. I heard one of the nurses on that side of the room tell him "Don't suction my baby unless I ask you to!".

When they got to my private room (with a sick 24 weeker inside), the RT told the new guy: "Be careful with the small ones, because some of the nurses are real tyrants. Especially this guy."

Now, this particular RT is fairly new to our unit, and I have metaphorically slapped his hand several times, because of his tendency to want to suction babies as the answer to any problem. Also not keen on his habit of pouring in the NS when suctioning. So, I've told him to never suction my babies unless I request it. In fact, just don't ever do it...I'll take care of it. If you can't assure me that you got all that NS out that you put into my preemie's lungs, then just keep your hands off.

Me: My heater is beeping, can you reset it?

RT: I'll just suction.

Me: Man, is it really only 4 am?

RT: I'd better suction.

Me: The Texans won!

RT: Hang on, I'll get a gallon of NS and suction!

Most RTs have more experience in adults, where frequent suctioning and use of NS may not have any dire effects. Not so with a micro-gerbil. I know any of you with more than a year or two in the NICU have seen the pulm bleeds and worse that can come from suctioning.

So, my question is: Are we tyrants? Also, is it really a bad thing that we are?

In the interest of being the best I can be...am I out of line on this issue?

I'm also often annoyed by nurses that have no idea whether lab came by to draw blood from their neonate (so, you're telling me someone opened your bed, poked a HOLE in your baby, drew out his life's blood, and you don't even know it happened? Get out!), or who run like a scalded dog every time the portable x-ray machine approaches...so sick of distorted x-rays that you can't even see the lung field for all the crap (lines, leads, ets) in the field.

I was taught by a wise old Neo that we should only be suctioning micros rarely, when we see stuff in the tube or the baby is rattling or if they are displaying sure signs of needing it. The age of q2* suctioning is in the past.

Specializes in PDN; Burn; Phone triage.

Dear god. Babies!

May I never take care of something smaller than my hand. Amen.

Specializes in CDI Supervisor; Formerly NICU.

I should point out that it wasn't Bortaz that dubbed us tyrants...it was the RT.

Specializes in Nurse Scientist-Research.
I don't know where people have read that these nurses are refusing a multidisciplinary approach.

I believe it was just South of Bortaz vehemently stating he refused to allow disproven & harmful interventions on his infant. Yes, I said his infant. Just like all y'all say "my patient".

Saoirse, thanks for giving a lovely relatable example from the adult world.

Specializes in Community, OB, Nursery.
I should point out that it wasn't Bortaz that dubbed us tyrants...it was the RT.

My bad, then. Sorry, Bortaz.

:blink:

Specializes in Going to Peds!.

:roflmao: You are too funny....:roflmao: suck it up princess...:roflmao:...Oh...if only we could.

I want to be granted 3 wishes one would be just let me work for month so I can say exactly what the public needs to hear without ramifications or lawsuits.

The next would be to have more money than Bill Gates....and the third......world peace.

Yeah....this whole customer service thing is out of control...clearly the alcoholic that wants to drink isn't thrilled that we refuse to allow him a fight of Jack Daniels....or the fluid restricted patient wants more water....and I believe all this is to dumb down bedside nursing to get rid of the bedside nurse....we shall see.

I'm glad you feel better...((HUGS))

I'm pretty sure that if I did wish to have more money than Bill Gates, the next day Microsoft stock would crash, they would file bankruptcy & Gates would have $98 to his name.

Sent from my HTC One X using allnurses.com

Specializes in NICU.

I think some people are getting waaaaay to hung up on the word tyrant. From wikipedia, "A TYRANT in its modern English usage, is a ruler of a cruel and oppressive character who is an absolute ruler unrestrained by law or constitution, and/or who has usurped legitimate sovereignty... Plato and Aristotle define a tyrant as, 'one who rules without law, looks to his own advantage rather than that of his subjects, and uses extreme and cruel tactics- against his own people as well as others.'" The RT was name calling. Nothing Bortaz did was "cruel and oppressive." He tried to reeducate. He was not looking to "his own advantage," but rather looking out for the patient by attempting to prevent unsafe practice.

Also, on a side note, suctioning causes a loss of surfactant. We sometimes have to give medical surfactant to make up for the patients lack of. So another reason we want to avoid unneccesary suctioning.

Specializes in CICU.
I should point out that it wasn't Bortaz that dubbed us tyrants...it was the RT.

Third-person?

Anyway, I just felt the need to comment on the "my baby" controversy. Again, I only work with adults (God bless peds and NICU nurses). BUT, they are MINE when they are in my care. When I lay hands on someone, I feel like I am claiming them - not really like ownership, but as family, as my responsibility. I care about them, and their families. Even the jack-wagons. Maybe especially the jack-wagons. Definitely the cranky old guys, they are usually my favorites.

My experience has been, when family of those very sick patients senses my determination, my "ownership" of that patient and his or her problems - they can relax a little. Maybe go home for a shower and a nap. They can stop being hyper-vigilant because they know that I will be. Because they trust me, trust that for that shift they are mine and I will look out for them like I would my own family.

Specializes in Transitional Nursing.

Third-person?

Anyway, I just felt the need to comment on the "my baby" controversy. Again, I only work with adults (God bless peds and NICU nurses). BUT, they are MINE when they are in my care. When I lay hands on someone, I feel like I am claiming them - not really like ownership, but as family, as my responsibility. I care about them, and their families. Even the jack-wagons. Maybe especially the jack-wagons. Definitely the cranky old guys, they are usually my favorites.

