We've all got them. Those things we find that just get us riled. Perhaps reviewing them will help newer nurses. Perhaps writing about them will just let us vent.
Here's mine:
OGTs that aren't in far enough. The OGT may be in and secured where it has been but the baby has grown. Nurses check placement: push in a little air, hear the sound over the gastric area, aspirate and find no aspirate. They also don't get the air they pushed in back but since they heard the air they think the tubes ok when in reality its just above the sphincter in the esophagus. Put the tube down another 1/2 to 1cm and then you get back the air, and possibly a large amount of residual that was being missed before. If you don't get the air you pushed in back, you have to ask why not!
1. The day shift RN immediately disturbs the infant (even while I'm still giving report) and changes my entire clean, neat, and developmentally appropriate bed "because I just have to do it my way" or "the stripes are in the wrong direction." We're talking even cardiacs with open chests here......
Hah, I think I'm the only female on my unit that could care less which way the ducks are facing on our blankets. It's a darn BLANKET! The ducks can be upside down and it still serves its purpose just the same.
1. The day shift RN immediately disturbs the infant (even while I'm still giving report) and changes my entire clean, neat, and developmentally appropriate bed "because I just have to do it my way" or "the stripes are in the wrong direction." We're talking even cardiacs with open chests here......
2. Older battle-axe nurses who obviously haven't read a nursing journal or learned (refuse to learn?) anything new in the last 20 years. Old habits never die, and it's hard to improve when people don't want to change. If you're going to lecture me (a grad student) on something, make sure you have some evidence to back it up.
3. Said battle-axes who attempt to chew up and spit out the nurse giving report, about things that are personal nursing judgement, NOT poor practice. Don't sit there and make me feel like I am a bad nurse just because I didn't go about it the way you did.....Especially overnight, when we have less resources/staff, less experience, and the meconium hits the fan. Maybe one of my babies didn't get a bath, but we did get 4 cardiac transports, two sets of twins, and had to intubate and balloon someone last night.....Sometimes we need to make judgment calls and give the best care we can. It may not be pretty, but night nurses do the best they can. And we do a pretty darn good job, too. We're not second class citizens, even if you day-shifters make us feel that way all the time. (DISCLAIMER: I've worked both shifts, so I know how it is)
4. Wrappers, tape, used suction catheters, gauze, syringes lying around the bedside. Clean up your patient's bedspaces before report. Only takes a few minutes.
5. Just because the baby isn't actively crying doesn't mean she isn't in pain. I'm pretty sure that pacifier you just jammed in her mouth does nothing for the chest tube pain she feels every time that vent delivers a breath. Opioids are NOT the Devil. They exist for a reason.
6. Please make sure there's at least enough thawed breastmilk for my 2000 feed. It's hard to make a baby understand why dinner's taking so long.
7. If the baby's getting 1cc/hr of EBM, don't thaw out 3 full bottles, only for me to throw most of them out later. Try and figure out how much he needs and only use that amount.
8. Stop taking the sensor off your baby's vent circuit just because it keeps alarming. Fix the problem. Your baby needs that synchronized ventilation, rather than getting a breath banged in regardless of what he's doing on his own.
9. Take a minute to wipe the blood/feces/vomit/betadine/formula/lord knows what off the isolette walls. Please.
10. Be sure to remember to change the position of the temp probe when you flip your baby. I get too many cold babies lying on their ISC probes.
This is one of many, but my latest personal favorite...
I guess one nurse must get really bored I come on and find that babies leads have been braided (!!!) together. So if that one annoying one loses it's stick, you have to pull all of them off, or spend precious time unbraiding them.
Or, they equally elaborately drape the cables in knitted fashion around the equipment. Again, fine when you work a shift when parents don't come in to hold, not so good for tryin to get baby out whilst still connected to monitors. Oops, there go those annoying braided leads again.
Another, people who don't administer O2 properly. An ex 26 weeker does not need to have O2 sats in the high 90's! Turn the O2 down!!!
