L&D/NICU hostility!!!! - page 2
Just wondering if this unfortunate situation is unique to the facility where i work or if it is everywhere! whenever the NICU gets very busy, the nurses become very hostile and rude to L&D nurses. ... Read More
Aug 26, '02READING MAGAZINES?
I insist that you tell me where this hospital is IMMEDIATELY because I have my resignation in my hand and am prepared to move with just the clothes on my back, husband and household belongings be damned!!!
NO, NO, A THOUSAND TIMES NO, we do not staff for 'what-if's'. We are ALWAYS short-staffed for various reasons. For instance, according to nursing services, we go by a grid that considers how many babies we have, which ones are on vents, isolation, etc., and determines how many nurses we get. At eleven PM, the grid drops by at least one nurse, despite the fact that we still have the same number of babies (not including new admits!) and the same number of vents and isolation babies. Apparantly, the adult units (i.e., Med-Surg, etc.) go down by nurses at 11PM because it is considered night time when the patients are sleeping- less work for the nurses, patients need less care, no doctors around.
Great, that's fine for THEM (well, it's not, but you know what I mean...) but our babies, take it from me nursing-service-dogs-from-hell, have NO IDEA that it is nighttime. Perhaps we should start informing the babies that the sun has gone down and they are no longer allowed to poop, pee, vomit, flail, cry, bleed, infiltrate, yank out their lines, code, or die until shift change in the morning.
I'm going to write a new policy outlining this very thing, and after passing a copy on to nursing disservices I am going to hand one out to each infant and have them sign consent. Those who cannot read will have the policy read TO them. Whaddya think? Stupid morons (I mean staffing, you know...).
Sorry, it just makes me angry to have to give borderline-sh*tty care to these babies who need every intervention they can get to insure that they are healthy and safe. Another thing they do that ticks me off to no end is they call for census. We say, 'We have 18....' and they say, Thanks and hang up. No asking, 'Oh, 18? How sick are they? Any one-on-ones? How many meds?' Etc. Then, they have the audacity to send a scout to the unit to HAND COUNT the babies, as if we are lying and trying to squeeze out another nurse just to piss them off. Or else they say, 'Oh, 7 babies a piece for two nurses in Level II is no big deal...these babies aren't sick like they are in III.' Um, no, but they're guarded and recovering, and did we mention that they are TOTAL CARE? They don't understand, when they're screaming their heads off and desatting and turning blue when we try to reason with them like adults. Were we to say, 'I'll be with you in just a minute' to them, I'm pretty sure they wouldn't give a damn.
so, to make a long story longer (you opened a can of worms there! sorry!), no. We never have extras.
Digressing a bit, I have seen L&D nurses waiting around in Obs and chatting numerous times, but you wouldn't catch me lamenting that we don't get breaks and they do, because just like it takes a certain personality and disposition to do neonatal nursing, it takes a special person to do L&D, and that person is most definitely not ME. ;>P
Aug 26, '02Kristi, it's not bonbons we have........didn't you know?? We lurk in the shadows with amniohooks and syringes of pit to secretly PROM 28 weekers and have 32 weekers come in fully dilated...............
Your unit is so freakin' busy because #1 it's a level 3, and #2.......honey.......you're in NEW ORLEANS at CHARITY. Ummm, that may as well be called VIETNAM OF NURSING. My hats off to you for working there......that crack whore story about the chick w/the garbage bag over her head just made me GAAAAAAAAG. You realize, don't you, that she's probably preggers, too??? Wugh.
I'm so glad there isn't hostility between your L&D and NICU, but it really really is a common problem. Thankfully, I'm working on a nice, supportive unit now where the nursery nurses know we don't lurk in the shadows w/hooks and bonbons....
Aug 26, '02That seems strange. Well, if you want to move up to a smallish town in Western Canada, you're very welcome to. Our nursery is fairly small, the really sick kids all get shipped to Vancouver. I can't remember the exact guidelines they have here, but anything under a certain weight and before a gestational age, etc. gets shipped out. I was interested in NICU as a student, but did a rotation there and found it wasn't for me. Of course, I may have liked it more if not for the fact that our hospital doesn't have a lot of babies. We would never have 18, really sick or not. Most days I did there the number of nurses equalled the babes (USUALLY 2 OR 3 up to 5), so it seemed kind of slow because a few were usually healthy c-section babies who didn't need much care. I don't like reading magazines for 2 or 3 hours at a stretch. Plus I don't have the manual dexterity to work on those TINY little people you all have to work on! I am always amazed at a nurses ability to hit a vein that small!
Our staffing in L&D can't be dropped because we are always on the minimum safely allowed(we require a minimum staff in case a woman comes in and needs a c-section).
