Someone answer me before I lose my mind

[fergus51]

Ok, I am new to the NICU and finding some things incredibly frustrating. Everytime I give report there is always something that I or a nurse before me has done completely wrong (according to the nurse accepting report). Then when I ask someone more experienced, they will often disagree. I feel like I am not providing good enough care because everyone (my preceptor, the docs, the other nurses, the team leader, etc) tells me something different. We also have primary nurses who know their babies very well, but that info does not get passed on and then they are understandably upset when they come back after their days off and the baby's "normal" care was done differently.

So, my question is: Do any of you have a good system for passing on the care plan? Even a copy of the forms you use would be helpful.

Also: what do you all feel about instilling NS with suctionning. Our policy is to go down dry, if still crackly or coorifice, instill and suction 2 times. I am asking because a nurse told me that the newest research says not to instill, and she feels that is the reason her primary is not doing as well on the ventillator. But, the RTs tell me that isn't the case.

Any help would be appreciated, I am going nuts:)

[CatRN]

Hi there....

First, don't get frustrated! Every nurse has a different way to do the same thing, and since our patients cannot verbally tell us what they like.....we like to think we know what they like. Most babies prefer prone to other positions, no left side postioning for reflux babies...etc. Also, NICU nurses are notoriously terroritorial...and sometimes are used the one way of doing things and don't like to learn different methods. NICU nursing is constantly changing and new literature and studies are constantly being published with different ways to feed, position, suction, etc. Developmental care is evolving, kangaroo care is more popular....but are still not being implemented in all NICU's. Just ask questions and like another poster suggested, if they want the history down to the apgars on a baby that's on Day 60 of life, pass them the chart and tell them to look it up. Kardex's are great....but unfortunately, I learned that some places are completely on computer now and the kardex no longer exists. As a travelor, I have learned so many different things from so many different NICU's and in turn, have taught some places new ways of doing the same things. It's a constant learning experience!

As far as suctioning, use your judgement. If the secretions seem thin and are visible frothing up and down the ETT, than no saline necessary. But if you suspect a plug or your baby isn't moving air on ascultation, give a few manual breaths and if you still don't hear any air moving......consider the hx of the infant of course.....baby is desat'ing, etc.....maybe a little saline is necessary....some literature supports saline, some doesn't. Such is the case with nursing.....one study suggests one thing, and another quickly suggests likewise. Just remember, each baby is unique and can change in an instant. Hope this helps a bit! :)

[prmenrs, RN]

Remember the current buzz words: evidenced-based care. As long as policies are established w/GOOD research in mind (and the pertinent references should be on the policy itself), they should be carried out. If people aren't doing that, management needs to solve that problem.

I agree about the territoriality thing--not unique to NICU's, either. And there is the mother hen thing--while the baby is there--s/he is YOURS!!

Re: dry erase boards--be careful about confidentiality issues.

[NicuGal, MSN, RN]

We haven't had an issue with the boards...we list labs, and things we need for the baby, things like that. No diagnosis,etc..those are on the kardex. We checked with legal about all this and they said that it was fine as the stuff on the boards was a need to know basis.

[fergus51]

LOL! I have heard people describe some NICU nurses as having a bad case of my-baby-itis:). I completely understand where they are coming from, and even get protective myself, but risking getting into trouble here, I have noticed people in the NICU are much more....... well, anal about the small stuff than in other areas I have worked in.

[Mira]

`Agree w prmenrs regarding confidentiality. Where I used to work `heard a complaint from a sensitive parents re: putting information in the board about their baby. Boards hasn`t been thrown away but we only put named nurse first name, consultant`s name and frequency of feeding, the rest goes into the nurses notes.