Are we tyrants?

[Bortaz]

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.

[FlorenceNtheMachine]

I have a fairly okay relationship with the RTs. Adult ICU here. I had a woman with a ton of secretions that took frequent suctioning to get her sats up. I did a little at a time and gave breaks because she had little reserve.

This jerk comes in and suctions her for literally, an uncomfortable minute. Too damn long. For God sakes! Desatted to the 80s for five minutes or more because of that dumb stunt. Good job guy! Show that loogee! And as she desats, he answers a phone call. I said are you going to turn her 02 up to 100% until she recovers? No answer because he's on the phone so I make my way to the vent and he taps the 100%*2 minutes.

Worst experience I've had. The tunnel vision kills me sometimes. It's a person lying in that bed not a tube with mucus in it waiting to be purged.

[FlorenceNtheMachine]

Oh and I got off track, it's a little tyrannical. I couldn't do my job without everyone coming and helping. Radiology, lab on occasion, respiratory, and secretarial staff all make my job easier. But the few bad apples ruin my tummy sometimes and I want to say out! out!

[Bortaz, MSN, RN]

I'm not a big fan of this attitude. You are caring for the patient. You do not own the patient. Hospitals for places of collaboration amongst healthcare professionals. This form of extreme territorialism hurts nursing, and is unprofessional.

Spend some time in an ICU (especially NICU) and you will quickly find that not everyone has the best interest of your patient in mind. We have too many automatons that just do crap because it's always been done that way, or "they" told me to do it. We also have ancillary staff that think a neonate is just a small version of an adult. I work with babies that often weigh less than a pound. That baby cannot protect himself from the ministrations of nimrods. I've placed babies in the morgue fridge that probably wouldn't have ended up there if all of the staff had been trained how to care for a premature neonate.

So yeah, I claim it as my baby...i'm there to protect them from harm, to get them through the night alive, and to get them home in a few months. I spend hours more time each day, with these babies, than even their parents do.

[monkeybug]

I'm not a big fan of this attitude. You are caring for the patient. You do not own the patient. Hospitals for places of collaboration amongst healthcare professionals. This form of extreme territorialism hurts nursing, and is unprofessional.

But ultimately the nurse is responsible. And if another person on the team is not providing care in an appropriate manner, then the nurse must advocate for the patient. Part of that comes with a sense of ownership. I don't think it's unprofessional at all. And it's hard to get it unless you've actually worked NICU, but it's very easy to kill these wee ones. You can't sit back and just let things go on out of professional courtesy, you have to advocate, sometimes vigorously.

[prmenrs, RN]

Most, if not all, NICU nurses, use the term "MY baby", often have nicknames for subgroups of neonates (mine was "microchip" for the

IMO, it's in the best interest of the baby that we are that way. We are very well aware that we are taking care of human infants and in the long run, it is NOT our baby; we are there to make sure that no harm comes their way while Mom and Dad cannot care for them in the way they need. Functions normally fulfilled by parents are ours for the time they're in the NICU-safety, hygiene, nutrition, growth and development-these are things we continually fold into the nursing/medical care needed to keep that little human alive.

If that's not professionalism, I don't know what the hell is.

[prmenrs, RN]

It comes down to the fact that neonates are a very different kind of patient. Everything you learned in school applies to adults. Most of that needs to be re-aligned to care for NICU patients. It's true-babies are not adults.

[ArgentumRN]

I'm not a big fan of this attitude. You are caring for the patient. You do not own the patient. Hospitals for places of collaboration amongst healthcare professionals. This form of extreme territorialism hurts nursing, and is unprofessional.

Well said!!!!

[ArgentumRN]

"So yeah, I claim it as my baby...i'm there to protect them from harm, to get them through the night alive, and to get them home in a few months. I spend hours more time each day, with these babies, than even their parents do"

You still dont get it..... now you have more rights that the parents themselves. It does not matter how much good intention you have. By being territorial only produces a barriers among health care professionals. But forget it. I dont expect you to see that either.

[lub dub]

Spend some time in an ICU (especially NICU) and you will quickly find that not everyone has the best interest of your patient in mind.

I spent over 20 years in adult critical care (ICU & CCU). That still doesn't give me the right to act in an unprofessional manner. No one single nurse is ever personally responsible for any patient's recovery. It is a collaborative effort.

[Bortaz, MSN, RN]

I spent over 20 years in adult critical care (ICU & CCU). That still doesn't give me the right to act in an unprofessional manner. No one single nurse is ever personally responsible for any patient's recovery. It is a collaborative effort.

I appreciate your point of view. I disagree with it, but I'm glad you posted because it does add depth to this discussion.

[HappyWife77, BSN, RN]

I respect tyrannical nurses. :) They are seriously competent and on their game.....Rock On.

[SaoirseRN]

I think that sort of extreme protectiveness labeled as "tyrant" behaviour is the exact perfect thing these fragile tiny babes need. Good for you all and keep it up!