Is it me, or am I being given unrealistic assignments in the NICU?

  1. Hey guys I just have to get this off my chest. Yesterday I had an assignment with 3 babies.
    #1: PICC scalp, meningitis, 2 broad spectrum abx Both were twice my shift... she had bath/weight, ng change, linen change, 2 person sterile like change, and she was very poor bottles- max 30 mins which I had to do each time if I went faster she'd vomit, would only take 15% of her volume.

    #2: Baby query CF, meconium plug, irrigations Q6H, weaning IV PIV, working up feeds, bottled over 30 mins as well, weight done.

    #3: Baby tube bath, weight, change ng, linen, oral eversion, genetics involved. very poor bottles - in 30 mins would only take 15% volumes... tons meds ex premi

    all three were fed Q3H... I ended up making a mistake and used the previous orders heparin flipped a page behind... had to write a safety occurrence on myself. I cried... idk if this assignment was realistic or if I'm just garbage. I didn't take any breaks, and the charge nurse just judged me like I was an idiot... bottling all three in an hour is unrealistic... with all the meds/assessment/ baths etc. I didn't eat, didn't sleep because I became so anxious. I feel like such a failure...
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    About tmjwe3

    Joined: Sep '15; Posts: 14; Likes: 11

    18 Comments

  3. by   bcandygurl
    Hi..this assignment is doable but definitely busy. If all of them were due at 0800..I would have started at 0730..did one at at 0730..the next at 0800..and the one after that at 830...starting with the fastest feeder..on my unit we don't have to have weights until midnight so I can time things so linen, baths, and weights can be done before then. If anything, the bath and linen can wait.With an assigment like this I def wouldn't have fed the babies longer than 30 mins and would have gavaged the rest of the feed. Hope that helps. It definitely takes practice...and the longer you are in the NICU the more you will feel comfortable with determining what is a priority and what can wait..
  4. by   bcandygurl
    Also, with very poor feeders...I would suggest feeding every other feed...unless they are showing cues in order to give them some rest..they normally do better with this method in my experience
  5. by   tmjwe3
    Hey!! Thanks for replying I know but the orders said to arouse the baby for every feed. All three had to be awaken....... otherwise I couldve caught up. Like that's what I did. Our feeding time starts at 2100, so I started at 2000, warmed up all the feeds and everything. Like with baths and weights, I did 2 first handle and one next. They took me 50 mins, assessment/ med prep 15 mins, 30 min bottle, 15 min bath linen change roughly. And he's around 50 weeks so he doesn't sleep much and is active. The little girl with meningitis she was irritable all night and didn't sleep poor thing. But was stressful because she wouldn't settle. Then I had to do that line change, took me like 20 mins to scrub in etc. Completely sterile. Prime lines chnsge pump. Was just stressful thanks for replying, really needed needed to vent to someone that would understand no one else gets it!
  6. by   redheadrn99
    Absolutely agree...busy but def. doable. I swear sometimes our best asset comes down to strategic planning on many days!..We should not be feeding these infants by nipple for more than 30 minutes no matter how much time we have. It's ends up exhausting, stressful and frustrating for the baby...and on staff as well!
  7. by   babyNP.
    It is a bit busy, but- You could limit the PO feeding times to 20 minutes each. 30 minutes is pushing it for feeding some babies and if they're nowhere near to going home, I wouldn't push them. They can get oral aversion when subjected to forced PO feeds for 30 minutes...
  8. by   Coffee Nurse
    *All* of the kids on your unit are fed at 2100? How bizarre. That seems like just a recipe for failure/situations like you were in. Why not deliberately stagger them?
  9. by   babyNP.
    That's not uncommon, all our feeding babies were 9, 12, 3, 6 no matter what and our NPO babies were 8, 12, 4. Realistically you started at 0830 for the first feed, of course. I allocated about 20 minutes to feed, 10 minutes for assessment and some charting if I had time. It was on the rare side that I had 3 kids that all bottle fed the full 20 minutes, but this was at a children's hospital.
  10. by   vintage_RN
    This sounds like a typical intermediate/level 2 assignment in my NICU, however my NICU is known for its crazy assignments that other area NICUs think are insane....so there's that.

    All of our babies are on Q2h or Q3h schedules which means they are all fed at 0900, 1200, 1500, 1800 etc or 0800, 1000, 1200 etc.....you just have to stagger the feeds if they are bottling and start half an hour/45 min early.
  11. by   NICUismylife
    Definitely sounds like a busy assignment. I have to comment on those nipping babies though. If a baby is taking 30 minutes and only nipping 15% of their ordered volume, you may find that gavaging every other feeding will result in them nipping the in-betwen feedings more effectively as well as resulting in better weight gain.
  12. by   champagnesupeRNova
    On my unit, this would not be an appropriate assignment. They would pair #1 and #3 together - it would not be a triple. Don't feel bad - anyone would be busy in that type of assignment!
  13. by   Leader25
    Very busy assignment,I would not po feed longer than 20 mins,that's our standard,three slow feeders is too much,not having a decent meal break is unacceptable,you are NOT paid for your lunch hour,you are working for free.Unless you know you will get back your time somehow when it is slow stop working for free.There is a value to your knowledge and experience.
  14. by   Ninjanurse51
    Wow. That sounds like a heavy assignment! I worked NICU a total of 25 years. At the first NICU, we never had 3 baby assignments because the babies were high level acuity. At the second hospital they gave us 3 baby assignments and ever just having grower/feeders can be way too busy!

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