Back to Sleep

[Flo1216]

OK, guys I know there are a lot of good nurses out there but lately I have been encountering a lot of bad ones and as a senior nursing student it is killing me. I have had 2 incidences with a pediatric nurse(she has only been a nurse 6 months) about " Back to Sleep, " I was taught that nothing should be in a baby's crib but the baby and a light blanket. I have also researched this on my own. Well, one day I was working and I removed an adult sized pillow from the crib of a 1 month old on an apnea monitor. The nurse came in and said, " Where is her pillow?" I said, " I thought we weren't supposed to put pillows in the crib, " She proceeded to roll her eyes and say, " Whatever," I later found out from the baby's mother that she kept the baby in bed with her because she did not have a crib. She was homeless during the majority of her pregnancy. I told this to the nurse who again rolled her eyes and said, " She has other children...what did she do with them?" (Uhhh...maybe she had a crib then. We are talking about NOW). So I figured a social services consult was in order. The nurse said it was up to the doctor whether or not this patient could get a crib.???? I also went to L&D to get the mother some info on back to sleep, but I couldn't because THERE WAS NO INFO. Last week, on peds there was a detox baby awaiting placement, however the mom comes in frequently. I went to check on the baby and there were about 10 stuffed animals and several pillows in the crib. The baby was on its side wrapped in a blanket with a heavy blanket over her. When I went to change her diaper I found she was wearing TWO outfits. I told the nurse this and AGAIN she rolled her eyes.When the mother came in I explained to her about Back to Sleep and S.I.D.S etc. She was very grateful and told me she never knew that. I am a CNA and I am resentful that I have to teach this mother something that she should have been taught a long time ago by the registered nurse.

And the fact that the registered nurse isn't even assesing her 3 week old detox infant is equally disturbing. I am now working on an education guide for Back to Sleep.

[sjoe]

One word: relax.

[kmchugh]

First, as with any other profession, there are good nurses and there are nurses who, well, are somewhat less than good. Remember that, and that you are bound to run into some of both.

Next, I'm sure you have already figured this out. There are some things that you will be taught in nursing school that you will leave behind the day you graduate. No big deal, just some things that aren't really applicable to your practice. The trick is figuring out what can be safely left behind, and what cannot. What you learn about patient safety absolutely cannot be left behind. I'm glad (both as a nurse and as a father of small children) you are not leaving patient safety issues behind, they are important. Some nurses have trouble filtering out what they can forget and what they can't, so they tend to want to forget things willy nilly, and hope for the best. Definitely not a safe way to practice.

Also, you will run into some nurses who are hard workers, and some who are lazy in your professional life. What the nurse told you about the social services consult is essentially true in most places, it must be ordered by the physician. But, what a nurse who does not fit into the lazy category would do (and I don't want to hear about being overworked, yadda yadda, patients come first) is to plant the bug in the physician's ear. I have gone as far as telling a physician "this family needs a social services consult. OK if I write for that under your name?" That's part of your job, you spend a great deal of time with the family. You will learn things about the patient and family the physician may not have time to learn. S/he counts on the nurse (if the physician is good) to bring those kinds of things to his/her attention.

Finally, as Sjoe said, relax. Do the best you can, and don't let nurses who do not fit into the hard working, or less than good categories, affect your learning as a student. Enjoy yourself.

Kevin McHugh

[Flo1216]

SJOE- Don't tell me to relax. Just because this isn't important to YOU doesn't mean it isn't important to me.

[Q.]

Flo,

Unfortunately, experience tells you that sometimes units are simply ill-equipped with adequate teaching information; most of our teaching materials were designed by US on our "spare time." Seeing as there is a severe shortage of nurses, "spare time" gets harder and harder to come by.

"Back to sleep" is a concept that I am confident every nurse on my L&D floor teaches. In addition, we have a small crib card that gets stuck on the crib so that patients know. But, as with anything, there are exceptions to this rule.

Positioning of an infant can depend on numerous things: gestational age, condition, delivery hx, etc. Sometimes the hard and fast rule of "back to sleep" doesn't always apply, and as you go through your experiences as a nursery nurse or L&D nurse, you will realize this.

