Overwhelmed!

prmenrs, RN · Mar 7, 2007

You poor thing!! You've been thrown into the deep end! You're in a no-win situation.

First of all, a new grad program in a NICU should start w/didactic. Nursing school is not set-up for teaching students the specifics of each and every specialty. They should be teaching you "babies 101" in a classroom setting. They should start w/the convalescing babies, then precept for a few weeks, then go back to the classroom for "babies 201", then precept in the ICU.

Preceptors should have NO OTHER DUTIES!!! You are the priority to her/him. You take one baby together, then 2, then 1 each w/her to back you up, etc until you can take a full assignment. Once you are taking a full assignment, you should have a specified resource person. Repeat the process in ICU.

A good thorough orientation takes several months.

Reconstituting meds: Ampicillin should be mixed w/in 1 hr of administration. The 250mg vials usually get 0.9ml sterile water; if you need 100mg, 250/1 = 100/x, that math gives you the correct amount to draw up. Dilute this stuff, it's very hard on the veins! The 500mg vials usually get 1.8ml sterile water, still comes out to 1 ml = 250 mg.

Cefotaxime: usually gets 5mls sterile water, 1ml = 100mg. Again, dilute the dose.

I have to go, but I'll try to answer some more stuff later if no one else does it first.

I'd really like to have a sit-down, come to Jesus talk w/your NM. (don't tell her I said that!! ) If it's @ all possible, check out other NICU's in the area, and see how they do it and if you can jump ship.

Also, buy Merenstein and Gardner (if you haven't already done so), and a Neofax.

http://www.amazon.com/Handbook-Neonatal-Intensive-Gerald-Merenstein/dp/0323033008/ref=pd_bbs_sr_1/103-4446450-9911064?ie=UTF8&s=books&qid=1173291939&sr=8-1

neofax.com

dawngloves, BSN, RN · Mar 7, 2007

If your co workers are taping up IVs so much you can't observe the site, they are doing it incorrectly.

Elvish, BSN, DNP, RN, NP · Mar 7, 2007

I do well-baby (or any non-NICU baby, really) but I have also found Neofax to be a Godsend. I'm sorry you are in this situation. A big hug to you!

Something else I really like is Care of the Sick Neonate by Paulette Haws, NNP. Lots of good info in there, easy to read, and it will serve you well whether you stay where you are or go elsewhere.

danissa, LPN, LVN · Mar 7, 2007

I am looking for help. I am a new grad, and have spent a grand total of 3 shifts in the NICU. I am smart, and I am capable of learning, and I am willing to learn, but my preceptor acts like I should know things that I don't. Could you help me please?
I have never reconstituted meds before. In the hospitals where I had clinicals, the pharmacy always did that. Now I am responsible for it, and I don't know how. Can someone give me a formula on how to reconstitute safely? I can learn how to do it if I have a formula.
...So sad for you babe that you feel so down!
as for reconstituting meds, does your unit not have a drug formulary? we have, in a big folder, as we often have to make up meds, but EVERY one we use has instruction how to make it up, very easy to follow and cuts out mistakes! dont rely on something you read on a site on how to make up drugs, sometimes variations occur from unit to unit, so you need to find out the correct way to do things in your unit.
Hope things get better for you, Im sure it will, and Talk with your preceptor! She may not be aware of how you are feeling! take care, and do something nice to pamper youself, just to lift you up a wee bit!

BittyBabyGrower, MSN, RN · Mar 8, 2007

Actually, you need to say something to the manager and education and training person, and your clinical nurse specialist. That is so wrong how they are orienting you. In our unit we never take an assignment, charge when we are precepting. You start with one kids and advance to 3 within usually a 1-2 week period, by week 5 you are taking stable vents with us. She needs to be showing you how to do things, going over protocols, watching you do meds, etc. You are truly getting the short end of the stick and if they don't change how you are getting oriented, I would personally find somewhere else to work.

