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.

[SaoirseRN]

Your example is not the same. You will still allow that PT to assess and do their job fully. Often PTs will ask or even postpose therapy if they feel it is inappropriate even though you are chasing them down the hall yelling "but it is ordered". PT will also write instructions for the RNs to describe how to move some patients. The nurses described in these NICU situations want total control and will go to great lengths to prevent others from coming near their baby. Some also do it so they can have a quiet easy day to themselves which is also something found in the adult world. A sleeping or snowed pt is much better than one who might hit the light for something.

No, actually, if you actually read what they are saying, THIS is the same. I think you've taken your idea of a "tyrant" and substituted that definition for what is actually being discussed here. I know that your definition of tyrant exists. Of course it does, but you seem to be reading a completely different thread than I am.

[ArgentumRN]

Read some of the support forums for mothers of NICU infants or the complaints made about nurses who cross the line of ownership. Bottomline, these babies are in NICU for a reason. The baby is not there for YOU and whatever is missing in your life. There are procedures and assessments which must be done to provide optimal and safe care for the baby. You may lack an understanding of the bigger picture and allow yoou own emotions or need for control to skew any plan of care thus derailing appropriate care by the other discplines including the neonatologist and the family. I bet you also go to great lengths to have excuses for not allowing time for the baby's mother to bond with YOUR baby. I just wish you could see the difference and infant outcomes of a NICU with a team approach. But, it is doubtful you will ever believe anyone has the best interest of YOUR baby like you.

You might also be surprised at the RTs who do work in NICU and are team members who work active, y at providing the optimal ventilation care for the infant. They are also the ones who do procedures because it is appropriate and not because it is time. An example of this would be with a few overbearing and less knowledgeble nurses drawing a CBG or ABG right after or during vigorous activity just because it was ordered the previous day for a"time". These nurses will then call the doctor an demand ventilator changes. What about all the RNs who retape or move a baby without asking for for assistance and pull out lines and tubes? What about RNs who keep breaking the HFOV circuit just because they always did on a conventional vent? The list can go on and on about things RNs also. If your unit is so poorly managed by tyrants who do not encourage well educated and highly trained staff to participate in the care then it truly does not have the best interest of the baby. It also shows education within that unit has stagnated.

Well said!!!!

[TraumaSurfer]

No, actually, if you actually read what they are saying, THIS is the same. I think you've taken your idea of a "tyrant" and substituted that definition for what is actually being discussed here. I know that your definition of tyrant exists. Of course it does, but you seem to be reading a completely different thread than I am.

Waving a PT off because the pt is medically unstable is not the same as these bullies. Unless you are actively in the face of every staff member and the family, you are no where close to these nurses. Bully Extreme would be a good term but tyrant also fits since they want absolute control but are quick to blame others when things go bad.

[Esme12, ASN, BSN, RN]

I think we need to be respectful of each others experiences. Clearly some of the nurses that posted here have had negative experiences with nurses that are extreme in their behavior....and that I do understand. B ut not all critical care nurses are bullies nor should they be considered bullies for doing their job. This is where I think the customer service model is inappropriately applied...we do things in hospitals that don't make people happy...but that's our prerogative...not everything that is necessary to make someone that is critical well is pleasing.

I believe that most critical care nurses are caring, competent, professionals that will care and protect their patients from harm.....These are competent nurses and present themselves accordingly.

The use of the term Tyrant was a figure of speech. I am sure our experiences vary and we have all ran into THAT nurse that was unreasonable...and we don't always agree with what each other says.

But we need to be polite and respectful of each other.

[prmenrs, RN]

"...I think we need to be respectful of each others experiences..." from Esme.

I second that thought. Thank you!

[pcorn020]

Wow, what a post!

Ok so I'll go back to the very first post and and comment on that situation. Being protective (or even possessive) of our clients is somewhat "normal" in a NICU. However, I think that we have to use our tyranny for the best of our patient AND the team as well. Yes it's normal for a nurse to advocate for their patient and make sure they have the best possible care. But those RT are there for their patients too, and they do what they think is the best for them. If you know the RT is not delivering the best care, just teach them! Especially the RT new to the unit... When we started nursing, we all did something that what not quite right, and nurses around us were kind enough to teach us, instead of shouting "don't touch my baby!"

So, for the tyrans out there (because yes, there is ), be "good" tyrans. Teach others. Show them the good way. Show them the preciousness of the little ones and the special care they need. I'm pretty sure the RT will be glad, and so the rest of the team. And sooner or later, you'll be glad that the RT is doing it the right way and is helping you like you would do it.