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BittyBabyGrower 12,376 Views

Joined: Feb 9, '04; Posts: 1,838 (19% Liked) ; Likes: 1,115
Nurse of course!; from US
Specialty: 30+ year(s) of experience in NICU, PICU, educator

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  • Sep 3 '16

    Couldn't it be a hydatidiform mole..also known as a molar pregnancy? From what I remember from Maternal Child the women will have all the presumptive signs of pregnancy and will test positive since there is a cyst growing in the uterus with or without embryonic tissue.

  • Sep 3 '16

    There is also a produce Bivona makes called the HyperFlex which is extended in length from the flange to the connection and can be ordered in custom lengths. It's a product you see a lot of roly-poly babies with.

  • Sep 2 '16

    Thought somebody had stolen the fridge!

    Yup, usually it's the Residents who are the thieves.

  • Aug 31 '16

    Did your preceptor specifically say you were too interactive with the family? A few questions come to my mind...

    Are your interactions turning into long conversations with the family that leave you unable to maintain time management with other things? This is sometimes unavoidable, of course, but it is very easy to get behind from chatting with families.

    Does your preceptor think you just need to tone it back just a little, rather than pull yourself way back?

    Sometimes it feels correct to just quietly do what you have to do and then excuse yourself so you aren't intruding. Maybe she perceives that's what the family wants.

    Is your preceptor uncomfortable interacting with dying pts and families and shies away?

    And finally, her opinion of the right thing to do may not necessarily be correct.

  • Aug 30 '16

    Quote from la_chica_suerte85
    Didn't want to say it but I'm glad you did. I would get the hint after the 2nd and definitely would think twice after the 1st. What a terrible way to welcome your newest addition into the world time after time after time....after time. If one of hers was a "golden hour" preemie, that is implying (I guess, since it's not really a widely established standard of care) very low birth weight. I'm also very jaded when it comes to NICU. When I had my clinical rotation at the county hospital I was assigned to, it was the first day I cried after clinical. My precepting nurse said something along the lines of, "Usually if a baby ends up here, it's because mom didn't have too much of a clue." And, considering the population that was being served by that facility, this is true. Women going into labor at 22 weeks (7th child or so) because they were high on meth and wondering aloud to the nurses "if CPS would let me keep this one." Women who were absent from their education sessions for their third or fourth preemie because the other two or three kids were disabled and it was a hardship just to get back to the hospital.

    Not that this has anything to do with the OPs situation but, when one chooses to start a family, the onus is on them to try make sure that conditions are optimal for the kid who, frankly, did not ask to be born. All I'm saying is that 4 kids in the NICU does not a good NICU nurse make. This unnecessarily highlights their personal situation and calls into question their judgment in their personal lives (which, again, does not have any bearing on their situation at work but...if the OP has made mention of that as a way of supporting their request to have harder assignments, I can see a big eye roll coming down from management).

    I won't pretend to know anything about NICU or what causes premature births, why anyone would have four premature infants or the heartbreak and terror that must surely cause. What I will remark upon is that making mention of one's four premature infants as a way of supporting their request for more difficult assignments will indeed generate a big eye roll from management, from the charge nurses and from one's fellow newbies. I cannot imagine that having an infant in the NICU has any more relationship to one's competence as a NICU nurse than having a relative in the CCU has to one's competence as a CCU nurse. And that is a topic I DO know something about, from both sides of that equation.

  • Aug 30 '16

    Quote from Wuzzie
    I read your OP and your second post. Stepped away from the computer for about an hour to think about this response because I don't want to appear as if I'm piling on but some things are becoming clear to me.

    First: anybody who describes their experience as "x number of years in healthcare" is often conflating that experience to try to make it something that it isn't which is usually actual patient care experience. So what exactly was the experience you speak of because it really does change things? Being evasive does not win points here.

