Frustrated by procedures/policies in new unit.

prmenrs, RN · Aug 20, 2004

I think I would run, not walk, to the exit, and find another place to work. I realize you have a lot of experience, but IMHOif a unit uses LPNs, it needs to be very careful how they are used. Grower/feeders who need consistent and sensitive care are very good choices for LPNs, not "ICU" babies. Please don't take offense.

Is there a reason you can no longer work at the other facility? I would sure prefer their approach!!!

Good Luck to you.

cswain12000 · Aug 20, 2004

I recently switching to a smaller NICU within the same healthcare company and am a little frustrated by some of the way things are done in this new unit.
Admitted a 25 weeker the other night...In my old unit, this infant would have been admitted directly into a giraffe with a snuggle and bendie available immediately for containment. Developmental care would have started from the minute the baby rolled through the door. However, at this unit, the baby *was* admitted to a giraffe (that stayed open for the next two hours when it really didn't need to be), but without any kind of boundary helpers at all. The infant stayed prone and spreadeagle until I finally couldn't take it anymore and at least put rolls around it to try to flex its legs and arms a little back to midline. When I asked about it, I was told that they don't like to put the baby in a snugglie or such until it is stable. They responded that they liked to be able to see the baby better before doing anything like that. Perhaps, but I've never had any trouble monitoring a baby in a snuggle before. *shrugs*
Also, my previous unit allowed the nurses a considerable amount of autonomy in caring for infants. This one requires a doctor's order for even things such as weaning an isolette or weaning nasal cannula oxygen. And these are the same doctors in both facilities!! The only difference is that the other unit was a teaching hospital and much of the care was done by residents, where this one is a private hospital that uses only attendings and neonatologists.
On one other occasion, my preceptor told me that she doesn't like to wean oxygen because she feels that the babies need the oxygen more when they are small and she'd rather just leave it turned up, regardless of their sats.
Maybe I'm just complaining about nothing, but it certainly doesn't feel that way. I'm an LPN and was only allowed to care for feeder/growers basically in my old position. In this unit, I am being vent trained and can care for much sicker babies. So, I'm having this conflict in my own mind about being precepted by nurses with much less NICU experience than my own, but also having to learn how to care for sicker kids from them.
Like I said, I'm probably just complaining, but its one of those nights, lol.

Regardless of autonomy--there should be doctor's orders for weaning O2--O2 is a medication--and weaning without a doctor's order is practicing medicine without license to do so. It is always good to have orders to cover our own behinds.

fergus51 · Aug 20, 2004

I could have written this exact post. I find the same things in my new unit and it is very strange to me.

Our O2 weaning was always a standard order written "wean O2, keeping sats above ____" (and nurses can play with O2 wihtout a specific Dr's order about the O2, otherwise when a kid desats, I'd have to call a DR before turning him up). I came from a hospital that was VERY strict about O2 use exactly because it is considered a medication and they don't want it used willy nilly and create a bunch of ROP. My old unit was also hardcore about developmental care, but it doesn't seem to be considered all that important here.

I have just become the reed, bending with the wind. I know no one wants to hear "At my old hospital..." so I don't even go there. I just try to focus on my babies and do what I believe is best for them and in line with my new hospitals policies.

cswain12000 · Aug 21, 2004

I could have written this exact post. I find the same things in my new unit and it is very strange to me.
Our O2 weaning was always a standard order written "wean O2, keeping sats above ____" (and nurses can play with O2 wihtout a specific Dr's order about the O2, otherwise when a kid desats, I'd have to call a DR before turning him up). I came from a hospital that was VERY strict about O2 use exactly because it is considered a medication and they don't want it used willy nilly and create a bunch of ROP. My old unit was also hardcore about developmental care, but it doesn't seem to be considered all that important here.
I have just become the reed, bending with the wind. I know no one wants to hear "At my old hospital..." so I don't even go there. I just try to focus on my babies and do what I believe is best for them and in line with my new hospitals policies.

That is how our orders read too--I just meant that there needs to be some sort of dr's order regarding O2.

fergus51 · Aug 21, 2004

Gotcha cswain:)

dawngloves, BSN, RN · Aug 21, 2004

This may be easier said than done, but why don't you try and bring them out of the dark ages. During rounds make suggestions about keeping sats between 85-95% and site the recent study in XYZ Journal. Or schedual a meeting witht hte attendidng about a policy on use of developmental items?

nekhismom · Aug 22, 2004

I feel your pain. I'm still settling in to the way things are done on my unit, too. It's so weird. Just try to go with the flow as much as possible, but be sure you know where to draw the line. Some places and some nurses forget about the board of nursing's practice act when it conflicts with hospital policy. If the BON says it's out of your scope of practice, you can't do it, no matter what your peers say.

nurseiam · Aug 28, 2004

We also keep our sats between 88-92. But there have been several babies in the last year that had severe CLD so we just try to find a happy place and let the kiddo ride it out.. Theses babies have had very little ROP????

As for developmental care....I love it, I am a firm believer in it. My unit is half and half. I figure I just try to catch the new peoples intrest and use peer pressure for the oldies. Whenever they give me "the line"...That is the way we have alsays done it and it has worked.....I say "Ya but you used also used to suck sh*t through a tube for a mec and we don't do that anymore". It usually gets at least a second thought after the shock value!