1. Hello all... I must admit that I feel as if I know most of you because I have spent quite a lot of time reading posts. I am a new grad.. May 2003. I just started working in the NICU about 1.5 months ago. I'm so thankful for this board because I have learned so much from you all. I have a question though. I have heard talk about being VERY leary of new nurses who seem to confidant in the NICU. My preceptor mentioned it to me. I must admit that I felt completely deflated after hearing this. Yes, I am very confidant. But only about the things that I understand. For example... I have read a great deal about anemia in premature infants. I feel confidant about that. However, I have read very little about ROP.. I would have to defer to my preceptor for info in questioned by a parent at this point. (I'm trying to take on one NICU topic every couple of days... there is so much to learn. AND, babies are so different.) Has there been a study that I'm not familiar with? One that found that confidant nurses are more likely to make errors? Gawsh.... anyone who can offer some insight?? Thanks in advance!

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    About SheaTabRN

    Joined: Jul '03; Posts: 35


  3. by   NicuGal
    I think that the ones I have encountered are overly confident and think that they can do it all....and those are the ones that make errors. I don't think you are going to find studies, etc on the topic. For example, we have one gal that is just off orientation, and instead of asking about something she will just rattle off some BS to the parents...sure it sounds good, but it isn't quite accurate. I said something to her and she said, well, I don't want to look stupid in front of the parents....I said,no now you will just looks stupid because I am going to tell the parents the right thing.

    Just keep asking questions and if you don't know something...ask!

    Good luck
  4. by   SheaTabRN
    <<<For example, we have one gal that is just off orientation, and instead of asking about something she will just rattle off some BS to the parents...>>>

    What a nightmare... NOOOO, I would never do that. I always tell the parents what I know and then look at my preceptor and politely say: "Is there anything you would like to add to that?" I hope that in my letter I conveyed my concern that I don't want to do anything that would jeoparodize the care of of my babies. I guess I just don't know how to change the person that I am. I know that it will take me at least a few years to feel completely at home in the NICU. I have even more confidence in the fact that there are ALWAYS several people around me that know leaps and bounds more than me. Hence the reason they don't orient us for several years! But I really appreciate your perspective and will be very mindful of your advice.

  5. by   NICU_Nurse
    I understand what you're saying, but I think that what you've been hearing is the difference between an overly confident-verging-on-arrogant new nurse and yourself, who may feel confident that you can learn anything given the oppoortunity?

    I have another example for you. On my old unit, we had a new grad who was orienting with a preceptor and she was of the overly-confident-verging-on-arrogant variety. She was a really sweet girl, but she was just totally sure that she could do it all by herself. I think she was worried about looking bad, or incapable, or stupid in front of her new teammates. I mean, as we all know, coming to a new unit is a little scary- new people, don't know who to trust, sometimes friendliness doesn't work, etc.

    If this girl had an assignment composed of two vented micro-preemies, she would end up handling them all night long, despite the suggestion that she should cluster her care or let them rest. She would smile, but she would go right back to doing what she had been doing, confident that she wasn't doing anything wrong. She just didn't seem to understand that they needed minimal stimulation. To her, part of her job was to change the linen and bathe the babies. So, she would come in and lift and roll and manipulate those babies- she'd take them off of the ventilator unassisted and put them on an external scale, she never asked for help. She'd give them lengthy sponge baths trying to scrub away all the flaking skin, etc. She didn't seem to understand how to prioritize, and numerous people tried to speak with her about it but it all fell on deaf ears. It should come as no surprise that her babies frequently extubated (wonder how that happened?) or needed around-the-clock sedation or often desaturated and needed to be bagged, etc.

    We had another new grad who would refuse to re-draw lab specimens if the lab called up and said they were clotted. Nevermind that the MD had ordered a STAT level, she insisted that it was the lab's fault and that either they come up and re-draw it or it wouldn't get done.

    We had another new grad who never asked any questions. One baby's OG tube had to be re-taped, and her preceptor asked her to do it. So, rather than ask (or maybe this never even OCCURRED to her!), she re-taped the OG tube. She taped it correctly, used the right technique. She taped it correctly with SCOTCH TAPE.

    And we had yet another new grad who, rather than be bothered to ask for help, would do this: If a vented baby was desaturating, she knew that he/she needed O2. If suctioning didn't fix the problem, she'd put an O2 mask by the baby's face.
    I'll give you a second to let that sink in! LOL! A vented baby. O2 mask by the face. See the problem here?

    That last one would also flick the soles of a baby's foot if he/she was desatting, and would give O2 to a bradying or apneic baby.

    I think the difference is that these nurses, and those that we talk about on this board that you've read about, are unsafe because they are confident. We weren't talking about *you*!

    You don't have to change the person that you are!!! It's possible that what you might be feeling are simply personality differences! If you're really worried about making the wrong impression, why don't you tell her? Ultimately, it sounds like you are being very conscientious about learning more about your new job, which is something to be proud of. Keep asking questions, be open to new information, and learn as much as you can- your preceptor is a great resource for you. Most of all, though, don't be afraid to ask for help. It's *not* asking that will get you in trouble!

    Congratulations on your new job!
    Last edit by NICU_Nurse on Aug 16, '03
  6. by   SheaTabRN
    Wow, what an informative post. Nicu-Nurse, you really helped to put things into perspective. Although, I doubt I would have put an O2 mask on a vented baby, there are many potential mistakes that I could make. All the while I would probably be thinking that I was doing the right thing.
    I think the one thing that bothers me is that my preceptor treats me like I'm a 21 year old, "this is my first job" little kid. I am 28 years old, have been managing restaurants for a few years, and graduated top of my class. She will say: "Now changing this broviac dressing is a sterile procedure" in a semi-patronizing voice. Maybe she just has no idea that I have changed MANY central line dressings in nursing school and in my short stay in the ICU after graduation. They place them in an adult for just about everything. I just thought it was one of the most ridiculous things I had ever heard. AND, now that I'm writing it out, I think that maybe she had just been doing babies for so long that she forgot. I don't know. ) Thanks again!