    Second: Being a NICU mom is stressful but it isn't the same as being a NICU nurse. The only advantage you have is that you can actually be sympathetic (rather than empathetic)and you have a greater understanding of what your patient's parents are going through. This is a wonderful thing but is not even remotely related to the clinical aspect of patient care.

    Third: You had an issue with a preceptor back in April. You challenged her. As a new grad this is not a good thing to do for a whole lot of reasons. There were way better ways for you to handle the situation. Yes, I'm aware that your facility's policy backed you up but if you read the responses across the board virtually every one agreed with your preceptor, after all even PO feeders get NEC and, as I'm sure you're aware, increased residual is often the first sign. Basically, you stepped in it...royally. But after all, you were right so you won...right? I'm suspicious that this may be one of the reasons you are only taking care of feeder/growers. You ticked them off. I'm guessing none of the nurses who take the ICU babies are going out of their way to show you interesting things that they think you might like to see/learn. That's a huge red flag. Any of the more experienced nurses taking an interest in fostering your growth? No? Then you posted this and it pretty much made everything clear. You stepped in it here too...royally. I know you wanted us to agree with you and tell you that the mean old charge nurse were wrong but if ALL of the charge nurses keep assigning you the sub-acute babies then there is something else going on. I believe this post tells us what it is. You've shot yourself in the foot here and probably at work but you CAN fix it. A little introspection would be a good start. Then find an experienced nurse that you think might have a soft spot for new grads and throw yourself at her mercy. By that I mean, tell her that you are really interested in learning all you can about the sicker babies. Tell her you'd like to progress a LITTLE bit farther and you could really use her help. Ask her if there is anything that she is aware of holding you back and then LISTEN to her. If you win even one ally the chances of you being successful are very much increased. As for here, although I'm afraid you don't really care, an apology for the attitude and name calling would probably be a good thing. A little humility would be a great thing. All of us experienced nurses really do want to help the newer generation but sometimes the best thing we can tell you guys is the last thing you want to hear. But in hearing it you grow as a nurse. Now, I fully expect a vitriolic, angry response from you or some other poster for what I've said but before I get flamed I would like you to understand the spirit in which this post was written. I've been where you are and only after many years of doing this did I gain insight into what I did that might have caused me some (not all) of the grief I've been through in my career. I truly do hope you can figure all this out so you have a long and happy NICU career. Now donning asbestos undies.
    Standing ovation

    A much needed bit of advice and very eloquently put.

  • Aug 30 '16

    I had something similar. I was off orientation for a year and felt that every week I was getting the feeder/growers. I vented to one of our PICC nurses. A week later, I started getting vents, arterial lines, High Freq. vents. Evidently, the PICC nurse had been talking to a charge nurse and brought up that I need to be given the more higher acuity babies. The old saying was ringing true "Be careful what you ask for, it might come true". There were some days that I was busy non-stop the entire shift. I am far happier that I am finally getting the higher acuity patients, but afraid that it will end and I will be back to feeder/grower world.

    You may need a seasoned nurse to vouch for you to the charge nurse that you are capable of starting to get the higher acuity patients. Like PP have said, it may be a factor that the charge nurses feel you need a little more time under your belt before stepping you up to the higher acuity patients.

  • Aug 30 '16

    I provide excellent patient care, and know exactly what a healthy patient looks like. I have over ten years experience in healthcare, and have four children. I also have a deeper understanding/appreciation on the NICU, something in which few nurses can say they have. Each of my kids were in the NICU, and one of them was a golden hour. So please, save that anti-new grad bulling attitude for a prepubescent new nurse.
    Hooooo boy. I sincerely hope this isn't your attitude in the unit.

  • Aug 30 '16

    Without specific evidence I can't see the BON reacting at all. I think they have other things to do.

  • Aug 29 '16

    Quote from BittyBabyGrower
    Yes, if you let it be known that you keep personal journals about work, they can be subpoenaed if there is a suit filed and you are called to give a deposition.

    "Oh, I don't really recall but I probably have something in my journal"

    Prosecuting attorney loves this,
    "oh, you have a journal, did your defense team know this? No, oh goody, we are going to subpoena your journal!"

    defense/hospital attorney will want to strangle you.

