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.

what is the "protective" nurse going to do on his/her day off? you see?

Just because you can't always ensure that your patient is getting the best care (because you can't always be there) doesn't mean you should allow others to give sub-standard care while it's your shift. Ultimately, NICU nurses have very vulnerable patients who most other people in the hospital haven't the foggiest idea how to take care of and any small mistake could end up with that nurse packing the baby into the cooler downstairs. Not only do these nurses take such heavy protective measures out of a bond with their patients, but they SHOULD do it because it's their professional duty.

just dont forget who is the nurse and who is the family. The "territorial" attitude screams unhealthy behaviour......

The initial post seemed more like the nurse did not like that particular RT at a personal level perhaps not sure...and the RN's way was the only way..... that was the point. Again that is an unhealthy behaviour. It does not matter how much you choose to ignore it or look at it is very unprofesional.

You keep accusing these people of trying to claim unhealthy ownership of these babies they watch over and I don't think you understand that this has absolutely nothing to do with that. If you read the thread, you know that they are perfectly willing to allow other people to care for the infants when those other people have been properly trained. The RT the OP has a problem with? He's been addressed personally as well as by his management. It's been handled professionally and yet he still doesn't comply with this basic rule. You are the one continually blinding yourself to the reality that in cases like this, untrained outsiders, no matter how well educated in general or well-meaning they may be, cannot and do not always know how to handle a specialized patient population.

These babies need protection from all the people who don't know how to handle them, and I'm pretty glad there are tough watchdog nurses to make sure they get that protection when they are at their most vulnerable and have no way to stand up for themselves.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

No one is saying that the nurse who is protective of her patients is participating in unprofessional behavior. No one said they exclude the family (who should NOT be touching ANYTHING)...but if at any point the family is causing instability to the patient they will be asked to leave. My job, at least while I am at the bedside, is to protect that patient and if I make a few people offended in that process then so be it.

Bortaz is a long term member here at AN and an excellent NICU nurse. These fragile micro premies need intense scrutiny and care at all times. If that means restricting certain personnel from the room then so be it. I had made my own changes, drawn my own labs, done my own ABG's because I knew the tech covering wasn't the brightest bulb in the bunch.....it makes my night less stressful.

All ICU nurses like things "just so" in their rooms and they want it their way when they are in charge of that patient. Physicians want these nurses to care for their patients because they know they will receive top notch care and some semblance of stability for tht shift. I have had surgeons call me at home when they have a particularly unstable patient with certain equipment because they don't want screw ups of a barrage of phone calls all night long. I always wold bring another nurse with me (in the days they allowed that sort of thing) to train and teach the tricks of the trade. If that makes me a tyrant...then I am proud to be a tyrant.

The critical nature of these patients makes ICU nurses be compulsive about their care....in that compulsiveness is organization and in that organization is safety for the patient. I am perfectly capable, as are most ICU nurses, to turn it off when we leave so that we can come back tomorrow and do it again.

I think this kind of nurse, the one who controls her environment in chaos, is what makes a good critical care nurse. Unfortunately one of my flaws is that I expect those around me to adhere to the same standards...fortunately I have worked in environments where we all felt the same way.

We each have our own opinions and I respect others opinions....even when I disagree.

How does "my baby" differ from "my patient"? I've heard we should call our patients clients, but can we no longer express possession either? Bortaz, from now on, you must refer to your mini-gerbils as "the client receiving care from me on this shift."

No one is saying that the nurse who is protective of her patients is participating in unprofessional behavior.

When did being a tyrant become considered to be professional behavior?

Also, shouldn't it be "...the nurse who is protective of his or her patients..."?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
When did being a tyrant become considered to be professional behavior?

Also, shouldn't it be "...the nurse who is protective of his or her patients..."?

I believe "we" ALL mean it as a figure of speech and not literal translation nor an interpretation of rude behavior.

One can be in charge of their patient and feel a personal sense of responsibility and exhibit professional behavior at all times. Just as hap hazard nurses can behave with arrogance and rudeness treat other nurses poorly in a demeaning manner.

The ability to be in absolute control at all times and appear calm and professional is a learned skill through years of expereince....which some nurses never achieve.

I will not engage in phonetics/grammar lesson for if I typed His/her every time I typed I'll go mad.....Bortaz knows I mean no disrespect.

Are you tyrants?Yes, you are.Hear me out.

This is NOT professional behavior in any way. I understand your "passion" about your babies but it does not help matters when their is such a vicious way of showing it.Can you pass your message across in such a way that it is felt and understood by all concerned? Absolutely! Just not this way that you are going on about it.It only drives hackles up.

You are an adult and would like to be treated as a professional.But you have to show it.Being tagged a "tyrant" does not a better nurse make you. Might I suggest you go back to basics and have a rethink on your course of action. Your defense might be you are too passionate about your babies. Maybe but that won't wash.If I were your boss, you would absolutely need to rethink that approach.

