Floating to NICU... how to be helpful?

[perfectbluebuildings]

OK, I have browsed this forum many times as it is quite interesting to read these stories and thoughts... I did not find this addressed though maybe someone else can help me.

I work in a children's hospital and once oriented x1 shift in any unit in the hospital, you can float there. Our NICU has been very busy and short staffed lately and we have all been floated up there more frequently than usual, for me twice in the past 3 or so weeks. My normal floor is more a general peds medical floor (not to get too specific on here), tiny babes up to the oldest pt I've had was 23, so of course it's a lot different!!

My question is what are some really important things for a float nurse to know/look for? Of course usually we have 3 feeder-growers but sometimes it can be a little more intense. I never know when someone else's baby's alarm is going off whether to do something or not, usually end up going over there looking useless b/c I don't know what to do to help, the kids are so different from our pts. I know this probably isn't specific enough, but maybe if you start talking I will be able to come up with something more. Right now I am not too fond of working in the NICU, and not too good at even the tiny ones. I had the hardest time getting enough blood for a heel stick the other day, another nurse ended up having to do it for me. (We only do Accuchecks and draws from central lines on our floor, or if we get blood w/an IV start, as far as labs go).

The feeding makes me nervous too... whether they are really eating enough or whether I'm pushing them and they are gonna puke, any tricks to getting them to eat better...

Also the parents in the NICU, usually being in a much much different situation than the parents on my home unit, act and react in very different ways and any tips for that would also be appreciated.

I guess it would help if I had kids of my own, but, I do not.

Wow this is a lot longer than I expected. Any input at all, your experiences with nurses floating to your units, good and bad, what you wished float nurses would be aware of, things you do on a day to day basis and probably forgot them in the routine of your care, what you want or don't want float nurses doing to "help" with your babes if they start alarming or crying or whatever.

Thank you so much!!!!

[doularoz]

I think it's great that you are taking this much time to gather information to increase your skills/knowledge in an area where you float. Your NICU should be thrilled to have you in the unit. Most people would not do this. It sounds to me that the staff should be resoursing you more. We would never expect float nurses to do blood draws unless they want to. Also you should not feel responsible to answer other baby's alarms when you are a float nurse unless you are really comfrotable doing so. It sounds with a little more time you will feel much more comfrotable but that you were thrown into it. You ask really good questions which is important.

[nell]

Sorry, I agree with wjf00 – but maybe it’s just a California thing.

California has competency laws. Nurses can only float to units they have been oriented to and are competent to work on. If we haven’t floated to a unit in a long while and/or are concerned about our ability to adequately care for our patients, we must ask for and receive further orientation.

All it takes is one shift of “care” by someone who doesn’t know what they’re doing, for a baby to get into trouble. Someone who doesn’t know what early sepsis or NEC looks like is a danger in the NICU.

As for "'grower-feeder' babies which are babies that used to be sick who are now transitioning to home.” - What about “Never trust a 35 weeker”?

nell

[Gompers, BSN, RN]

Sorry, I agree with wjf00 - but maybe it's just a California thing.

California has competency laws. Nurses can only float to units they have been oriented to and are competent to work on. If we haven't floated to a unit in a long while and/or are concerned about our ability to adequately care for our patients, we must ask for and receive further orientation.

I do think that California is a whole other bag of chips when it comes to many nurse staffing issues. But unfortunately, the majority of us aren't in California and this is the reality for us. We're just trying to help each other out.

[justjenny]

Any input at all, your experiences with nurses floating to your units, good and bad, what you wished float nurses would be aware of, things you do on a day to day basis and probably forgot them in the routine of your care, what you want or don't want float nurses doing to "help" with your babes if they start alarming or crying or whatever.

Thank you so much!!!!

Our hospital is the same. I received 1/2 a day in PICU (GASP!) and 1/2 a day in Peds for orientation. I find it frustrating because I can never find what I need in another unit and waste tons of time looking and/or asking for help!

