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.
I work with adults but I am very territorial over my pts too. I want to know who you are and what you are doing. Iam not rude or anything and iam more then willing to help or answer their questions. If my baby was in NICU I would want a awesome nurse like Bortaz advocating and taking care of my baby. :)
No, that's ludicrous. I'm saying that the signs and symptoms of the bleeds were first noticed immediately after suctioning. My point, like Bortaz, is that we shouldn't be exposing micropreemies to unnecessary interventions that heighten their risk of complications such as bleeds. Excessive suctioning is one of these interventions. We have no way of knowing when the bleeds definitely happened, but they first manifested right after suctioning.
If my post-op hip replacement patient is having some complications, and I don't feel that it is in their best interest this day to have their full PT treatment, I am going to ask PT not to mobilize my patient today. I know that PT is an essential part of the recovery process, but in that moment say my patient had a large blood loss, is extremely symptomatic because of it, and even though is likely being transfused, they just aren't up to it and could even be greatly at risk for a fall. Maybe later in the shift, or on the night shift, we might look at getting them up, but right now is not a good time.
This is an adult example, but I believe this is what the NICU nurses are essentially talking about. I don't know where people have read that these nurses are refusing a multidisciplinary approach.
Aside from the obvious difference in acuity, there is no difference between me asking PT not to see my patient (or likely to reduce the treatment to bed-based exercises) for specific reasons, and the NICU nurses asking for no unnecessary auctioning or asking PT/RT, etc to come back later because this isn't a good time. The nurse has a picture of that patient on the whole, and this is what they mean.
Specializes in NICU, PICU, PCVICU and peds oncology.
I was just about to suggest that Bortaz edit the title of this thread to something a little less... erm... incendiary, but elvish beat me to it. I like her reference to the five rights too. Those of us who care for these most vulnerable of patients do tend to be very protective of them and vigilant as to what is done to and for them when and by whom. In my (not inconsiderable) experience when bad things happen to patients, it's ultimately the RN or LPN who wears the noose. Collaboration, by definition, demands cooperation. Unplanned extubations happen. On our unit they happen rarely, because the bedside RN is able to proactively plan for things like imaging, turns, physio, and yes, suctioning, by premedicating the child as needed. If I say to the tech or the therapist, "You're going to have to wait a few minutes while I... (whatever the patient needs to make the process go more smoothly)" then I mean they're going to have to wait. I've rarely encountered any other team member who has refused to allow me to ensure the patient's safety and comfort... and cooperation. Many of the other disciplines are at the bedside briefly and mostly in consultation. The nurse then carries out their plan of care. In the real world, no OT is going to come onto the unit every 2 hours to put on or take off splints. No PT is going to come onto the unit at 11 pm to ensure that twice-daily passive ROM is carried out. Physicians don't check back every hour to ensure that vital signs have been recorded and meds administered. You can bet that if they're called to the bedside because some untoward event has occurred and the patient was harmed, they're going to blame the nurse. We're all on the same side, but the nurse who is with the patient for the entire shift is the team captain. The nurse who abdicates responsibility for controlling a patient's care environment will likely end up on the receiving end of an inquisition the likes of which NO ONE would actively seek, no matter who or what causes harm to their patient.
I was just about to suggest that Bortaz edit the title of this thread to something a little less... erm... incendiary but elvish beat me to it. I like her reference to the five rights too. Those of us who care for these most vulnerable of patients do tend to be very protective of them and vigilant as to what is done to and for them when and by whom. In my (not inconsiderable) experience when bad things happen to patients, it's ultimately the RN or LPN who wears the noose. Collaboration, by definition, demands cooperation. Unplanned extubations happen. On our unit they happen rarely, because the bedside RN is able to proactively plan for things like imaging, turns, physio, and yes, suctioning, by premedicating the child as needed. If I say to the tech or the therapist, "You're going to have to wait a few minutes while I... (whatever the patient needs to make the process go more smoothly)" then I mean they're going to have to wait. I've rarely encountered any other team member who has refused to allow me to ensure the patient's safety and comfort... and cooperation. Many of the other disciplines are at the bedside briefly and mostly in consultation. The nurse then carries out their plan of care. In the real world, no OT is going to come onto the unit every 2 hours to put on or take off splints. No PT is going to come onto the unit at 11 pm to ensure that twice-daily passive ROM is carried out. Physicians don't check back every hour to ensure that vital signs have been recorded and meds administered. You can bet that if they're called to the bedside because some untoward event has occurred and the patient was harmed, they're going to blame the nurse. We're all on the same side, but the nurse who is with the patient for the entire shift is the team captain. The nurse who abdicates responsibility for controlling a patient's care environment will likely end up on the receiving end of an inquisition the likes of which NO ONE would actively seek, no matter who or what causes harm to their patient.[/quote']
I think the issue with posting on a forum, is the fact that the one who reads makes a choice in interpreting a TONE to it as well as negative personal experiences, instead of reading objectively...I believe there are some that are making gross assumptions of "us tyrants", even though I am surely positive that most of us are staunch advocates for our patients..
We are truly the captains of the interdisciplinary team; and we have a right to minimize complications...that may ruffle certain feathers, so be it, ESPECIALLY if you have already been "reeducated" as Bortaz has pointed out....if anything, the RT that stated that "some nurses are tyrants" in this case is UNWILLING to take in new information for the sake of the patient; in my opinion, the RT is the "tyrant"....not Bortaz, or ANY nurse that advocates for the patient first...
I will say this again, TRUE advocacy is not sunshine and rainbows, and sappy dialog from your favorite golden era movie...
I just want to thank all the "tyrants" out there in nursing land for their dedication to the patients. It is ultimately the RNs responsibility for what happens to their patient. If more nurses were tyrants then maybe, just maybe, less patients would be harmed.
There is good evidence out there that lavage when suctioning does more harm than good. Check it out and pass it on to your unit head, clinical advisor.
lub dub
254 Posts
OK SoldierNurse22. You are part of a multidisciplinary healthcare team. Does that make you feel better?