Gompers, BSN, RN · Mar 8, 2007

I agree, your preceptor should NOT have any other duties besides helping you! To have a full patient load plus being in charge is enough, that nurse cannot possibly precept at the same time.

You need to talk to your manager. This is NOT a typical NICU orientation. Like others have said, usually there is a classroom portion first, then you have a one-on-one unit orientation with a preceptor for several MONTHS.

The oxygen thing - preemies not only need oxygen, but also airflow to help stimulate them to breathe and to help keep their airways and lungs open so they don't have to work so hard. What we do is hook up nasal cannulas to an off-the-wall air source as well as oxygen. This way, we can provide up to 2 LPM of airflow and then we "blend" in as much oxygen as needed to keep the sats within range. So a baby can be on 2 LPM airflow with between 21-100% oxygen. There should be an analyzer hooked up to this system that shows you exactly how much oxygen the baby is getting, and you can tell what liter flow the baby is on by looking at the flowmeter connected to the airflow port in the wall.

As far as reconstituting meds, every hospital kind of does it differently - your unit or pharmacy should have written guidelines as to what concentration meds need to be diluted to, whether to use saline or sterile water, etc. The Neofax is helpful, but there are other pediatric drug guides out there as well that are good resources as far as mixing meds goes. There should also be a compatibility chart somewhere within your unit as well. If none of those things are available to help you with meds, then I don't know what to tell you except beware of this unit.

Overall, this unit sounds a bit overwhelmed and disorganized. Please be careful!

travel920 · Mar 8, 2007

Thanks everyone. I have been feeling really incompetent. I was promised by the manager that I would get 16 weeks orientation in the NICU. She did not tell me that part of that orientation would be in Postpartum. The time that I spent in the well baby nursery really helped me though. I feel competent there (or at least a whole lot more than I do now).

They are talking about putting me on nights in a week with a different preceptor, and I will get 2-3 weeks with her. I have decided that I will not allow them to take me off of orientation until I feel comfortable. If that is not satisfactory, I will leave. I will not do anything that I consider unsafe. Regardless of how much pressure that they put on me.

I went and took boards this morning. The saddest thing is that I almost hope that I did fail, and they fire me. Pretty sad huh?

I will get that book. I have no problems with studying on my own, and being responsible for my own learning. I just wish that things had been done differently. I feel like I have been lied to.

RainDreamer, BSN, RN · Mar 9, 2007

RUN RUN RUN away from that place!!

Awww I hope you don't really wish you failed boards. I hate that this place has done this to you!

Is there another NICU in your area that you could maybe apply to? You could talk to the manager and educators, but I'd be leary about working at a place that felt like something like this was ok to do!!

I had an AWESOME preceptor and great support from all the nurses in my unit. I remember the first time I ever mixed up amp ...... I had never done it before either. My preceptor talked me through the whole thing and didn't make me feel stupid for not ever having done such a thing. And even then, with all the support and help I got, it was still incredibly overwhelming and stressful. It's a really scary time, and you need all the support and help you can get.

I hope you didn't fail boards, and I'm sure you did just fine. Don't let them just fire you without telling them that you were deceived and that their orientation isn't safe ..... you can help others from being put through this hell that you're being put through. Please let your concerns be known!

Good luck to you!

travel920 · Mar 10, 2007

She passed!

Exactly 48 hours to the minute after the test start time, the results were available on PearsonVue.

Larry the Husband

dansamy · Mar 10, 2007

Thanks, Larry the Husband. Now, get her out of that hell-hole. She shouldn't be crying every night at the end of her shift because she doesn't know something that she's never done before. She's not getting a proper orientation and shouldn't risk her new license in that environment.

Imafloat, BSN, RN · Mar 11, 2007

Congratulations on passing boards.

I am orienting in a NICU right now too. While I am not completely satisfied with my experience, it is nowhere near as dangerous as yours sounds.

You worked too hard for that license you just got today to lose it by not getting a proper orientation. There are so many things to know in the NICU, if they aren't teaching you the basics, you will have a difficult time with the more subtle duties.