Okay, let me see if I can help out a bit here. We also have float nurses trained to work in the NICU when things are busy for us. Usually they're from Peds, PICU, or OB and we don't really give them an orientation - more like a tour of the unit to see where things are, a review of the flowsheet, standard NICU schedules and procedures, etc. But we've had adult float nurses want to help out, too, so we've given them 2-3 week orientations 1:1 with a NICU nurse and then they're able to work with us and take care of stable patients on their own. They seem to enjoy having the opportunity!
Quote from Rayrae
My question is what are some really important things for a float nurse to know/look for? Of course usually we have 3 feeder-growers but sometimes it can be a little more intense. I never know when someone else's baby's alarm is going off whether to do something or not, usually end up going over there looking useless b/c I don't know what to do to help, the kids are so different from our pts. I know this probably isn't specific enough, but maybe if you start talking I will be able to come up with something more. Right now I am not too fond of working in the NICU, and not too good at even the tiny ones. I had the hardest time getting enough blood for a heel stick the other day, another nurse ended up having to do it for me. (We only do Accuchecks and draws from central lines on our floor, or if we get blood w/an IV start, as far as labs go).
About the alarms - I'd ask right off at the beginning of the shift what they expect you to do about them. Generally, you will go over to the baby and assess the situation. First, look at the baby. If the baby is obviously cyanotic, generally they're apneic and need to be stimulated to breathe. We do this by rubbing their backs or flicking their heels if they're exposed. Look at the monitor - if the baby is bradycardic (generally under 100 beats per minute in neonatal patients) they need to be stimulated to breathe. If they're desaturating (generally under 85%) you need to investigate why. If they're apneic (no movement on the respiratory monitor or obviously not breathing) they need stimulation. If they're breathing, check to see if they have a nasal cannula and if it's actually IN their nose! They also might be vomiting, and in that case just get their heads to the side so they don't aspirate and use a washcloth to help clear the area. If the baby is laying there, breathing, not vomiting, not bradycardic, but just desaturating - again, assess the situation. Make sure the wave form is picking up well from the pulse ox and that the cannula is in. If all seems well, look and see if there is a nurse around and ask if they just want you to increase the baby's oxygen flow. But like I said, ask the nurses at the beginning of the shift what they expect of you, and let them know you work in general peds where they aren't always on monitors. They should be able to help you out.
For the heelsticks - make sure their heels are warmed. Ask if they have heel warmers - these are little packs that you crack and they heat up, then you wrap them around their heels for about five minutes. This increases bloodflow to the area and gets lots of perfusion to the capillary beds. If they don't have heelwarmers, you can wet a washcloth with warm (not HOT) water and wrap that around the foot and ankle, securing the whole thing with a disposable diaper to keep the heat and wetness inside. Then make sure to stick the sides of the heel near the back - not the bottom or back of the heel. They should have a chart somewhere on the unit to show the optimum area to stick. Hold the baby's calf in your palm and use your thumb to bend back their foot while letting the blood flow. Don't pump the leg - just let it rest a bit here and there. If the blood is starting to slow down or the whole heel is messy, use a sterile 2x2 gauze to wipe it clean and the blood should flow better.
The feeding makes me nervous too... whether they are really eating enough or whether I'm pushing them and they are gonna puke, any tricks to getting them to eat better...
If they're on PO AD LIB feedings, look at how much and how often they've been eating for the NICU nurses. Use that as a guide. Also, unless told to, don't wake a baby to feed it - they generally don't eat as well if they're still sleepy. Swaddle the baby firmly and hold it on your knee, facing you. Trying to feed a smaller baby in the crook of your arm isn't the best plan - they end up getting lost in your elbow, their chins smoosh down to their chests, and they get warm and sleepy. Plus you can't really see their faces and how well they're sucking, swallowing, and breathing.
Also the parents in the NICU, usually being in a much much different situation than the parents on my home unit, act and react in very different ways and any tips for that would also be appreciated.
Remember that these parents have never had these babies at home - we have always done most of their care, so they need a lot of guidance. In Peds, the parents can often take over a lot of the care and while that is our goal in the NICU, it's a challenge, especially with first-time parents. We start them slow with caring for their babies and if we're doing the work in front of them, we often explain what we're doing and why so they are always learning. We wouldn't expect a float nurse to do any discharge teaching, so don't worry about that. Just ask the parents - have you changed a diaper/fed/bathed the baby? They'll let you know what point they're at and where they feel comfortable.
As far as things NOT to do...
Like I said, no discharge teaching. NICU babies are unique and have special needs at home.
I wouldn't rock the boat too much - don't try and change anything unless there is really something crazy going on. Just go with the flow and follow the routine.
Look at the flowsheet for that day and previous days. You will see how we chart. That's the biggest problem we seem to have with floaters and agency nurses is their charting - which we can't figure out because they have our previous flowsheets to look at for guidance. If we chart things like color, oxygen sats, activity, and position every hour...why are they not doing the same when it's right there in front of them??? Or if we do vitals on a particular baby Q3 hours, why are they doing them EVERY hour? Just follow what we've been doing and you should be fine.
Thank you for wanting to help out a busy NICU!!