Circumcision

elizabells, BSN, RN · Oct 21, 2007

I'm morally opposed to parents insisting that we run a full code on a child with a uniformly lethal malformation and torture them for months, but I still have to do it.

On my unit the OBs come down and circ babies before they go home, if the parents ask for it and the baby has been in house less than 30 days. The RN taking care of that child is expected to set up and assist the OB. I'm sure you could come to some accommodation with your NM, but I'd also be prepared for whoever has to pick up that slack to be irritated about it.

prmenrs, RN · Oct 21, 2007

Usually, there are enough people around to cover for your circ if you do their feeding, VS, whatever for them. It's really not that big a deal.

I hate circs too, but everyone knows it; I don't think it happens that often in NICU. The parents are usually so happy to get the kid out of there, they don't even think about the circ. Either they have the pediatrician do it in the office, or, if Jewish, hold the Bris after d/c.

We had a chronic kid who died after many, many months in the unit. The parents were Jewish, and the Director of the unit and another Jewish doc went down to the morgue and did the circ as a courtesy for the parents. I thought that was a wonderful thing to do.

Preemienurse23 · Oct 22, 2007

We have a pediatrician or OB come, and they take them off the unit and do it. We play no part in it. Usually they get it the day of or the day before they go home.

RainDreamer, BSN, RN · Oct 22, 2007

Along the lines of what Eliza said, there are some things that I'm morally/ethically against, but are still done in the NICU.

In our NICU though, no, circumcisions aren't done. They're done by the ped once the child is discharged from the unit.

Elvish, BSN, DNP, RN, NP · Oct 22, 2007

I work well-baby and ICN babies get circed the day before d/c or the day of. And it is the RN who brings them to us and usually the OB is pretty self-sufficient in circing. The RN just does after-care.

I feel you on opposition to circ. I don't assist at them, but it's not because I've asked not to. It's just always worked out with just one exception (don't ask how) that I've never had to. My supe knows how I feel about it, too. She's also anti-circ.

EricJRN, MSN, RN · Oct 22, 2007

My experience with circs has been similar to prmenrs - it's not that common on our unit. Although it might be difficult to work out a permanent, set-in-stone arrangement where you never assist with circs, you could probably swap duties with another nurse on a case-by-case basis.

FWIW, I'm having more and more trouble justifying circs in my mind, but I'm a pushover and I'm not likely to stop helping any time soon.

elizabells, BSN, RN · Oct 22, 2007

I agree, Eric, I'm having more trouble with them too and will probably not circ my own (eventual) sons unless my spouse feels otherwise.

I'm sorry if I came off as harsh in my first post. I was thinking specifically of my unit and its layout - we have a 65 bed unit with a pretty open floorplan, so if the OP "couldn't even be in the room" she'd have a very hard time helping out the nurse who swapped the circ with her. We usually stay at the bedside and hold the paci with SweetEase. Also, since we're a teaching hospital, once in a while you'll get a green doc who you really need to watch for signs of trouble. I'm not taking my eyes off anyone who's got a scalpel on one of my kids. I have seen a circ go very, very badly, and I'd hate for that to happen while no one was there but the resident.

I do stand by my statement that the OP should be prepared for whoever switches with her to be a little ticked. Maybe that's just the culture of my unit, though, who knows. But especially as a new nurse, WHOO boy, that would not have made me any friends.

I have many further thoughts about our role as pt advocates as it pertains to things we morally object to, but that's another thread.

2curlygirls · Oct 22, 2007

I've had to assist with one circ in almost 7 years. It was awful. Fortunately, one of our fellows stepped in to take my place. HE could see I was having a very hard time with it.

They are normally done at the ped's after dc.

RN mom of 2 · Oct 22, 2007

I want to thank all of you for your responses. :)

I do understand that there are moral dilemmas you must deal with in the NICU that are beyond your control. It must be so difficult at times. As a mom, I can also appreciate how difficult it must be for the parents to finally let go of their baby. I doubt if anything in life could prepare a parent for that moment. I'm not saying that putting a baby through unnecessary trauma is right, just that I see their reasoning for doing so. Having said that, I view circs in a different way from life saving measures. I personally find them unnecessary in every way. I have never forgotten the circ I witnessed in nursing school, which lead me (during my first pg) to question and research (for months) routine newborn circumcision. Anyway, both of my boys are intact and problem free in that region. At the hospital I was in (when I saw the circ) there was a tiny room where circs were done. They would shut the door so no one else had to hear the baby screaming. This was what I meant when I said I didn't want to be in the room.

From your responses, it sounds like circs are not that common in the NICU. I'm glad to know this. I'm wondering if this is something that is important to discuss during the interview? To be honest, I'm so opposed to having a hand in it that I would choose to work in another area if I was required to assist with circs.

lovemyjob · Oct 23, 2007

i say you dont have to be part of anything you feel strongly about, they cant force you to. I am also very much against circs. I do assist because I feel like I can position them well, give them plenty of sucrose prior and during, and hold them tight when its over to soothe them. I feel like since they are doing it and there is nothing I can do to stop it, then I might as well be the best nurse I can for this baby who is being tortured.

FYI, circs are done very rarely in our NICU, they usually dont want to stress the kid and just have ot done outpatient in surgery or during a hernia repair or other surgery before going home.

elizabells, BSN, RN · Oct 23, 2007

i say you dont have to be part of anything you feel strongly about, they cant force you to. I am also very much against circs. I do assist because I feel like I can position them well, give them plenty of sucrose prior and during, and hold them tight when its over to soothe them. I feel like since they are doing it and there is nothing I can do to stop it, then I might as well be the best nurse I can for this baby who is being tortured.

Yes, yes, YES. This is what I was not eloquent enough to say.

As my favorite charge nurse told me when I was crying in the break room over a messed up futile-care situation: You give them the best care you can, and all the love you can, because the decisions are not yours to make.