EBP project help,please let me pick your brains!

[TakingCareOfBabies]

Hi Everyone!

I have been totally MIA for a while. I've been doing my MSN for Nurse Education. I am about to start my next (and final) class that includes creating a EBP proposal.

From reading the syllabus, it appears that I just have to create this proposal, not implement it. However I would like to be able to use something that I can then take to my unit as a proposal to implement a positive change. I currently have two ideas, i would like to pick your brains if you will, and if you have any other suggestions that are going on in your unit or have gone on in your unit I would greatly appreciate it.

1. Head neutral positioning for preventing IVH: this has come up for me because of two little ones I have been caring for for some time. One is my primary. They both have severe IVH one more than the other and I noticed that there really isn't any practice/protocol for head neutral position in the unit. Many of our micros and preemies have head bleeds of some sort.

2. Extended continual education/rare skills/skill & comprehension for novice nurses: this has come up because since I have been at this unit for just about 2 years we have gotten over a dozen new/novice nurses. Some did not last through orientation, some did not last much past the end of their orientation, some are still struggling. Some (at least half a dozen) have come to me to vent about how they feel thrown to the wolves, or are struggling in one form or another with a variety of things. I would like to implement some kind of continuing workshops available for new/novice nurses for 6 months to a year after they are finished with orientation to revisit skills/practice/concepts to help them feel more confident/comfortable/safe in providing excellent care for these precious patients. It wold include flame free round table meetings where the new nurses can bring forth questions or concepts that they are struggling with. These round table meetings would address areas that need improvement and additional education.

I HAVE discussed both of these ideas with a few of my peers and they like both of the ideas. But I also want to know what else is going on out there in other units.

Thanks in advance for your thoughts and ideas.

[umcRN, BSN, RN]

my unit does not have policies in place for either of these things but as someone who was a new grad in the NICU a few years ago I really like your second idea.

[linzzo82]

i would definitely choose #1. i see way to much improper positioning and handling during care. many of our neonates lay prone; this still puts the head in an improper position. with the amount of challenges these preemies face in their future we should be doing everything possible to ensure they get the best care. not to mention the rates of cp in neonates is very high; i wonder how this might decrease with policies on proper positioning. i believe #2 is a good choice also, however unfortunately i think its a loosing battle that has went on forever and is not going to stop anytime soon. it is just a process of new nurses becoming more confident and learning to understand senior nurses as well as senior nurses learning to trust the new grads. with turnover rates due to numerous reasons, it just doesn't feel as strong of a topic. hope this helps. good luck!

[NicuGal, MSN, RN]

I'd chose number one. We have a "little baby protocol" that we follow and it includes neutral head positioning. We get those kids with bleeds, but it isn't because of positioning anymore.

The problem with number two would be getting out of staffing time to do that, and you might have new people who don't want to participate due to being afraid of backlash of some sort, and when you get that rare new person that is kind of a know it all in a setting like that(round table), it wouldn't go well. We orient our people for 3 months, but they have a nurse buddy for 6 months after. The also have a mentor that does not work on the same floor that they have breakfast meetings with once a month for those 6 months so that they can bring up any concerns they have or just to talk to someone that is neutral. If there is a big problem, the mentor goes to the CNS. The reason many people leave during orientation, at least where I work, is that NICU is NOT what they thought, they really think that we have all these cute little preemies and we snuggle and play with them, they don't want the sick, bloated dying 22 weeker. Sometimes they don't realize how intense it is. This one would be way too broad. Many of the issues new grads have are things that work out over time.

[TakingCareOfBabies]

Thanks for the input. I found out that some one is in the process of doing number 1. I have spoken to our education resource nurses and will be working on number two. It will be more like an enhanced orientation where we will provide more support through out the first year of employment in the NICU. NICUgal, it would be very similar to what your unit is doing as our unit hasn't been all the proactive in supporting new nurses once their original 3 months is over.

I have actually found a lot of support in the research in helping new nurses to be better prepared.

[NicuGal, MSN, RN]

We implemented our new nurse program about 4 years ago and we have had great success with it. It takes away that fear of being "on your own". This is your go to person besides the charge nurse, and it can be anyone on the unit, not just preceptors. We make sure to push their boundaries...we will give them a really sick kid, but we have to have the staff for the budddy to be in the same room with only easy kids. The only kids we don't give them for the first year are the cooling kids, on their own that is. They can be the secondary nurse who is the "helper" (our cooling kids are 2 to 1 for the first 24 hours). Those kids are a handful usually and a new person would be overwhelmed, heck we are sometimes lol Good luck on you project!