Nursery nurses?

Is this nursery a newborn "well-baby" nursery or a special care nursery? There are some things that are the same and some that are very different.

In the newborn nursery, you would admit the newborn and perform a newborn assessment. This is a head to toe examination looking at weight, length, skin integrity, color, pulses, facial features, oral cavity, extremities, abdomen, chest, genitourinary system and so on. There's an assessment form that is completed so that any variations from the norm can be documented. (We recently admitted an infant who had an imperforate orifice who subsequently died of sepsis. His anomaly had not been picked up in time and he perforated his bowel.) You may also do an assessment of gestational age if there's some question of dates. Then you'd give the Vitamin K injection, apply the eye ointment if ordered and any other physician orders. The baby may remain in the nursery for some time if Mom was sectioned or is ill. Some babies you might feed, others you would take to Mom for feeds. When it's your turn, you would provide a bath demo, do teaching about normal baby care, car seat assessments and so on.

In the special care nursery you would do all of the above, more or less PLUS. Babies admitted to the special care nursery may have craniofacial anomalies such as cleft lip/palate or choanal atresia, tracheoesphageal fistula, micrognathia, Down Syndrome or other problems that make feeding a challenge. They could be infants of diabetic mothers and require close glucose monitoring. They may be premature but not requiring intubation and ventilation, they may have been exposed to illicit substances in utero and be in withdrawal.

Does that help?

You can assess for imperforate orifice by doing a rectal temp and also by direct visualization. One major assessment is whether or not the baby has passed meconium. With the baby I mentioned, he was born unexpectedly at home and although he was taken to the hospital and assessed in the ER, they don't usually do newborn assessments so it was missed. There was nothing else obviously wrong with the baby at that time so he was d/c'd from the ER. He was reassessed a day later after he started vomiting. And the rest of it just snowballed. The move to ever-shorter post-partum stays has created all sorts of interesting problems, like hyperbilirubinemia after discharge. You may see some of those babies too, but typically once they've been home they'd go to peds, not the nursery. Some heart defects also pop up after discharge (when the ductus arteriosus closes) and the kids are REALLY sick then. So you wouldn't likely see that.

I haven't worked in a newborn nursery for a long time. Got floated there from the PICU once and it was such a nice break!

Hey, this is your thread. If you wanna take it off topic so be it!

I graduated into the last big nursing purge so didn't find a job until I'd been out of school 7 months. I was hired by an agency to do pediatric home care and staff relief. It was a horrible way to start a career and there are posts in other threads that expound on all the reasons why. I didn't start hospital work until exactly a year after graduation when I took a casual position in a special care nursery. It morphed into a series of temporary part time positions but my main goal was always PICU (my 26-year-old son is a PICU grad - 6 1/2 weeks of PICU when he was just little). I wasn't sure I'd ever make it there though so I was looking for the best in the nursery so I applied for the neonatal resus team and was turned down three times because I wasn't in a permanent position. The third time I was rejected they decided that they'd train one of our casuals though so that was it for me. I started looking for options. I was offered a temporary position in PICU about halfway through one of my many temporary positions in the nursery but the manager of the nursery wouldn't release me. So then I was more ready than ever to get out of there. As luck would have it, when my term was nearing its end, there were no postings for PICU so I applied for a position on an adolescent medicine ward. Right after I dropped that application off there magically appeared a temporary full time position in PICU and although I really didn't want to work full time I applied for that one too. All of a sudden I had two offers and had to choose. PICU it was and I've been there ever since. I moved to a new city 7 years ago but still work in PICU. It's my niche for sure.