Are we tyrants?

Specialties NICU

Published

Specializes in CDI Supervisor; Formerly NICU.

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.

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Specializes in CICU.

I only work with adults - but still, my room = my rules. I will say that I generally work with many excellent RTs.

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Specializes in CDI Supervisor; Formerly NICU.

Yeah, I feel the same. I'll be the guy remaining with the baby in my care after the RT, lab, x-ray tech, PT, OT, neo, etc all move on down the road. I'll be there to fix whatever problems arise from their treatment, to take care of the baby for my entire 12 hour shift. I'm ultimately responsible for the care of the infant, while the rest are just passers-by.

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Specializes in Community, OB, Nursery.

I am not NICU....but I do care for babies and moms. I tend to be a bit, um....territorial....when it comes to them. If you are not there to really help, then get out.

This goes for anyone, including parents who visit their withdrawing neonate and want to fiddle with him and change his clothes a hundred times an hour and play with him when he is clearly not handling it well.

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Specializes in NICU, ICU, PICU, Academia.

We just got rid of a very experienced/ otherwise wonderful RT whose answer to any and all issues was to lavage and suction- a LOT. While we don't have micro-preemies- it is a Peds ICU with little patients.

Everyone else was sad when she left- but not me! I think we'll see our usage of saline bullets go way, way down!

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Specializes in CDI Supervisor; Formerly NICU.

The use of saline just drives me crazy. Why use something that all the evidence shows to be detrimental?

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Specializes in Surgery, Trauma, Medicine, Neuro ICU.

I'm an adult ICU nurse but I'm just as territorial. Don't touch my stuff!!!

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Specializes in NICU, Infection Control.

I don't think we're (in my case, were) tyrants so much as gatekeepers. If you want to touch my baby, you have to go thru me. And I was not alone. Most of the nurses I worked w/were the same way. New RTs got scrutinized closely til we knew we could trust them. We did all the blood work. Period! We held for all the X-Rays, and we knew if we got a finger in the image, the Radiologist would include that in his report, our kids were NOT rotated, and laterals were cross-table from the right side.

OK. If that means we were tyrants, we were soo ok w/it! When I went to the Level 2 hospital, the lab drew all the tests, X-Ray techs told us to turn the babies on their sides for the laterals, and you couldn't figure anything out cuz the kid was so rotated. The nurses @ this facility were a little better @ eval'g the X-rays because they were there, and the docs weren't, @ least not yet, so they had to be. I always loved it, when 6-10 hrs later the radiologist would call the unit to tell us something we had treated a long time ago and perhaps already transferred the kid out to Level 3. "Yes, sir/ma'am, we know that, thank you."

Protect your babies!! And don't let anyone diss you when you do!

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Specializes in NICU, OB/GYN.

I prefer the term "assertive" to the term "tyrant".

Neonates can't advocate for themselves. They need somebody who's willing to do it for them. I've gone so far as to threatening to call the department chair at 3 AM (after exhausting all other options) because I've vehemently disagreed with an infant's plan of care, and I was concerned that my patient was actually going to die.

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Ugh, the saline. "But so much more comes out!" No, it sounds like more comes out because you hear the saline being sucked up. Ergh.

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Specializes in ICU.

Adult ICU here- I still feel that it's my patient, my room, my IV pumps, etc. Respiratory is pretty aggressive at my current hospital (when they want to do stuff...not when you ask for something:/)- but I experienced the worst loss of control over my patient/room today when a visitor would not step out when I asked him to, and another forced her way in (through another nurse). I can't describe how bad that feeling was. Unfortunately (ironically) for the patient, she definitely did not receive the care that she should have. Ugh. I think I need to go for a run to get this anger and anxiety out of me...

Now, if it wasn't within the last hour of my shift, I would have handled the situation differently. I had to weigh the benefits vs. negatives that would come from forcing "my way" on them...it would definitely not help in the customer service department. Like I care about that. (Well I do, because my boss does...I do not like this new model of healthcare.) :banghead:

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Has anyone had a discussion with the RT about why neonates shouldn't be suctioned as frequently as he thinks?

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