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.

[TraumaSurfer]

Yis YOU wah, 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.

The only problem with that is YOU do not hold a license in their professions. If something happens to the airway or ventilator YOU will be the first to throw the RT under the bus. If the Xray is delayed because it conflicted with YOUR time rather than the baby's YOU will throw the Radiology Technologist into the line of fire. YOU will also not be the one who has to answer to their professional board and legal proceedings even though YOU may have been directly responsible for preventing them from doing their assessment and job. Everything is fine with YOUR baby until something happens but then YOU just can blame one of the passerbys conveniently.

At some point you need to understand the meaning of teamwork. The baby in your care might actually benefit from the services of those who have significant education and expertise in a specialty which has been ordered by a physician to provide care.

[TraumaSurfer]

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".

It also sounds like he would prevent others like PT and OT from doing their job or making them hurry which would not be in the best interest of you baby. I also would rather have the nurse who welcomes an RT do a proper check of the ventilator and assesment of the baby's airway. Too many things can go wrong which can harm the baby especially when territory protecting stands in the way.

[Bortaz, MSN, RN]

I must have missed the part where I refuse to let anyone do their job. Maybe it was when I was trying out that crown earlier.

[TraumaSurfer]

I must have missed the part where I refuse to let anyone do their job. Maybe it was when I was trying out that crown earlier.

Surely you have read what you have written.

Keep up with the journals. The NICUs (or any ICU) which have adopted an interdisciplinary team approach have the best outcomes. The units which maintain this tyrant attitude lag in technology and skilled practitioners. While you maintain your crown, the baby does not get all the necessary time with all the other therapists who could help the baby move further in life. You with your crown becomes more like the dreaded family member and nobody wants that patient, regardless of how nice the patient is, because of the crap they have to put up with. Eventually the NICU becomes the dreaded hellhole nobody wants to venture into and the therapists (RT, OT, PT, Radiology, Lab) draw straws to see who the unlucky one will be for that shift who has to try to do a quickie on your baby and get the hell out as fast as they can. Who do you think benefits from this other than you for knowing YOU rule? The baby definitely doesn't. Reputation gets around and any decent RT, OT, PT etc would not apply at that hospital. It is also doubtful the better NICU RNs would either since many like progressive work environments to see the better outcomes rather than territorial spats which usually spill out amongst the RNs as well.

[wooh, BSN, RN]

The baby in your care might actually benefit from the services of those who have significant education and expertise in a specialty which has been ordered by a physician to provide care.

Yes Bortaz, the baby in your care might actually benefit from being drowned in saline and deprived of oxygen by someone with significant education and expertise in a specialty which has been ordered by a physician to provide care. (I'm not sure about your rodents though. They might not.)

[TeenyTinyBabyRN, BSN, RN]

TraumaSurfer, it sounds to me that, you have never worked in a NICU. Things in a NICU are very different from the adult world. Things like "minimal stimulation" and "hands on q 6" are very important in the NICU world. Sleep and rest is one of the most important things for our little ones. Studies show that interupting a preemies sleep cycle is detrimental to their development and can have negiative neurological outcomes. We are our patients' advocates. We are the ones sitting at the bedside for 12 hours and must make sure our teamwork functions like a smooth dance, into our patient's care, rather than the cluster muck it wants to turn into. We see the big picture of what is going on in our 12 hours. Doctors, surgeons, residents, NNPs, PT, OT, ST wants to come in whenever they have the time and wake up my tiny preemie, who is sleeping peacefully and proke and prode my patient in the 5 minutes they can squeeze in. My preemie isn't able to speak up when things will not be tolerated or are not being tolerated anymore. We believe in "cluster-care." You go in, do everything that needs to done now, so you can let your little one rest and sleep as much as possible, but people who are only there for a few minutes don't get the big picture. They don't stay long enough to see the unneccesary pain/stress a 5 minute assessment can cause to our fragile babies, when it comes inappropirately or at the wrong time. I have my eyes on whoever touches my patient. I sure as heck will send other staff away, when it is not the time to touch my baby. I do potlitely tell them it is not a good time, and I will come and find them when the baby wakes up or to come back at such and such time, when other care is being done.

[MunoRN, RN]

NICU, ICU, Med Surg, ER, the same standard applies; the RN is the primarily responsible for the safety of the patient. There is a difference between irrational controlling behavior based on paranoia, and well substantiated concern for the safety of a patient at the hands of another caregiver. In terms of saline instillation with respiratory suctioning, that's long been considered to be bad practice and potentially harmful based on an overwhelming majority of studies, the most at risk group of this practice are infants. I think you could be more direct with your concerns, but either way, protecting patients from practices that arguably have risen to the level of negligence is a big reason why patients have Nurses.

[boogalina, ADN, ASN, BSN, MSN, LPN]

Although I've never set foot in a NICU (cause I'm too chicken...babies scare me), I can speak to the stress of ICU nursing, as a fairly experienced fly on the wall (CNA in 30-bed MICU/SICU for 2 years).

