karnicurnc

karnicurnc MSN, APRN, CNS

L/D 4 yrs & Level 3 NICU 22 yrs

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About karnicurnc

karnicurnc has 27 years experience as a MSN, APRN, CNS and specializes in L/D 4 yrs & Level 3 NICU 22 yrs.


Latest Activity

  1. NICU ratios

    I work in a 60 bed Level III unit. Admissions, CPAP, vents and stable HFJV/HFOV are 2 patients per RN. Other intensive care status patients are 1 of 3 patients cared for by 1 RN. Intermediate care (stepdown/PCU) patients are 1 of 4 infants in an a...
  2. Phasing out CNS

    I am a neonatal CNS who graduated in May of last year. My hospital paid for me to go to school as the state requires a CNS in a Level III or higher NICU. I am 1 of 11 CNS's in my hospital (a large teaching/tertiary regional facility) and we are wel...
  3. NG/OG placement

    X-ray verification is the gold standard for tube placement, but is not a feasible option to irradiate an infant before every feeding or when the tube becomes dislodged. Best practice also dictates 2 methods be used. We have recently stopped checkin...
  4. What is the common practice for oxygen use for diaper rash?

    Agree with post above about oxygen and it's detrimental effect. Pumping 100% FiO2 into a preemie's closed incubator can contribute to ROP (think Stevie Wonder). Also oxygen is a drug and I would think it is out of an RN's scope of practice to admin...
  5. Residual Checks/Abd Girth

    I wanted to share our newly developed feeding protocol related to gastric residuals. This is a section taken from our staff education presentation and explains the evidence behind our decision to no longer check residuals. Gastric residuals are a s...
  6. Should I ask HR?

    I agree, good idea to apply. All they can do is decline to interview, but you will never know if you don't try. Good luck!
  7. Weekly NICU MRSA swabs

    We do weekly surveillance swabs. If positive then infants are isolated until d/c. We recently had a large group (about 20%) of MRSA-colonized infants. We had to isolate, cohort, treat with bactroban, bathe with CHG (those that qualified) and then ...
  8. Residual Checks/Abd Girth

    We do not check abd girths as they are useless as stated previously. Here are two articles that helped to provide evidence to change our practice from checking residuals to NOT checking them unless there are other signs of feeding intolerance (abd di...
  9. Which Milk Warmer Do You Use?

    We have used the Medela warmer for years, but only had 1 per pod of 12 infants, so it was not very useful except for the one person who got to it first for that round of feedings. We have also used warm tap water in Styrofoam cups for years (a horri...
  10. Which Milk Warmer Do You Use?

    From Medela's waterless warmer user guide: "Medela Disposable Inserts are a limited use item. Medela recommends changing the inserts every 12 hours. Inserts should be changed if human milk comes in contact with the inserts. Inserts should also be cha...
  11. NAS, How do you score?

    Inter-rater reliability training can improve the accuracy of scoring and boost the confidence the providers have in the nursing staff related to scoring. I have read several research articles that use this training. Neo Advances
  12. COMPUTER CHARTING

    We use EPIC also, but don't let them sell you the adult ICU version and tell you they can modify it for NICU. Buy the NICU module to begin with.
  13. 8 weeks of orientation

    I agree that is not enough time for orientation. Request more time, if you can. Talk with other newbies to see how they handled it. Ask for a buddy when off orientation - a person you can go to for advice, help.
  14. New job!

    The NICU is an intimidating place. The patients are often very sick, and families are extremely stressed. So it is good to heave a little bit of healthy fear. It will keep you on your toes. Make sure you have a good relationship with your precept...
  15. Nicu in need

    I am quite concerned about how your unit is handling this escalation in level of care. The "blind leading the blind" puts everyone's license in jeopardy. You can't just start running a Level III NICU. I agree with the other posts about having APNs...