Need opinion from experienced NI nurses, please...

Specialties NICU

Published

Specializes in Case Mgmt; Mat/Child, Critical Care.

I had a really bad shift the other night, and can't stop thinking about what could've been done differently.I work in a 50 bed level3 NICU...we are combined with a step down/level2 nursery.

All of the nurses, pretty much, are assigned randomly, sometimes you'll go for mos in the highest acuity/level3 area. Other times you'll spend weeks in the step down nursery w/only grower/feeders. then boom you're back in the ICU w/vented kids w/liones, drips, etc.Usually this is OK, I guess.

I have only been in this unit since last Jan. And part of last yr I was out on maternity leave, then right after Christmas I had surgery, so I was out 3 wks. I have 10 yrs previous experience w/L&D-LDRP, normal newborn and Peds. However, as you know, NICU is a world unto itself! :chuckle

I have been PRN since I came back from maternity leave, so the last 4 mos or so. I try to work 1 to 2 days per week. I am certainly feeling more comfortable in this area, I really like it, but I know I still have a lot to learn...I'm not to the point where this is "old hat" yet. LOL! :)

OK so the other night I come in and have 2 ventilated kids, 1 kind of unstable. And I've been assigned to get the 1st admission. There are a few other nurses w/babies only on cannulas, not as sick as mine. The nurse I was relieving could not believe I was up for an admission.

Of course, I got an admit w/in the 1st hr, a 30wkr....needed a lot of stabilization. No one took over either one of my 2vent babies. I had told the charge that I didn't feel comfortable w/the situation. Went in one ear, out the other. A couple hrs after my admit, the unstable vent kid I had coded!

My night was soooo horrible, I was so behind the whole night, I could not keep up w/all the charting! Plus, there were nurses sitting around reading magazines! :angryfire

Am I just being overly sensitive? Is it just that I'm not as experienced in this area yet that I feel frustrated by all of this?

I guess I just needed to vent....thanks for listening. :)

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That is absolutely unacceptable. I am shocked that any charge nurse would think that was ok. We NEVER take more than one vented baby. If we have a vent, we can have another non-vented baby only (2 other babies if they are very stable, and even that rarely happens). No 2 vent assignments here, especially if one is unstable. I would not have accepted the admission. It's just unsafe and my lisence is too important. I am sorry this happened to you and I would follow it up. There should be some guidelines in place as to who gets admissions and what type of assignments are acceptable. And no way should other nurses be sitting around reading magazines while you are running your a$$ off.

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In my NICU we sometimes have 2-3 vent babies. Just tonight one of the nurses had 3 vented babies and one more :uhoh3:

This was OK, but if something had gone wrong we would be there to help her (not that I had much time to help her with my 12 f/g kiddos and one nurse aid to help me :rolleyes: ). We always have the one with the lightest assaignment take admissions, and help each other out as much as we can. I would go CRAZY :angryfire if I was running around and someone else was reading a magazine.

You shuld talk to your manager about this.

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Specializes in NICU.

I agree with Fergus, that is totally unacceptable that your coworkers weren't helping and that the charge nurse didn't change your assignment or something! Is the teamwork always this poor? When we get admits, there are usually too many nurses around trying to help!

Here, we can have two vents but only if they're both stable. Usually we'll have one vent and one easier kid. But I don't understand how you guys do your admissions!!! The way we do it here is wonderful: the nurses assigned to get the first and second admissions (others are assigned if needed later on) get easier assignments - like 2-3 kids on cannulas, things like that. Then if they get an admission, they give up those babies - nurses whose assignments aren't that bad are pre-assigned to pick up these babies for the rest of the shift. Then the admit nurse gets to concentrate on her new baby for at least 4 hours. If it's busy, she'll pick up another baby later on in her shift once all the admission stuff is taken care of.

If one of our patients codes, and we have another baby too, the charge nurse usually tries to quickly assign that baby to someone else so you can concentrate on your now very-sick baby and his/her family.

Hope your next shift is better!

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Gompers I want to come work with you!
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Specializes in NICU.
Gompers I want to come work with you!

Let me tell you, sometimes Chicago weather feels like Iceland's. You would feel right at home!

I do like where I work. Of course, some nights all heck breaks loose, but on those nights teamwork is even stronger and we manage to get through it.

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Specializes in Maternal - Child Health.

Gompers,

I'm pretty sure I used to work in your unit, and I can attest that the staff was very supportive, and helpful to each other, especially in busy times. No unit is perfect, but I learned how good it was there when hubby was transferred and we moved to an area with only one NICU, which was horribly staffed and poorly managed. My best to all my former co-workers!

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I don't work nicu but that sounds absolutely horrendous. What happened to teamwork?

Luanne

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I would have walked out the door if I saw that on the assignment board! We pretty much follow what Gomper's place does. Two vented kids and first???? Sounds like Hell!

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Specializes in Case Mgmt; Mat/Child, Critical Care.

Thanks for your replies and support! I just wanted to make sure I wasn't being a "crybaby", or wimping out :rolleyes: . This is really the first time I've had this kind of experience in this unit. Usually things aren't assigned that way. This charge nurse is "new" to being charge, she worked for yrs as staff, just recently took over charge, and I sometimes think she's more worried about maintaining her "social status/freindships", if you know what I mean!

I also have to work on my assertiveness skills in this unit, before I knew what I was doing... like the back of my hand, in my sleep kind of thing; here I feel like I'm still "learning", so I'm more easily intimidated! Definitely need to work on that!

Gompers, your unit sounds ideal! That's the way it should be done! :)

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What happened in your shift in unacceptable :angryfire . I get burned up when there is no teamwork and you feel like you are sinking while trying to swim. Follow the chain of command until you are heard. That was very dangerous at put all of your patients lives at risk.

Next time you may want to suggest to the nurse reading the magazine that you need him/her to do cares or give meds to your other patients while you tend to your patient that is circling the drain.

Do not forget that event when it is time for peer evaluations.

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Sorry you had such a terrible night. Where I work ALL vents are 1:1, except on very very rare occasions you may have a grower feeder, but only until they get another nurse. Seems to me you would have been within your rights to refuse the admit. Never done that myself, but I have never had a vented pt. and been asked to admit. The unit I work on was just cited by one study, to have amoung the best outcomes in the nation..... well DUH! Staffing makes all the difference in outcomes.

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