Aug 26, '02Shay, did I tell you that just last night, I was on my way to the cafeteria and was approached by a weeping, obviously pregnant woman who wanted to know if I could hide her from the L&D nurse who had just tried pushing her down a flight of stairs in an effort to rupture her? I couldn't remember if I told you or not... Anyway, she also wanted to know if I was white. I told her no. ;>P
Aug 26, '02We get along with L/D for the most part. Most of our squabbles are related to us saying a term tachypneic baby 9or something similar) is "just transitioning" and don't press us to take the baby and them saying the baby has had dusky spells or was satting low and should go to the NICU. We assume that they put a sat monitor on a wiggly baby and got an inaccurate result, they (most likely) are frustrated because they baby pinks up right when we get up to see the baby. They have an IOU (infant obs unit) and we'll want the borderline babies to go there instead and be observed for awhile. They want us to take the baby because they're not comfortable with it.
We talk about them and I'm sure they talk about us. When it comes down to it, we take the baby if they press us (or if the baby really needs it!). It's really not too pissy back and forth.
We staff with one or two people with easy assignments for admissions, first admit person often with only one easy pt. We don't get admits if we have a vented pt. We staff extra if we know for sure we are getting an admit during the shift.
I've seen no b!tchiness towards L/D assuming they are not stopping labor or inducing for no reason, etc. If they have to deliver a preemie, we just accept it without question. They know OB, we don't.
Aug 26, '02Ps. If anyone from MY hospital is reading this, please let me state for the record that I LOVE my unit, LOVE my job, and am prone to a bit of exaggeration. My hospital is HUGE and the only one in this area serving a desperately-lacking population, and if you're interested in the grit of neonatal nursing, it's the place to be. However, I do get a bit weary of the politics time and again. ;>) Disclaimer over. As you were, soldiers.
Aug 26, '02We don't really have that kind of hostility from NICU at my hospital. Most of the NICU nurses are pretty knowledgeable about why Mag isn't just for PTL. We all (L&D/PP/WBN/&NICU) all whine about the DOCTORS inducing 36 weekers for "discomfort of pregnancy" or LGA and the baby comes out at 5lbs. Not all of the docs are like that, but there are a few that if you see one of their 36 weekers coming in for a labor check, you just know, regardless of the assessment, that that lady is not going home undelivered. And, these women are not given a clear picture of what delivering a 36 weeker could be like.
Aug 27, '02PS,
For your info Adult patients that are acutely ill, are still as much work at night as during the day - much like any baby unit - the suits are just using the "Night is slower" excuse to decrease staffing. ALL!!!!!!! patients poop , pee, have IVs go bad, status go South, or perhaps sundown.
Aug 27, '02Gosh, thats unfortunate. That lack of information or innocent ignorance between areas is the reason we have to circulate through all of them. As a PIH patietn WITH a complete previa, no way did anyone want me to deliver early BUT, as my peri orbiital edema, liver enzymes (actually edema everywhere) AND near seizure like state was dangerous not only to me but especially to the baby, I had to be delivered. Tell them it isn't all about the time frame, Its about saving lives. Maybe someone should leave open a book with illustations as to how pih and toxemia affect blood vessels, and therefore, mom and baby ( who are a unit, and not just the person that they receive), so they can figure it out...Lets see.....If I were to choose life or death for myself or my child, which would I choose? Well, I would and did choose life...
Aug 27, '02If we get "vacation" inductions or not quite term being induced for "sick of being pregnant", the nurses refuse to participate. That slows things down considerablu and makes the docs think twice. Your license is involved, after all....
Aug 27, '02I was in the nursery the other night and reporting off actually had a day nurse tell me we have it easier because they have babies in the nursery all day. Hello, where do you think most of them are at night? Why couldn't you do a hearing screen, I ask. Well, its noisy in the day time because the babies cry. Hello, again I ask, What do you think they do at night? I need some help in here because I have 10 babies, she fairly shouts. Hello, I had the same ten babies AND managed to get things done. More patients talk at night to the nurses, usually get better and more involved care and we always have less staffing. We also work better and quicker between pp, delivery and the nursery because we have to. We are more assertive and interactive with docs and the rest of the hospital, and if we have to float or be forced to work on the day shift, we are done before 10 am with things they can't do their entire shift. NO ONE had better EVER say to me that we have less staff because we have less to do. We actually have more to do because there is our stuff and the stuff the other shifts either can't or won't do....I respect the differences in the activity between shifts, but until you have worked nights for awhile in a hands on capacity, do not wrongly assume it is easier, or in any way a slower pace. Babies don't check with shift change angels to show up.....Babies could care less about staffing...Apparently, neither does management......
Aug 27, '02You know, just about everyone is short staffed. Those pf you who don't circulate through all three areas to actually experience what each other is going through, should consider asking your NM to have you meet together and try it. And, as for assisting and circulating as the only nurse in a vaginal delivery, you don't need sterile gloves for that. The doc does, but you don't necessarily. You need clean ones. And, we sometimes have to do epidurals alone if the other nurse is with another patient. You can't scrub and assist at a c/s alone, but, though you would rather have someone else there, drawing up pit, adjusting the light, helping the pt push or anything else you would do in a delivery is no big deal. You get the coaches involved and you go back and forth. If the baby is not good, that is a whole other can of worms.....