First - if you are given an assignment that you are not comfortable with - speak up and tell the charge nurse right away!

Second - after getting report on your babies, ask the other RNs in the room if there is anything important that you should know about their babies. That way, if baby #1 is on 1 L NC FiO2 of 30% and starts to desat/alarm...perhaps you will know that that baby needs to be turned up to 35% (or whatever)

Third - be sure to let people know that you usually work in Peds Med/Surg rather than NICU. Hopefully, the RNs working near you can offer their help if they know that you are receptive to it.

Fourth - the feeding thing...it really depends on the kid. Ask the RN you are getting report from if they have any suggestions for feeding...what works for one baby does not always work for another.

HTH!

Jenny

[perfectbluebuildings, BSN, RN]

Well, for the third time in I think the last five weeks, I was in NICU last night. I tried to be positive and remember what you all had told me but it did not work out in the end. The oncoming nurse muttered to her preceptee about how we "always get the 7:30 stuff ready for each other" with a babe who had a 7:30 NG feeding. And was upset about how I'd made the bed, throwing the blankets onto the floor in a huff; and saying something about how I'd screwed up the NG tube (which I'd checked placement on EVERY TIME I gave a feeding- of course- I'm not dumb) and saying they were going to have to place a new one. Another was giving me looks b/c the baby's temp had been a little bit low- by the time she got there it was up to 98, and she hadn't had any issues, but she seemed to think I should have done something about it and I don't know what- the babe was in a Giraffe isolette with a skin temp probe regulating the temperature. The other babe's nurse was asking all these questions about what the mother knew about breastfeeding, and was disgusted that I didn't know. I never even met this mother, I have never taught anyone anything about breastfeeding and how am I to know the details of what was taught? I just know that the lactation consultant was there yesterday helping Mom out. As for "getting ready" the 7:30 feeding, no one did it for me last night or ever has on other shifts in the NICU for early feedings- ever. And I manage just fine. I had to feed one baby at 7 who was PO ad lib and hadn't been fed for 4 hours and woke up crying and still managed to do fine with the assessment and feeding of the 7:30 NG kid. I had 3 patients by the end of the night. Two had IVs, one had IV antibiotics, one was eating every 2-3 hrs po, and I could go on. I didn't get lunch at all. I am just tired of being treated like an idiot because I don't work there all the time. I'm not an idiot. I am very competent at my own job, and I know that those same nurses who treat me like an idiot up there would have a hard time on my unit. I don't treat nurses from other floors rudely or act disgusted about the way they took care of my patients, even if they did make some mistakes- if they are big mistakes, maybe I'd talk to them about them. TO them, not NEAR them to another nurse being sure they are in earshot!! That particular nurse (the one so disgusted with my not preparing the feeding, not having the bed a certain way, etc.) said to her new grad- "Can you tell teh difference between today and yesterday?? We are behind.." etc. I wanted to say something but I didn't know what. She knew I was sitting right there waiting to report on one of my other babies.

I am very sorry this is so long. I do not expect you to read it all. But please take it to heart to treat the people who float to NICU nicely even if they do not know every little thing you do about how things are supposed to go on the unit. Sometimes you think they are stupid little things- but if that is the case, please tell the person so they will know for next time, not just complain about it to another nurse there without being specific.

I think I am just disgusted with my hospital's NICU. They have literally over a hundred nurses on their payroll but most are PRN, so they are ALWAYS having to call for staff from other floors- I don't know why they do not try to hire more nurses. And right now, they are not even really busy and still had to have 2 nurses from my unit last night. I would rather stay home now than work in that unit although I know it is not an option. It's just not worth the humiliation.

Thanks for listening. I appreciate it.