The effective ICU nurse has to set aside the desire to be popular or easy-going in favor of what the patient needs. If that means being a tough monitor/enforcer so a noisy environment doesn't agitate their CHI patient, making the ICP go through the roof, then so be it. Adult child wants to go wake up their parent who has an AM date with the OR (who is sound asleep at 2300) because that is easiest on Junior's visiting schedule? No go! I could go on with more examples, but you get the idea...

As with any specialty, unless you've worked in that unit, avoid judgement until you have the experience to really evaluate that which you see!

[Esme12, ASN, BSN, RN]

TraumaSurfer, it sounds to me that, you have never worked in a NICU. Things in a NICU are very different from the adult world. Things like "minimal stimulation" and "hands on q 6" are very important in the NICU world. Sleep and rest is one of the most important things for our little ones. Studies show that interupting a preemies sleep cycle is detrimental to their development and can have negiative neurological outcomes. We are our patients' advocates. We are the ones sitting at the bedside for 12 hours and must make sure our teamwork functions like a smooth dance, into our patient's care, rather than the cluster muck it wants to turn into. We see the big picture of what is going on in our 12 hours. Doctors, surgeons, residents, NNPs, PT, OT, ST wants to come in whenever they have the time and wake up my tiny preemie, who is sleeping peacefully and proke and prode my patient in the 5 minutes they can squeeze in. My preemie isn't able to speak up when things will not be tolerated or are not being tolerated anymore. We believe in "cluster-care." You go in, do everything that needs to done now, so you can let your little one rest and sleep as much as possible, but people who are only there for a few minutes don't get the big picture. They don't stay long enough to see the unneccesary pain/stress a 5 minute assessment can cause to our fragile babies, when it comes inappropirately or at the wrong time. I have my eyes on whoever touches my patient. I sure as heck will send other staff away, when it is not the time to touch my baby. I do politely tell them it is not a good time, and I will come and find them when the baby wakes up or to come back at such and such time, when other care is being done.

THIS THIS THIS^^^^^

[Esme12, ASN, BSN, RN]

You're eliminating the human element in caring for a very fragile, vulnerable being. My babies' nurses were not just cogs in the wheels of the healthcare machine. For 4 weeks, 3 weeks and 12 days (each child respectively), they cared for & fed & changed & nutured each one while in their care. They did for my babies what I couldn't when they were too small & vulnerable to be handled in the clumsy, unfamiliar way a first time mother would handle a newborn, much less a very unexpected preemie. I needed teaching. And encouragement. And patience. I'm GRATEFUL for the protective, fierce care each of my babies received. They were only in need of Special Care and not NICU. By the time the third came along, all the SCN knew us & our experiences with our first two. That last one was much easier.

Sent from my HTC One X using allnurses.com

wooh was being sarcastic.....she was quoting another poster....she is good at that....((HUGS)) She didn't actually MEAN it.

[dansamy]

I fail at blatant sarcasm! Obviously! :-D

Can I blame it on an undiagnosed personality disorder? No? OK, interwebs then! :-D

But I really do wish administration would stop, halt, cease & desist with this whole customer service BS and treating the nursing staff like replaceable little widgets. Supposedly, you pay me to think. Then, you enact redonkulous policies whereby I'm not allowed to make an individualized decision for each patient. All patients with X are required to have Y. Period. No exceptions and no individualized care. Period. Not allowed.

And the customer service BS. I'm all for making the patient/family as happy as possible, comfortable as possible, etc. But in the end, this is STILL a hospital. Not a hotel or resort. Sometimes, things aren't going to be just the way the patient/family wants/expects in the interest of providing for the health needs of the hospitalized patient. Suck it up, princess!

I feel much better after my completely off topic rant.

Sent from my HTC One X using allnurses.com

[Esme12, ASN, BSN, RN]

I fail at blatant sarcasm! Obviously! :-D

Can I blame it on an undiagnosed personality disorder? No? OK, interwebs then! :-D

But I really do wish administration would stop, halt, cease & desist with this whole customer service BS and treating the nursing staff like replaceable little widgets. Supposedly, you pay me to think. Then, you enact redonkulous policies whereby I'm not allowed to make an individualized decision for each patient. All patients with X are required to have Y. Period. No exceptions and no individualized care. Period. Not allowed.

And the customer service BS. I'm all for making the patient/family as happy as possible, comfortable as possible, etc. But in the end, this is STILL a hospital. Not a hotel or resort. Sometimes, things aren't going to be just the way the patient/family wants/expects in the interest of providing for the health needs of the hospitalized patient. Suck it up, princess!

I feel much better after my completely off topic rant.

Sent from my HTC One X using allnurses.com

You are too funny.... suck it up princess......Oh...if only we could.

I want to be granted 3 wishes one would be just let me work for month so I can say exactly what the public needs to hear without ramifications or lawsuits.

The next would be to have more money than Bill Gates....and the third......world peace.

Yeah....this whole customer service thing is out of control...clearly the alcoholic that wants to drink isn't thrilled that we refuse to allow him a fight of Jack Daniels....or the fluid restricted patient wants more water....and I believe all this

redonkulous policies whereby I'm not allowed to make an individualized decision for each patient. All patients with X are required to have Y. Period. No exceptions and no individualized care.

is to dumb down bedside nursing to get rid of the bedside nurse....we shall see.

I'm glad you feel better...((HUGS))