Parents commonly put stuffies, blankets, and other things in the crib. We allow it. In the hospitals, the infants are constantly watched and monitored, and as long as they are at the foot of the crib, away from the baby's face, there is typically no harm. We will address the issue with the parents as well. Bottom line: you want to educate your patients - not alienate them. Parents will do want they want with their kids; as a nurse it's your job to work around that and work with them to make the best decision/compromise possible.

[indynurse]

At my hospital, the pt can request a social services consult. We ask all pts on admission if they want one. Some people have a negative image of social workers. They seem to think the social worker is looking for a reason to take the baby away from the mother. If I think that a pt may benefit from a consult, I try to explain that the social consult is to assess if the pt has a need and if there are any community services out there that can help them. If the pt requests a consult, then I do not need a physician order.

When I do discharge teaching for a newborn. I explain to the parents why back is best and why the only things you should have in the crib is baby and light blanket. Yes, bumper pads are cute, but even a newborn can move/squirm around the crib and end up with her face up against the padding. In the end, all you can do is educate. You cannot follow every baby home and make sure that your instructions have been followed.

As for the attitudes of other nurses, well, you will run into a major resistance to change from a lot of nurses everywhere you go. And it's not just the nurses, some peds and OBs are this way, too. What about your NM or risk mgmt? If the American Academy of Pediatrics advocates Back to Sleep, why is your facility not advocating it?

[Flo1216]

In our hospital a nurse can initiate a social service consult without a doctors order. What I am upset about is that these patients are NOT being educated and that is part of a nurse's job.

[Flo1216]

Our facility is SUPPOSED to advocate it. Don't ask me why they don't...I wish I knew. They don't even have information about it. i am working on making up some pamphlets with the former nurse manager of L&D who is now an instructor at my school.

[Flo1216]

sUSY, I am aware of all of the things that you just mentioned. And I didn't alienate anybody. I merely gave information and the patient was very grateful. I know people will do what they want with their kids but they certaintly aren't going take the teaching seriously if they see the nurse doing all of the things that they were just told shouldn't be done.

[kittyw]

Question.... when I had my baby (in 96) the school of thought was moving towards placing the baby on it's side so that you get the advantage of both back placement and prone placement without the negatives of each.

[Q.]

I didn't say you personally alienated anyone, Flo. I am speaking in general terms.

I am assuming that the stuffies/pillows were placed in the cribs by the parents in an effort to make their child "feel better." Things from home, etc. All I am saying that sometimes rules can/should be bent, so long as they are done in a safe way. If you have a sick little baby and you (you as in a general sense) don't allow the parents to place stuffies in the crib, are you really doing any favors? All I am saying is that there are ways around it. What this nurse should have done when you questioned her is explain why she allowed it, etc.

One additional point: with the shortage again it makes it very hard for teaching to get done, much less adequately. I have run through a post-partum teaching checklist lickity split - due to time constraints. So, I taught yes, but did learning take place? Hard to tell. Maybe the nurses at your facility are teaching Back to Sleep; maybe they are not. Just do what you can when you come across a situation like this - as you've done, provide information, etc. Just try not to get too upset because you will get burned out before you even start.

[Flo1216]

The nurse allowed it because basically she didn't give a shit. This same nurse also didn't know that you shouldn't put pillows in the crib. This 3 week old baby was at the far end of the hall, the furthest room away from the nurses station. This baby was born addicted to cocaine and heroin, which increases their risk for SIDS. I know that the mother had good intentions, but she is only there for a few hours each day. the rest of the time the baby is alone.This baby was also being overheated(2 outfits, 2 heavy blankets). As for teaching, are you saying that because their is a nursing shortage and that nurses are busy that teaching shouldn't be done? By the way, our peds unit has the lowest census in the entire hospital and most of the kids are there for things like dehydration and gastroenteritis. We don't get the really sick kids. If this nurse has time to talk to her husband on the phone every 10 minutes then she has time to teach.