    Everything in said journal is now an open book. You might even get to read some excerpts from it for a jury. Could even get you fired if there is any violation of HIPAA.

    Keep it in the down low and lock and key.
    I would seriously hope that someone wouldn't be dim-witted enough as to readily give up info like that, but I'm guessing it happens pretty frequently. Golden rule about law proceedings: don't speak unless spoken to, and only answer the question being asked. If they don't SPECIFICALLY ask about the journal, then don't talk about it.

    Also, and not sure if this is commonplace, but in nursing school several teachers gave us advice about CYA in charting and law suits. Sad that it has to be a focus, but its the reality in a lawsuit happy society / culture.

  • Aug 28 '16

    My MSN and DNP research is about this very topic. (I've long lobbied for a separate discussion board about night shift issues- but alas...)

    Anyway, there is a genetic difference in strongly morning types (larks) and strongly evening types (owls). This difference appears on the CLOCK gene. There is actually a screening tool to measure morningness and eveningness. I almost think that this tool would be useful before extending job offers.

    That said, sometimes the lack of adjustment to night is because the person is trying to keep up a daytime existence and not allowing enough time for sleep. For example, mothers of young children who will not place their children in the care of others and instead try to maintain wakefulness for 36 hours to avoid this and still work their shifts. SOMEthing has to give.

    If anyone's attending Nursing Management Congress in Vegas this November, I'll be presenting on the topic of nurse fatigue. Fun fact: the presenter right before me (who I am now referring to as my 'opening act') is none other that ZDoggMD!

  • Aug 25 '16

    Quote from babyNP.
    Wow, what a thread. Just out of curiosity, where was it located before it was placed in the NICU forum?

    I can speak to your questions as one of the few NNP posters on allnurses who has read a lot about getting into NNP school and the shortage of schools, now working as a NNP for almost two years now. There was a lot of good information laid out for you so far.

    From your initial post:

    1. It's not actually that difficult to get into NNP school as compared to other specialties (FNP might be easier since there are so many, CRNA is definitely harder). What is it that is making it so difficult in your mind? Just the required experience? I'll discuss that in this post.

    2. Why do you have to work in a NICU prior to NNP school as compared to ACPNP or even ACNP?

    Nursing school prepares you to work for adults right out of school. Every rotation is focused around adults (med-surg, elderly, psych, community, etc etc). You may get a smattering of experience with newborns in your OB rotation (although it's largely focused on the mother) and you generally just get one clinical rotation through pediatrics, of which you might get an introduction to the NICU. You certainly don't get a a semester's worth of knowledge in the NICU like other specialties (including peds), but if you're lucky, you might get to do a cap stone/senior practicum/etc rotation in the NICU during your last year in nursing school.

    So while I personally still think it's somewhat questionable for a RN with no clinical experience to become an adult NP, at least if it's with the adult world, the nurse was specifically trained on common adult pathophysiology & treatments. It's a bit more circumspect for a nurse with no experience to become a PNP (particularly acute care PNP), but at least everyone has had a semester of didactic and clinical knowledge regarding pediatrics while in nursing school. I will tell you that it's probably virtually impossible to work in the PICU as a PNP with absolutely no experience as a nurse or a NP.

    Then we come to NICU. The NICU is its own little world with a completely different way of doing things. You have to essentially unlearn nearly everything you learned in nursing school, down to the most basic of things like what a normal vital sign is. For example, adults breathe 12-20 times a minute. Babies breathe anywhere from 30-60 times a minute. Let me assure you that if an adult was breathing 60 times a minute as a regular rate, unless I'm mistaken, a rapid response would be called pretty quickly. An oxygen saturation of 85% may be of no cause for concern in the NICU whereas it can be a panic number on an adult unit. This small bit of representation doesn't take into account any of the "biggies" of just learning that a baby's organ systems are different than that of an adults (even things like basic blood circulation) and there is no way you can learn how it all works in graduate school with no nursing experience (unless we significantly extended the school education). They simply do not have the time to teach you basic pathophys- you are being taught on a much higher level on what to do with treatment and diagnosis differentials and it's expected that you already have a basic knowledge of this. This basic knowledge is not taught in nursing school.