Specializes in Pediatrics, Emergency, Trauma.
Are you tyrants?Yes, you are.Hear me out.

This is NOT professional behavior in any way. I understand your "passion" about your babies but it does not help matters when their is such a vicious way of showing it.Can you pass your message across in such a way that it is felt and understood by all concerned? Absolutely! Just not this way that you are going on about it.It only drives hackles up.

You are an adult and would like to be treated as a professional.But you have to show it.Being tagged a "tyrant" does not a better nurse make you. Might I suggest you go back to basics and have a rethink on your course of action. Your defense might be you are too passionate about your babies. Maybe but that won't wash.If I were your boss, you would absolutely need to rethink that approach.

Ummm....I hope you read Esme's post above; she summed it up VERY nicely about taking care of EXTREMELY FRAGILE patients and the RESPONSIBILITY of minimizing complications an mortality.

That's not passion; it's COMPETENCE.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Are you tyrants?Yes, you are.Hear me out.

This is NOT professional behavior in any way. I understand your "passion" about your babies but it does not help matters when their is such a vicious way of showing it.Can you pass your message across in such a way that it is felt and understood by all concerned? Absolutely! Just not this way that you are going on about it.It only drives hackles up.

You are an adult and would like to be treated as a professional.But you have to show it.Being tagged a "tyrant" does not a better nurse make you. Might I suggest you go back to basics and have a rethink on your course of action. Your defense might be you are too passionate about your babies. Maybe but that won't wash.If I were your boss, you would absolutely need to rethink that approach.

Where do you see that anyone has behaved in a vicious fashion? No where is any post has anyone said they behaved in a vicious fashion. Tyrants has been used a s a metaphor...a descriptive term...I am positive ICU/Critical care nurses have been called much worse behind their backs.

I am POSITIVE that competent ICU nurses, whether they are premies or not, will intervene when they feel their patient is being harmed or when a procedure it detrimental. If my patient went asystolic every time they were suctioned...I would only allowed that patient to be suctioned by certain personnel and only when ABSOLUTELY NECESSARY! If that makes me a tyrant.......then so be it!

Might I suggest that, for the most part, all nurses want only the best for their patients and will intervene and stop someone who is doing them harm. As a hiring manager I would rethink the nurse that would allow "his/her" patient suffer deleterious effects without intervening...and suggest they go back to the basics and know that the first rule of medicine is to do no harm and that the nurses main function is to advocate for his/her patient and their safety.

I am positive the you would want a nurse to protect your loved one if they were ever that critical and that vulnerable from all possible harm.

Let me never fall into the vulgar mistake of dreaming that I am persecuted whenever I am contradicted.......Ralph Waldo Emerson

I don't work with babies, healthy or otherwise. When I work in ICU they are relatively stable patients (we are not large enough to keep the really sick ones). I work mostly in routine med/surg. But what I do recognize is the passion and care these nurses in this thread have for their most vulnerable patients, and that's exactly the kind of nurse I would want looking after my baby if I had a very sick or very premature infant. I don't see any unprofessionalism in their posts at all.

Specializes in NICU, Infection Control.

I need to [again] point out that "clients" being cared for in a NICU and those in a MICU, SICU, etc. are two entire different entities. From a physiologic, psychologic, developmental point of view, there are so many variances. Yes, they both have hearts, lungs, brains, kidneys, livers, families but all of them function in different manners in one than the other. Viscera are immature, handle drugs differently because of that immaturity. Families may have different needs in terms of follow up and support.

I don't know how else to say this, but NICU nurses are a different (and more protective) species because their "clients" are different and have different needs than adults.

And if I ever call "my baby" "my client", could someone please slap me? It might be correct from a nsg theory point of view, but it's just not right.

And if I ever call "my baby" "my client", could someone please slap me? It might be correct from a nsg theory point of view, but it's just not right.

I will slap you right now! The client is not YOURS. You are simply a cog in the wheels taking care of this client.

:)

Specializes in Going to Peds!.

I will slap you right now! The client is not YOURS. You are simply a cog in the wheels taking care of this client.

:)

You're eliminating the human element in caring for a very fragile, vulnerable being. My babies' nurses were not just cogs in the wheels of the healthcare machine. For 4 weeks, 3 weeks and 12 days (each child respectively), they cared for & fed & changed & nutured each one while in their care. They did for my babies what I couldn't when they were too small & vulnerable to be handled in the clumsy, unfamiliar way a first time mother would handle a newborn, much less a very unexpected preemie. I needed teaching. And encouragement. And patience. I'm GRATEFUL for the protective, fierce care each of my babies received. They were only in need of Special Care and not NICU. By the time the third came along, all the SCN knew us & our experiences with our first two. That last one was much easier.

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