Tips for speed without sacrificing accuracy?

[cherokeesummer]

Please help! I'm on week 3 (the end of week 3) of my orientation, and its been about a total of 5 days or so in the actual unit (the rest of the time has been classroom or other stuff).

Anyway I had very little exposure to NICU in school, even though my internship was a NICU one, it was hard to get a lot of hands on b/c I was a weekend student and had a new preceptor every week, they didn't like to hand over a lot of care but I did as much as I could - however it was a much lower level nicu then what I'm working in now. Also that was 6 months ago...so I'm kind of "new" and in a new hospital. Anyway enough of that...

My preceptor has been great, she is very nice and understanding and really helps to clue me in and help me remember stuff. I can always approach her with a question, I won't have her anymore after tomorrow though b/c then I get a new one. Anyway, today I had two "stable" non vented babies and I somehow just got off track, almost forgot a med and just was behind for a large part of the day, mostly towards the end, thankfully she did a lot of the end of shift stuff for me so I would not be late. I don't want to have that happen again. I need to figure out how to be faster but not miss anything. I'm slow when it comes to assessment b/c I want to be sure I don't miss stuff - I start 30 mins early get their feeds warming, then go in to assess them - sometimes it takes less time, sometimes the whole 30 and sometimes longer, depending on how many interruptions I have or if I have meds to give at the same time, or if the baby is really fussy, and flailing around. I know I need to get this down to a smoother and faster method without feeling so bad.

Any tips? Right now I feel so bad. I cried on my way home from work. I know it could be a lot worse. I know this is what I wanted and still want to do, but I have to be hard on myself b/c nobody else is going to say its ok, you can be slow LOL, so I need to make sure I"m not slow but at the same time be accurate and thorough.

Please please please please share any tips or advice. I really don't want to cry at the end of shift b/c I feel like a loser, and I know I can do it, I just have to figure a way out to smooth things.

[CRDBear]

I love everyone's tips. I too am a fairly new NICU nurse, and I felt the same way you did cherokeesummer...I wanted to cry some nights when I went home. I think it was worse for me because I had expereince as a nurse with adults but babies are a whole other animal! It takes a little while before you feel somewhat comfortable. Just know that it does get easier. Time management is something that comes with time. Writing down a schedule at the beginning of your shift especially if you don't know the babies was helpful for me. Also, I try to work with one infant at a time and do everything for that baby before moving on and have everything I need at the bedside to make my assessment and cares quick and efficient. Overall, what I an suggest is this: Celebrate your successes, learn from your mistakes, know the only stupid question is the one not asked and know that we are all here to make the babies better! You sound like a great nurse and you will do well!

[elizabells, BSN, RN]

Its like as soon as I come close to the isolette the alarm stops.

Ah, I love the babies who just want you to get up.

In all seriousness, though, I feel for you. During my orientation my preceptor was always on me about speed, and my (internal, silent) mantra was "I can do it fast, or I can do it right." One thing that helped me was while I was checking my orders at start of shift I would make a list ALL the supplies I needed. Gavage feeder getting 7ccs q3? I'd get ten 12cc syringes - two for each feed to check residuals and for the feed, plus two more. I'm like that - whenever I go to the supply room I get one extra of whatever it is. Then if it turns out you had the syringes at the bedside already, great, you don't have to stock for the next shift. Assume you have NOTHING at your bedside. This was a huge time-waster for me at the beginning, and sometimes I still have to stop during cares to grab something, but it's much rarer now.

You WILL get it. I promise.

[RN mom of 2]

During my orientation my preceptor was always on me about speed, and my (internal, silent) mantra was "I can do it fast, or I can do it right."

I love it... wonderful advice! :)

[lccougar02]

Well heres my advice to a new NICU nurse. I started as a new grad in the NICU about 1.5 years ago. What I did to get organized was this...I made a 3x5 index card on one side it listed what I needed to assess on the infant, set up as a "look" then "touch" approach. Heres what is kind of looked like:

Write down: Isolette temp, count respirations/retractions, color, ac/pc isolette, activity, pain, check for any skin lesions/rashes ect

Then put on BP cuff, get temp, change pox probe, feel for liver, check abd for loops/venous patterning, check fontanel

then listen and check aspirate, suction if needed, listen again

change diaper

change gloves

reposition and feed

Thats what i do for my assessments. I hope that helps. On the other side of the card I wrote down what supplies I needed and gather BEFORE entering the baby's bed including for example:

diaper, cottonball, wipes, tape, suction supplies(saline, surgilube and catheter), 6cc syringe, feed and meds ect.

then I would tape the card on the isolette and as I was doing care I would look at it to make sure I didnt forget anything.

It made my time mgment really speed up and it still helps!

Also, when you start your shift get all your med calcs done BEFORE starting your shift so when life in the NICU gets crazy you can just draw up your med without double checking at a crazy time.

And about checking the baby for the alarms...its normal to feel that way until you are used to the baby and why and how much they desat or brady and what your interventions need to be.

I hope that helps! Good luck and message me if you ever need help! :)

Jackie

[LilPeanut, MSN, RN, NP]

The alarms thing comes with time. We have the same three tones as the poster above has, and you just learn which ones are which. We teach parents too, so they aren't concerned about every little ding.

Part of it is also getting to know the babies in your pod/area. You may have a heart kid who needs sats >70, so when he dips into the 60s every once in a while, no one is panicked. Or a BPD'r who constantly desats and self-stims up.

As for what you do, it depends on what's going on. Brady, first thing after assessing color, whether it's a true brady and equipment (all that though is just a quick glance), you stim. Some kids need vigorous, or if they are vented, they need a breath on their vent. If possible, find the nurse who has the kid so you know whether this is "normal" for them.

Desats are similar, except you don't usually stim, just increase FiO2.

The trick with both is being able to recognize at which point the minor interventions aren't going to work and you need to escalate care, ie bagging, compressions, checking for extubation.

Don't be afraid to call for help. If I have a kid who is vented, I'm comfortable on my own up to bagging. If I'm bagging and still not getting anywhere, I start calling for help! *L* And if you aren't sure, don't turn off the alarm, because even when you are concentrating on the baby, the alarm will bring the attention of other nurses to help.