My experience has been, when family of those very sick patients senses my determination, my "ownership" of that patient and his or her problems - they can relax a little. Maybe go home for a shower and a nap. They can stop being hyper-vigilant because they know that I will be. Because they trust me, trust that for that shift they are mine and I will look out for them like I would my own family.

Awesome and well said :)

Specializes in Wilderness Medicine, ICU, Adult Ed..
When they got to my private room (with a sick 24 weeker inside), the RT told the new guy: "Be careful with the small ones, because some of the nurses are real tyrants. Especially this guy."

Me? A tyrant? Damn straight, Buba. Now get the heck out of my way berfore you get hurt.

I should point out thinfants who have beent it wasn't Bortaz that dubbed us tyrants...it was the RT.

Read some of the support forums for mothers of NICU infants or the complaints made about nurses who cross the line of ownership. Bottomline, these babies are in NICU for a reason. The baby is not there for YOU and whatever is missing in your life. There are procedures and assessments which must be done to provide optimal and safe care for the baby. You may lack an understanding of the bigger picture and allow yoou own emotions or need for control to skew any plan of care thus derailing appropriate care by the other discplines including the neonatologist and the family. I bet you also go to great lengths to have excuses for not allowing time for the baby's mother to bond with YOUR baby. I just wish you could see the difference and infant outcomes of a NICU with a team approach. But, it is doubtful you will ever believe anyone has the best interest of YOUR baby like you.

You might also be surprised at the RTs who do work in NICU and are team members who work active, y at providing the optimal ventilation care for the infant. They are also the ones who do procedures because it is appropriate and not because it is time. An example of this would be with a few overbearing and less knowledgeble nurses drawing a CBG or ABG right after or during vigorous activity just because it was ordered the previous day for a"time". These nurses will then call the doctor an demand ventilator changes. What about all the RNs who retape or move a baby without asking for for assistance and pull out lines and tubes? What about RNs who keep breaking the HFOV circuit just because they always did on a conventional vent? The list can go on and on about things RNs also. If your unit is so poorly managed by tyrants who do not encourage well educated and highly trained staff to participate in the care then it truly does not have the best interest of the baby. It also shows education within that unit has stagnated.

If my post-op hip replacement patient is having some complications, and I don't feel that it is in their best interest this day to have their full PT treatment, I am going to ask PT not to mobilize my patient today. I know that PT is an essential part of the recovery process, but in that moment say my patient had a large blood loss, is extremely symptomatic because of it, and even though is likely being transfused, they just aren't up to it and could even be greatly at risk for a fall. Maybe later in the shift, or on the night shift, we might look at getting them up, but right now is not a good time.

This is an adult example, but I believe this is what the NICU nurses are essentially talking about. I don't know where people have read that these nurses are refusing a multidisciplinary approach.

Aside from the obvious difference in acuity, there is no difference between me asking PT not to see my patient (or likely to reduce the treatment to bed-based exercises) for specific reasons, and the NICU nurses asking for no unnecessary auctioning or asking PT/RT, etc to come back later because thisisn't a good time. The nurse has a picture of that patient on the whole, and this is what they mean.

Your example is not the same. You will still allow that PT to assess and do their job fully. Often PTs will ask or even postpose therapy if they feel it is inappropriate even though you are chasing them down the hall yelling "but it is ordered". PT will also write instructions for the RNs to describe how to move some patients. The nurses described in these NICU situations want total control and will go to great lengths to prevent others from coming near their baby. Some also do it so they can have a quiet easy day to themselves which is also something found in the adult world. A sleeping or snowed pt is much better than one who might hit the light for something.

Specializes in CDI Supervisor; Formerly NICU.
Read some of the support forums for mothers of NICU infants or the complaints made about nurses who cross the line of ownership. Bottomline, these babies are in NICU for a reason. The baby is not there for YOU and whatever is missing in your life. There are procedures and assessments which must be done to provide optimal and safe care for the baby. You may lack an understanding of the bigger picture and allow yoou own emotions or need for control to skew any plan of care thus derailing appropriate care by the other discplines including the neonatologist and the family. I bet you also go to great lengths to have excuses for not allowing time for the baby's mother to bond with YOUR baby. I just wish you could see the difference and infant outcomes of a NICU with a team approach. But, it is doubtful you will ever believe anyone has the best interest of YOUR baby like you.

You might also be surprised at the RTs who do work in NICU and are team members who work active, y at providing the optimal ventilation care for the infant. They are also the ones who do procedures because it is appropriate and not because it is time. An example of this would be with a few overbearing and less knowledgeble nurses drawing a CBG or ABG right after or during vigorous activity just because it was ordered the previous day for a"time". These nurses will then call the doctor an demand ventilator changes. What about all the RNs who retape or move a baby without asking for for assistance and pull out lines and tubes? What about RNs who keep breaking the HFOV circuit just because they always did on a conventional vent? The list can go on and on about things RNs also. If your unit is so poorly managed by tyrants who do not encourage well educated and highly trained staff to participate in the care then it truly does not have the best interest of the baby. It also shows education within that unit has stagnated.

This is the most ridiculous missing-of-the-point post that I've ever read.

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