Communication with parents in nicu

karnicurnc, MSN, APRN, CNS · Mar 31, 2012

We use a variety of tactics, but one of the most effective ways is the Plan of the Day Sheet. It is filled out by the doc/NNP and posted at the bedside for the parents. It includes the names of the care team (doc/NNP, nurse, RT) and any planned changes and orders, such as increasing feedings to 35 mls, xray tomorrow, wean vent if tolerated, check for PDA this afternoon, corificeat study, take out PICC line, may room in tonight with discharge likely tomorrow, etc, etc, etc. Parents really like it. The doc/NNP can also write "ask your nurse to call me so that I can update you personally." This is based on direct feedback from parents that they would like to speak to the doc/NNP more often. The docs/NNPs have become much better about coming to see parents and documenting these conversations in the chart. And that was no easy task, I assure you!

catlover314 · Apr 5, 2012

Parents can come to rounds any day. We hold rounds in our conference room so family is present only for discussion of their baby. They get the full plan and can ask questions at that time. Nurses give a full update on changes if parents cannot attend rounds. In addition our NNPs try to update families when they visit, if the family wasn't at rounds. Once a baby has been there for 7-10 days the family has a care conference to determine if they are understanding the plan of care, assess for additional needs etc. Those conferences are attended by the Neo, NNP, charge nurse, nurse assigned to baby, Developmental Specialist, Social work and any other disciplines involved. The families really like this, and it tends to head off misunderstandings with the families that will be with us long term.

Bortaz, MSN, RN · Apr 5, 2012

Since I work in a medievel bordertown NICU, it amazes me to read about all this fancy stuff you all do back there in civilization. It also makes me realize how much damage I'm probably doing to my career development by staying here.

MomRN0913 · Apr 5, 2012

I have to give kudos to my daughter's neonatologist when she was in the NICU. When I was still in recovering from my C-section, she sought me out in my room every morning first thing to update me and tell me her plan of care, and what she felt was going on. It was easy to contact her and she was very honest.

Some of the ways it is being handled as mentioned on here is completely impressive.

karnicurnc, MSN, APRN, CNS · Apr 9, 2012

Bortaz

Wow, that makes me wonder about where you work. I would encourage you to move and find a better NICU to work in, if that is what you want to do. Never settle for something less. We are hiring, if you are interested. :)

Bortaz, MSN, RN · Apr 9, 2012

Yeah, this job is just the means to an end. It's on the Mexican border in Tx. We will most likely not be staying here too much longer. As bad as it is here, I got to start in a level 3 NICU right out of school, and have picked up almost 3 years of level 3 skills and experience that I'll be able to take with me when we move back to civilization.

You can learn something even from bad situations. I work with several very, very good nurses with lots of NICU experience, and they have taught me much over my time here. So, I've sucked up the experience and their knowledge for when we're finally in a position to sell the house and move somewhere away from Mexico.

My wife is also an employee of the same hospital (actually one of the best hospitals in the Rio Grande Valley...), and we're both rather specialized in our career paths, so it'll kinda take a perfect storm for us to both find jobs in our specialties wherever we decide to relocate to.

What part of the country are you hiring in? We need level 3 nicu for me and trauma services for the DW! :)

karnicurnc, MSN, APRN, CNS · Apr 9, 2012

It is great that you have gained so much knowledge and experience! I work in a facility with a Level III NICU and a Level I trauma center. Feel free to send me a PM and I can fill you in on details.

dixRN · Apr 9, 2012

Bortaz

You should consider Houston. The Texas Medical Center meets all your requirements. There are 2 level I trauma ERs there. Memorrial Hermann has the busiest trauma ER & busiest life flight in the country. There are too many level III NICUs to name & a couple of level IVs! But the icing on the cake is that cost of living is low compared to the rest of the country & Houston pay is good for RNs in the city. I am a traveller & have worked a couple of times there. Most of the nurses had beautiful homes in the suburbs but they did have to commute. The downside were the freeways but if you lived on the southside of Houston then it was an easy drive. I would love to take a permanent position there but it is too far from my family.

Bortaz, MSN, RN · Apr 9, 2012

Actually, Houston is my favorite city. We go there for Astros games several times a year. Before I graduated in 2009, I had applied to a lot of the new grad residencies in NICU at most of the hospitals in Houston (and Austin) but that was about when the economy tanked and those prospects dried right up. So, I took this job locally and we decided to stay here till the economy was better and I had experience in a NICU to carry with me.

I would love to live in Houston and work in TMC, and that is definitely one of the places we'll be looking into when we decide to evacuate the Valley.

dixRN · Apr 9, 2012

Michelle,

I am a travel nurse & worked in many NICUs but none with such nice systems of communication as mentioned below. Usually care conferences were only set up at parental request or for babies with severe developmental problems or very complicated cases involving many specialties. Usually the bedside RN was the main line of contact with the parent & in my case I usually get the chart & tell the parent the new orders for the day. Then clarify the orders for the parent & answer any questions. Then I do a general review of the babies current condition. I always reassure the parents that if there are any major changes in condition I will call them. If it's been awhile since they spoke to their child's NNP/Neo I will ask them would they like to speak with them. I have been working NICU forever & I can tell you that in the last few years the Neos have become much more accesible to speak to parents. It used to be like pulling teeth to get them to come to the bedside to talk to parents but that has changed for the better.

In the majority of places I have worked the bedside RN is the main communicator & the facilitator of communication with physicians & NNPs. Wow, that was a mouthful. Hope this helps.

dixRN · Apr 9, 2012

Bortaz

I left Houston 2 weeks ago. Memorial Hermann had NICU level 3 positions posted. I believe Women's did also. The Medical Center just had a major shift of NICU nurses. Texas Children's hired a bunch of Memorial's level 3 RNs, then Memorrial hired a bunch of Women & Children's, but some of them changed their minds & went back. There may even be a position or 2 at Texas Childrens still as they are opening a new hospital with L&D,etc which they have never had before. This might be a good time to make that major location change.