[perfectbluebuildings, BSN, RN]

So I've slept... feel a little better. But still dreading the next time I must float to NICU. Is there anything I can do other than grow a thicker skin that will help me. I know to "ask" if there are things I'm not sure of- and believe me, I do ask, and frequently. But seems the things that people get upset about are different each time, and not things I would think to ask. (Except the temp thing- if that pt's temp had not kept going up I would have asked someone for help, but it did and was never extremely low to begin with.) And also- why don't they listen to my report? They just read their little sheet, nod their heads and interrupt me to ask questions four times a minute about things I was about to say anyway. Overall I just get the impression these nurses think I do not care about the patients or doing a good job and therefore give care not up to their standards, which is not true- I DO care about them and always do what I can to the best of my abilities when floated there. I wish we could all just respect each other. Anyway... I have gone on again way too long and still not said exactly what I mean because it seems I never can do that any more. and I know most of you are probably not like these nurses. But I appreciate your help in learning how to make them happier and how to do better with the patients.

[RainDreamer, BSN, RN]

(((((Rachel))))) That's just awful how that nurse treated you!! I'm so sorry you're having to go through all that I would be pissed and upset too. It definitely sounds like their NICU has issues with nurses. In our NICU we get travelers, registry, and floaters from other units and we're always helpful and grateful that they're helping us out when we're short-staffed!

I would have said something like "look, I'm here helping out because yall are short-staffed, this isn't my regular unit so I'm sorry that everything isn't perfect". I bet that woulda shut her up. If you don't feel comfortable saying something to her, then say something to your manager on your unit. You don't deserve to be treated like this.

You can't do anything more than you're already doing. It sounds like you're doing everything just fine. These people just need to grow up or they're not going to get much help when they're short-staffed .... and for good reason.

[justjenny]

I agree with the above poster. I would discuss this with your manager, and if you feel that you can, the manager of the NICU. My manager would be horrified to learn that the RNs were treating others this way. Hopefully, your manager can advocate for you to get some things changed.

It sounds like you have been "lucky" enough to get/give report from the crabbiest RNs on the unit! (LOL!) I can say that we have similar attitudes and I have learned who to just ignore (they will complain and be mean NO MATTER WHAT you say/do)

Jenny

[RainDreamer, BSN, RN]

It seems weird to me that they would expect the previous shift to get their 0730 feeding set up for them. Just this morning I reported off on a baby that had a feeding due at 0730. Did I set it up? No. It wasn't set up for me last night at 1930. It makes no sense to me that someone feels like it should be set up. That nurse needs to get in and do her assessment and check placement of her feeding tube before getting that feed started anyway.

[perfectbluebuildings, BSN, RN]

Thank you all very much. You know, I have reported and gotten report from some nurses in this NICU who are perfectly polite, as well. That is what happens more than half the time. But unfortunately the difficult experiences are more memorable and do happen more than they should. I talked it out with another nurse from my floor who also floats up there often and she has had some similar experiences. I am thinking about talking to someone but I don't want to be a tattle-tale either, and am afraid maybe I was a little too sensitive.

[Humbled_Nurse]

Rayrae:

I'm sorry you were treated that way by a NICU nurse. That nurse's behaivor in unexcusable! I can't stand people who are rude and act like they are better than you. If you have the guts I would talk to the nurse manager and let her know about the unprofessional behaivor you have been subjected to. In our NICU if we have floats or agency nurses I am always very nice to them. It's hard for any of us to be out of our own unit/floor. We nurses hate to be out of our comfort zone.

As for the nurse being irritated about not having the 0730 feed ready that is just stupid. Unless that is a standard of care for the unit, but I doubt it is. I personally would rather get my own 0730 feeding. The bed thing is stupid as well. She is just being rude and getting pleasure out of making herself seem better than you.

Hang in there Rayray and thanks for taking good care of the little ones

[NurseKymba]

I just want to thank all of you for this posting and the replies. I'm an adult critical care float nurse who is cross training for our Extended Care Nursery. The info here is wonderful! I'm cross training for only 3 shifts, and am performing the tasks well (or so I've been told so far), but needed the pearls here to help!

I have so much to learn about these little munchkins