Or the person who wanted to help me straighten my 22.6 weeker's linen because it was whonky. If it ain't botherin' her, it ain't bothering me! You wanna give her a bleed because her bunting isn't sqared center in the Giraffe? Sorry, if you touch her I'll say something unpleasant.
Coming in and doing your initial assessment to find caked, dried on meconium or stool all over the baby's bottom, but none in the diaper. Honey, even I know it's been there for longer than an hour.....
While I'm giving report, the nurse organizes my already perfectly organized bedspace by moving the oral kits a foot down the counter and the computer monitor 5 inches back and the suction tubing across the bed. It's FINE, let's chat about the baby and not make me feel like I made a mess of things.
You finally quiet the frantic crying gastroschisis kiddo by morning when the surgeon pops up at the bedside to do his rounds - flops open the blanket, puts a hand on the belly for 5 seconds, and "i'm outta here!" You're left with, what else? A frantic crying baby.
Brand new residents. Period. But in particular, when they round the first morning and don't know a clue about the way charting works, what NIPS are, or what's going on with your kid. Were you not oriented at all???
Overanxious parents who ask you a question and get your answer. Then ask the nurse beside you the same question. And then the nurse on the next shift. And then you again. Comparing notes obviously... and freaking out if they get slightly different answers. Ahhh!
Nurses who freak out when you actually used PRN pain drugs for your obviously in pain baby... He was 5 hours post-op when I got him! He needed it!
This is so minor in the face of Steve and some of y'all's c/o, but it bugs me nonetheless: in our unit, some folks put a pile of wet 4x4's on the surface under the bed; they then use the same pile all shift long when they change diapers. Not only do I think it's miserable and COLD, it seems somewhat unsanitary.
I also don't like to see babies w/their lead wires tied in a knot (it's damaging to the wires inside the plastic covering) or babies kept where the nurse wants them in their incubator by way of a rolled towel "slung" between their legs.
Lead wires fastened under the velcro tabs of diapers. Once I found a baby like this, he moved around a lot and the wires ended up in the crease of his leg and left red indentions there. These babies have enough negative stimuli thrown at them.
Manipulative parents. We have one now who is sick, it's all about her, not her baby. She makes everything a battle, she gets what she wants, then pushes a little more.
Parents who put you on their primary list without telling you. Then come up to you in front of other parents during report and demand to know why you don't have their baby.
Parents who try to pit nurses against nurses by "firing" perfectly good nurses from their primary lists, then talking smack about your coworkers whom they fired.
In my limited experience, I really don't like the x-ray folks that come in and think they know how to move our kids. I was tending to a kid that was screaming her head off and the x-ray tech came in to get a picture of my vented kid and proceeded to move her around when I saw her and the ET tube was being pulled! Argh!
I've learned to never turn my back around 5am when they come by and to watch them like a hawk and step in to move the kids myself!
As far as the band-aids go, I have to do a "change" project by the end of my first year and I was thinking about trying to get rid of all the band-aids (in favor of using a gauze that wraps around the foot with a piece of tape that doesn't go on the skin). We had a kiddo recently that was 30 weeks and had the top layers of the skin off because of a damn band-aid.
We use something called webril in our NICU. It's a roll of cottony material (think ironed out cotton balls) that sticks to itself. So we just put a 2x2 on and wrap this around it and around the foot.
I can agree with almost every one of the previous gripes but I thought of one more.
We put ID bands on the babes once they aren't tiny, usually on a leg. So you go to get your bp at the beginning of the shift and you can't get a good reading and the baby keeps squirming. You then see where the bp cuff was placed (routinely the off-going shift places the bp cuff on the infant with last hands-on). It's wrapped nicely around the ID band making it not only difficult to get a reading but causing the infant discomfort.
NeoNurseTX, RN
1,803 Posts
Hah, I think I'm the only female on my unit that could care less which way the ducks are facing on our blankets. It's a darn BLANKET! The ducks can be upside down and it still serves its purpose just the same.