    I will also tell you that in my own experience, new grad nurses flourished much more easily in the NICU as compared to experienced nurses with non-NICU experience. It was very hard for the latter group to transition into this completely different way of thinking and we had very little success in training many of them as compared to our new grad groups.

    Why isn't the NICU taught more in nursing schools? They are trying to prepare you to be a generalist nurse with the expectation that you can specialize later after you pass boards. There is simply not enough time in a nursing program to focus on niche specialties, of which NICU is one of them. NICU also has very little cross-over with other specialties, so there is little incentive for a school to give it any air time. Even a specialty like newborn nursery may be difficult for a NICU nurse to handle at first. For example, my unit sometimes gets newborns who are otherwise completely healthy and normal besides that they have a defect (in this case, an in-utero repaired spinal defect). Newborns do not eat hardly anything for a few days and certainly not much in the first 24 hours. Yet, I had many phone calls from multiple nurses who were concerned that the infant in question wasn't eating "enough" and wanted more interventions, such as placing a nasogastric tube for artificial enteral nutrition or an IV for fluid administration. I educated them and refused the interventions, but they were uncomfortable enough that I kept getting the same phone call for the first two days that this baby was in the unit. They were so far caught up in what they "knew" as a NICU nurse that it was hard for them to break out of that mentality.

    3. Why is there a shortage of NNP programs?

    There are about 20 or so, probably less at this point. I did a whole spreadsheet back in 2010 of all the schools I could find (posted somewhere in the bowels of this forum, but sadly outdated at this point) and read a lot about them. It's a national concern that there are so few and many of them closing. My own MSN program nearly shut down its NNP program. It was avoided by the board of directors who found out about this continual shuttering of programs and they didn't want to be another contributing program, as they are a top-ranked program for graduate nursing school in general and felt a responsibility to continue the torch (for now).

    I am by no means an expert on this topic nor do I claim to know all the factors. I can tell you what I've read, heard, and experienced in my 8 years of working in the NICU. It largely boils down to finding instructors willing to get paid peanuts (when they easily make six figures in clinical practice) and finding clinical sites for students. Some schools flat out tell their students that they are responsible for finding their own clinical site (one of the most ethically wrong things in nursing graduate school, IMO). Hospitals are generally less willing to provide this type of education to students unless they are an academic center because it is completely altruistic on their part. When you put in the fact that many students are trying to get into just a few sites, the competition means that hospitals can be choosy about which schools they will accept students from. I made sure to choose a school who would set up the clinical for me, not the other way around. Another factor is that you are completing nearly all of your clinical time in a NICU (although I did have probably about 50 hours split among newborn nursery, NICU follow up clinic, and shadowing a midwife for L&D). Other specialties do not have this restriction. Adult clinicals can go to any number of floors or settings as well as PNPs, but there is only one NICU in the hospital. The amount of resources this requires of the NICU is large.

    My own hospital is currently orienting 4 new NNP graduates who are FTEs on a 4 month orientation (standard at this hospital and not too far off the mark for other similar hospitals that are Level IV). I was recently asked to precept a NNP student even though it's not an ideal situation since I have <2 years experience as a NNP; showing you our lack of resources.

    I hope to teach one day in a NNP program to give back to my profession, but I am under no illusions that I will put in more than I get out monetarily.

    4. In regards to your question about requiring experience before starting school, that may be the case at that particular school, but it is not the case at all schools. Look further into this because many schools will let you take didactic non-NICU courses (like research or pathophysiology) before you start clinical. You generally have to have the clinical experience before you go into NICU didactic/clinical time though.

