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.

[Carpediem1012, BSN, RN]

In a, ahem, "man's profession", this would be considered "having balls". I admire these nurses dedication to their patients. Want respect as a profession?.... Here is a prime example. Dissecting their vocabulary and coping mechanisms (I think microgerbils is sweet) is irrelevant. Look at what these people are accomplishing.

[babyNP., APRN]

Wow, this thread certainly blew up from this morning!

Bortaz, routine instillation of saline down an infant's ETT is not evidence-based and can actually cause harm in the form of inflammation and increased incidence of VAP. This is to say nothing about the stress problems that come from an infant's oxygen supply cut off temporarily while you suction: you know how some of these kids have a come to Jesus moment.

I've never worked anything but NICU as a RN, but I'm having a hard time picturing an adult in an ICU who presents with severe bradycardia at the level of needing CPR...during ETT suctioning. Perhaps this does happen, but I'm sure everyone can agree that with these events occurring, any reasonable person, RN, RT, MD, NP, etc etc would be protective of the manner in which this procedure goes down and would certainly dismiss unnecessary procedures causing this level of trauma.

As far as referring to our assigned patients as our "babies," well, you'll find that in nearly every profession involving children. We don't call daycare toddlers "clients" just as a preschool teacher call her charges, "clients." I liked what someone said about the word "client" de-humanizing these infants. NICU and the peds world in general is completely different from the adult world--on another planet. Many nurses also refer to "their mom" when talking about the infant's mother.

...just burst out laughing, thinking about a call to the resident..."My client has been non-compliant with his goal PO intake. Shall I place a NG tube?"

[Twinmom06, ASN, APN]

to those of you who are decrying Bortaz and Esme et. al. I ask you this - have you ever in your career held a neonate that weighs 500 gms, has skin you can see every pulsing vein and artery through and who's eyes are still fused shut because they were born at 24 weeks? Babies who are so fragile that they can't be held because they will desat or brady down? That the parents can't even reach through the portholes in an isolette to touch their babies tiny heads to reassure them that they are there? If you haven't then I strongly suggest you stay out of the way and let them do their jobs as fiercely as they need to - regardless of who they **** off.

If it was YOUR infant you'd want the same care and protection for them. Talk to a NICU parent some time - the nurses that took care of their babies ARE their second family. Or just read this article - maybe it will help you better understand.

Dear NICU Nurse

[LaRN]

I think its okay to be a tyrant ....it's not like the baby can stick up for himself [h=1][/h]

[NicuGal, MSN, RN]

Yes, it is MY baby for the 12 hours I am there, it is MY family for the time I spend with them. I have literally "grown" kids from a tiny fetus whom looks like a naked mole rat to a beautiful 9 month old who has lives in our unit for his whole life who now is trached and gtubed. When his mom can't be there we are his family...we have helped him meet milestones, have helped that family to bond with this child who by all means should be 6 feet under, who by all odds and because of our being tyrants, has grown to be much more than anyone has ever anticipated.

In the adult world, can suctioning when not necessary cause huge swings in ICP and blood pressure and blow out all the vessels around your ventricles? Can being places any way but midline cause you to bleed into your brain in the first 72 hours of admission to your unit? Can bagging with a PIP of 20 cause a pneumothorax, especially if it done my someone who has no idea how to bag a 400gm patient? Can just being touched by the ones who love you cause you incredible pain because your skin is so thin? I could go on and on, but I think the point is this: Parents are trusting me, and my staff, to make sure NO HARM comes to these little souls who have NO voice. So if I have to be a beotch to get my point across, after I have nicely tried to re-educate and teach , then I will.

Come work with us for a day or so, my bet is that you change your attitude. And if you are ever unfortunate enough to have a baby in a unit like mine, and your baby is sick beyond sick, you will be more than happy to have a tyrant nurse being your babies advocate over the one that let's it ride for the next shift.

[ComeTogether, LPN]

There's no such thing as being a tyrant? Blanket statements like that concern me. Working in a NICU (or any unit, for that matter) does not give anyone the right to act in an unprofessional manner. Just remember this: whatever marvelous acts of nursing you have done during your shift can be completely undone by the next shift, or on your next day off. Be humble, and recognize that fact that you are a cog in the wheel of patient care.

Well, I guess I am refering to the OPs post as the example. Meaning, I don't think OP is doing anything wrong. I was taking "tyrant" to mean "over protective" in that context. I don't think its literal definition would ever be appropriate ...and the way I read the original post I didn't feel like the OP literally meant the true definition of tyrant but was trying to imply he/she is overprotective and strict when it comes to the care of his/her babies.

[Bortaz, MSN, RN]

Yes, it is MY baby for the 12 hours I am there, it is MY family for the time I spend with them. I have literally "grown" kids from a tiny fetus whom looks like a naked mole rat to a beautiful 9 month old who has lives in our unit for his whole life who now is trached and gtubed. When his mom can't be there we are his family...we have helped him meet milestones, have helped that family to bond with this child who by all means should be 6 feet under, who by all odds and because of our being tyrants, has grown to be much more than anyone has ever anticipated.

In the adult world, can suctioning when not necessary cause huge swings in ICP and blood pressure and blow out all the vessels around your ventricles? Can being places any way but midline cause you to bleed into your brain in the first 72 hours of admission to your unit? Can bagging with a PIP of 20 cause a pneumothorax, especially if it done my someone who has no idea how to bag a 400gm patient? Can just being touched by the ones who love you cause you incredible pain because your skin is so thin? I could go on and on, but I think the point is this: Parents are trusting me, and my staff, to make sure NO HARM comes to these little souls who have NO voice. So if I have to be a beotch to get my point across, after I have nicely tried to re-educate and teach , then I will.

Come work with us for a day or so, my bet is that you change your attitude. And if you are ever unfortunate enough to have a baby in a unit like mine, and your baby is sick beyond sick, you will be more than happy to have a tyrant nurse being your babies advocate over the one that let's it ride for the next shift.

AAAAAAAAAmen, sister.

[prmenrs, RN]

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

:)

I just turned the other cheek--have @ it!

[SaoirseRN]

I wonder if that is what people are stuck on in this -- the literal definition of tyrant versus the context in which is it used here.

[IrishErin]

If it was YOUR infant you'd want the same care and protection for them. Talk to a NICU parent some time - the nurses that took care of their babies ARE their second family. Or just read this article - maybe it will help you better understand.

Dear NICU Nurse

I was JUST literally on my way to posting this, I am glad I decided to read through first. I'm do not currently, or ever desire to work in a NICU. Frankly, the thought of babies or even children that sick terrifies me. Which is why I am glad that there are people like the previous posters who exist to do this job. To fiercly care for and protect the most fragile patients one could have.

These tiny adventurers are just beginning their journey in life... Why not give them the best shot they can have by guarding over them closely, even tyrannically?

[Bortaz, MSN, RN]

Or just read this article - maybe it will help you better understand.

Dear NICU Nurse

That has been sent to me, this week, by about a dozen parents of my former NICU "clients". Presumably because they appreciated my "passion" and my "tyranicism" in the care of their "biological offspring". I appreciated it.

[workingharder]

Well, I had a long dissertation prepared but, just to keep it simple: Bortaz, if you were the nurse caring for my grandchild, I would hand you a fine Cuban cigar and shake your hand. From your post, you seem to possess the attributes I expect from a member of this profession.

I kinda wish we could hijack the Marines' "Semper Fidelis".