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Discussion

Nicu in need

Our hospital recently went from a level II to level III nicu. I've been a nurse there for 4 years and now we are being asked to do procedures with minimal training and experience. With the nearest nicu 2+ hours away and permanent relocation not an option at this time, I'm searching for suggestions on how I can get more experience in nicu procedures beyond just stable or nrp. It is the blind leading the blind in our nicu. I'm desperate for knowledge that could only come by spending time in a nicu with competent nurses. My basic skills are far below what I need to feel competent, but not sure of the best wats to get exposure. I'm sure we are not the only specialty department in the country with need for exposure to improve skills, but lacking the patient load or knowledgeable staff to develop proper skills. My 2 uvc/uac insertions are nowhere near what is needed to develop competency and leave me fumbling through the procedure...any suggestions? Thanks!

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    • Featured Replies

    Can you suggest your educator host a skills day to simulate those skills? We have done that with our code cart to give exposure and talk through a mock code for our newer nurses.

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    Sounds like you need to hire an educator or staff nurses with Level III/IV experience to be a resource person on the higher level procedures until everyone is up to Level III competency.

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    You guys are allowed to insert uvcs and uacs in the states?! That's pretty cool. Only docs and NPs can do it here. And I work in a level 3.

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    It depends on the facility, our transport people can put lines in if necessary but we have enough residents, fellows and NNPs to do it.

    Do do you have a CNS or educator? They are the ones that should be heading up skills labs, etc and writing the protocols to follow.

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    Only docs/NPs put in UVCs/UACs in my Level 4 NICU. What other kinds of procedures are you doing?

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    • Experts

    I worked @ a Level 2 unit for a while after I retired from the Level 3; they had "ALS" nurses who had been sent to a Level 3 unit and been taught skills like intubating, inserting lines, and so forth. They went to deliveries, did resus'es, stabilized the baby til they were transported out. The neo on call gave orders and helped manage over the phone, liasoning w/the transport team and us. The system worked pretty well. We always had a "neo du jour" who rounded, wrote daily orders, communicated w/parents; he or she might actually get in their car and come to us while we managing a sick kid, and stay til transport arrived.

    We did not keep these babies; they went to a higher level unit until close to going home, then they came back so parents could take care of them before d/c.

    Perhaps your facility could arrange for workshop(s)--plan a series of classes, utilizing personnel from higher level units, teaching the skills you need. Do it over a short period of time, so all staff have a chance to attend all the classes or workshop, gradually raising the skill level of all your personnel. Or, hire an advanced practice (CNS or NNP) to educate staff.

    Don't know how big your unit is, or what other resources you have, but I have every confidence you will acquire what you need. The hospital should be sending people to conferences, too. Like the big one in Florida next month?

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    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 train and support as you transition to caring for patients with higher acuity.

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