    It actually used to be a requirement to become licensed by the NCC (where one takes the board exam to become a NNP), but this dropped a few years ago. It's more driven at this point by schools. It's still a good thing IMO for the reasons I said above. You would simply drown without the experience.

    5. In response to GeneralistRN comparing to the medical field, as llg said, you go to medical school (which prepares you as a generalist in the adult world) and then you are required to have further training in residency and/or fellowship. As she pointed out, to become a neonatologist, it requires 3 years training in pediatrics and 3 years training as a neonatologist. Keep in mind that during these 3 years each, the doctors are working 80 hour weeks, largely clinically based (except in the last years of each). If nurses worked 80 hour work weeks they could probably get away with 1 year of nursing experience for appropriate entry into graduate school to become a NNP.

    6. In response to GeneralistRN's comment about PAs working the NICU, they are very rare for a good reason. PA school is 2 years long and (like nursing and medical school) are equipping them to work in the adult world. A PA without experience working the NICU would require an extensively long orientation and many of those folks do not make it out because they have to (again) unlearn nearly everything they did while in school. They may know the basics of making a diagnosis or knowing basic drugs, but not as it applies to the NICU. Most employers are not willing to train someone for 6 months (paid) with a high risk of them not being able to transition successfully into the job. If they are hired, it's generally at large academic institutions where they can support them more fully. I know that my hospital refuses to hire them (even experienced ones) in my NICU.

    There is a PA residency that has cropped up over the last few years, but only in a few sites as someone else pointed out. As I understand it, it is like a true residency where one is not working the general 40 hour week, but more on par with a medical residency type hours. I want to make it clear that this is not being created out of the desire for PAs to be in the NICU. They are not trained in neonates unlike NICU nurses who go to graduate school and solely focus on NICU. This is being propped up as a response to the national shortage of providers in the NICU and hospitals are becoming desperate just to hire people.

    The average age of a NNP is older than other NPs and with programs shutting down, the shortage will only get worse. Couple that with the fact that pediatric residencies no longer require a full 3 months in the NICU during their training- so many programs have dropped the extra month. Someone has to fill that role for those months that there is no resident. PA residencies are a response to this national shortage.


    I hope this answers some of your questions. I can sense your frustration about the required clinical time, but trust me, it's needed. I had 4 years going into grad school and had 6 by the time I graduated. I didn't necessarily need all of that time (I lacked self-confidence about my own knowledge), but 2 years is definitely a solid number that I think people need. If not, then the clinical time and didactic time in grad school needs to be upped, which will not happen due to shortages as I listed above.

    It's hard to get into the NICU as a new graduate but there are ways. Be the best candidate you can be, read the threads on this forum (for the love of everything, please don't ask on a new thread because there is so much information on this topic littered throughout dozens of threads).

    Best of luck in your journey through nursing school and your transition in the RN role. Keep us posted on how it's going. Let me know if you have any other questions.
    Is there not an applauding smiley? Because this deserves one.

  • Aug 25 '16

    Quote from BittyBabyGrower
    Really? You are such a troll. Lol Are you even a nurse because you just cut yourself down also. The only program I know of is in PA and only accepts 2 per year, and you have to have PA experience. You start in a level 2 for
    the first half and then move to CHOP I believe for the rest. It's pretty intensive. I asked one of our attendings about it ( he is from there) and he said they take ones with ICU or peds experience only. And several of them were NICU nurses who went back to PA school, have their Masters and then applied for this. So it still isn't like you can just apply and do it. You are totally missing the point.
    There are 3 PA Neonatology Programs (that I know of): CHOP, Univ. of New Mexico, and Univ. of Kentucky. CHOP and UK only take 2-3 students. PAs in NICU are very rare. I live 80 miles from UK and we have 0 PAs in our NICU (or employed by our 2 Neonatal Physician Groups).

  • Aug 24 '16

    That's borderline reportable if you ask me.

  • Aug 24 '16

    Hold, rock, cuddle yes. Skin to skin is intimate and personal.