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!
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.
Not only do we have the 3! ID bands, there's the baby "lo-jack" sensor to manuver around. And then there's the kids who outgrow their ID bands, and nobody notices how tight it is for a while.
Not only do we have the 3! ID bands, there's the baby "lo-jack" sensor to manuver around. And then there's the kids who outgrow their ID bands, and nobody notices how tight it is for a while.
You lo-jack your NICU kids? Wow. We totally don't bother. I guess we figure that it would take you so long to unhook one of ours from everything that *someone* would notice.
And we recently went to one ID band after a rash of kids having two that didn't match each other. They decided that one correct one was better. Most of us still put two, but we only require one now.
We only put our "HUGS tags" on when they're on room air and no IV fluids... when they're ready for trips to the parent rooms. And yes - I have coming in to do my first hands on assessment to find that the HUGS tag is way too tight - so tight there's no way it happened in the last 6-8 hours since the last hands on assessment. (let alone all the diaper changes inbetween those!!!)
You lo-jack your NICU kids? Wow. We totally don't bother. I guess we figure that it would take you so long to unhook one of ours from everything that *someone* would notice.
And we recently went to one ID band after a rash of kids having two that didn't match each other. They decided that one correct one was better. Most of us still put two, but we only require one now.
Ours aren't lo-jacked either. A lot of them don't even have ID bands on..esp the micropreemies. They are taped to the bedside. The bigger kids that grew out of their bands also have them taped to the bedside..never seen them get new ones because each kid only gets 2 bands @ birth.
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.
Eww gross that sounds like a breeding ground for...klebsiela!
They have 2 handwritten #'d bands that match mom's and SO's #d bands, and they have an ID band stamped w/their Medical Record #. Lab draws our bloods, and they won't touch the kid w/o that band on. Usually I loop that one thru one of the others.
As for the lo-jack, I've seen 26wk micros that are going to be transferred any second, but the L&D nurse has managed to get that lo-jack on them!!
I hate when a nurse is in an isolation bed (or any other bed for that matter) trying to care for a baby who is desating, having a bradycardia, or vomiting and her other infant starts having a brady or something and the nearby nurse says, "your baby is having a brady" or "do you want me to save your baby?" Should this be a question?! If you are available, save the baby!!!! I don't believe in this "your" baby or "my" baby. All the babies are important--save them all!!!
I also hate when a baby is desatting slightly and a nurse turns their FiO2 up 10+ percent. Then you spend forever weaning them down when they never even needed that much to begin with!
I hate when a nurse is in an isolation bed (or any other bed for that matter) trying to care for a baby who is desating, having a bradycardia, or vomiting and her other infant starts having a brady or something and the nearby nurse says, "your baby is having a brady" or "do you want me to save your baby?" Should this be a question?! If you are available, save the baby!!!! I don't believe in this "your" baby or "my" baby. All the babies are important--save them all!!!
I also hate when a baby is desatting slightly and a nurse turns their FiO2 up 10+ percent. Then you spend forever weaning them down when they never even needed that much to begin with!
I had that the other day. I was in isolation, and my other kid had a HR drop. The only other nurse on that side was just sitting at the computer.
I hate it when the lab calls and tells you they never received a sample, even though you placed it in the same sealed bag as the other 4 that already resulted, AND the computer shows someone in the lab scanned it in.
Do you REALIZE that I just took 2% of my baby's blood volume to send those labs???
I realize you can't quite wrap your mind around the concept of developmental care and proper positioning. It's tough stuff. ([/sarcasm]) But if you really, really must rip it out of my bed at the start of your shift, put it in the damn cabinet! Those of us who actually find ourselves able to use it are really sick of going to clean utility to get more so we can put our micros in prone.
Liz--before they had positioning devices, I once spent ~ 3 hours creating a "lounge chair" for a baby using some foam 8x10 pieces, cutting and rubber cementing to make a positioning aid that kept her off her very skinny and very sore bum, supporting her head, shoulders and arms so they weren't just dangling. You could turn her side-to-side by just tipping the whole thing and putting a blanket roll behind it. It was a LOT of work.
The next day, another nurse threw it away. "She just needs to be off her back!" She refused to consider the concept of side to side, or that this foam thing could alleviate pressure on her skin. I was just astonished. Felt (and was) amazingly dissed!!
prmenrs, RN
4,565 Posts
Not only do we have the 3! ID bands, there's the baby "lo-jack" sensor to manuver around. And then there's the kids who outgrow their ID bands, and nobody notices how tight it is for a while.