preemiepoweredRN

Thank you! Great catch! I know I take great pride in the sweat and tears it took to earn my nursing degree and then licensure.. to think that other people are able to carry the title nurse without any legitimate work or accountability is ridiculous! Thank God for the "Nurse" protection act.. the remaining states need to get on board.

We still use bean bags (frog positioners) and log-style bean bag positioners for the tiny babies in our NICU; haven't heard of anything about this study? Please forward if you find out officially :)

Follow your heart. Saying that, I would clearly not jeopardize my license or job for the sake of maintaining a relationship with a former patient, so if you feel that continuing the relationship would some how be non beneficial down the road, Don't do it! "Most" NICU families have pure intentions in wanting to stay in contact. From my experience, I think its a great relationship to maintain- if its done correctly, with the right families, under the right conditions. It has always been permissible for me in the units I've worked to remain contact after discharge and I have for many over the years. I NEVER GIVE out health advice/opinions at ((ANY)) time. You must ESTABLISH BOUNDARIES from the beginning, which should always include that either of you can stop the interaction at anytime, for any reason. Another thought, maybe not use social media and use a private email dedicated for this purpose? Limit the information you share of yourself; if meeting, always in a public setting. I've never had a negative experience with doing this, but you will know that families that you can do this with and those you cannot. Follow your heart. Good luck to you.

It sounds like you did the best that you could have done in this situation. The fact that you are able to reflect now is good thing and by doing so you will definitely be even more vigilant with all your IVs going forward. No matter what you do to prevent it and how vigilant you are, the IV will STILL go bad and you will feel bad each time. It happens to everyone. Those baby veins just don't hold up long especially with high IV rates. I've had IVs infiltrate within an hour, even after flushing it in every position the baby could move and protecting the site with tape/cotton balls/armboards/other deterrants. It's inevitable. I think the one thing I would have done ( which you mentioned) is advocate to increase feeding volumes to try and decrease IV rate/discontinue to the IV sooner; however with IDM babies this plan often back fires. The baby may not tolerate increased feeding volumes, blood sugars won't stay up. Also, depending on the concentration of glucose in the TPN, it may be a slower process to wean, so then the discussion switches back to placing the PICC ( which is great, but those come with their own risk as well). Just remember : You grow through what you go through! Good luck to you!

^^^^Amen^^^^

I've been given report on the " most challenging patients and families" and then went on to have a completely pleasant shift with the same people. I think if it's a matter of safety ( for myself or other pts/staff) or a matter of liability ( non compliance with care, turning off monitors/ alarms etc) these things are absolutely important. Just passing along " I think the Pt/ family ..xyz" is not important and usually just creates unnecessary tension. Every nurse/ pt interaction will be different..Let's face it, not everyone works well together even in the best circumstances. Our job is to provide safe and professional nursing care regardless of our personal opinions.

My advice would be: Do not overthink the interview. Considering that you have had some nursing experience, you are a little bit more grounded than a new grad and that is to your advantage. It will be intimidating (as any new area of practice would be) but keep in mind while interviewing "Why do I want to be a NICU nurse?" and "How will this opportunity prove different from your previous nursing work/What will I gain from this experience?" I personally believe that your passion for any work speaks louder than just answering questions correctly. Good luck to you!

I've only seen single lumen UACs and double lumen UVCs in my practice. What benefit did the director anticipate using the double UAC line/why the change in practice?

^^^My sentiments exactly.. We have to make the most of the opportunities we are presented, WHEN they are presented..

Wow- HIGH FIVE for advocating for your patient, even in such an intimidating situation with the MD!!! I can still remember at 2 years being somewhat terrified at times to do what you did, but uncomfortable is part of the territory. I'm presuming that the MD was irritated 1. because he would have to possibly do more work and 2. that he was "certain" he knew what was going on with the patient and that he was being questioned about something he was "sure" was nothing. It sounds like you did everything correct from making the calls to the MDs the day before and documenting (ALWAYS document everything) and communicating all the information in report. Only other thing I would have done is fill my charge nurse/director in about the situation (which you may have done). If nothing else, this is an example of how being a good advocate for your patient and trusting your gut can truly make a difference. Your patients are fortunate to have you caring for them!

You are definitely not too old to travel, but may want to consider more experience under your belt as a staff nurse. Travel nursing is a great opportunity, but you will be expected to know what you may not know yet(especially if the unit is super busy or there more new grads than experienced nurses)..1-2 days of unit orientation on a travel assignment cannot replace the experiences you get in a stable staff position. Good luck to you!

I agree with the above comment. As long as you are marketable and have good references, most recruiters will not hound you for too much information (in my experience)..but with that said, do not withhold any information that would be better coming from your mouth rather than found out from other sources ( ie diversions, violations etc). Honesty is the best policy.

I have worked on a couple of different units and each did things a little different (1) Triple paste (2) Vaseline/A+D-prophylaxis most places (2) Z-Guard/Hydraguard cream (3) Desitin/Illex cream or Desitin /Illex cream/Stomahesive powder-more severe rash (4)Marathon/Cavilon-nonsting barrier (5) Oxygen to open butt-moderate to severe rashes. I personally like open to air if possible, but it's hard to be consistent shift to shift due to the messiness factor and if the baby is wild, but I think it heals sometimes quicker than all these preparations.

Wow..I think about this often (especially when work gets "hard" aka most of the time). I think I still would choose nursing.. Not sure what I would do otherwise for a profession.

Totally agree with what's been shared. As a current traveler, I feel your pain related to having less acute patients than you're use to, but none the less I wouldn't trade the experience for anything in the world. You have to appreciate and learn what you can, even in your stable, "simple" patient assignment. You really can learn something new everyday.. Maybe you have more time to brush up on reading, or studying for certifications, or just being a help to the other nurses around you. I've found over the last few assignments the best way to "prove yourself" is to help the other nurses on the unit and make yourself available. Everyone likes a team player. Another thing that I did personally the last 2 assignments (not that it always works but) I went to the charge nurses I worked the most with and discussed how "although I'm willing to work where I'm needed, I would prefer to work with higher acuity patients"- and it worked. I got a chance to work with these patients when it worked out for the unit..keywords: when it worked out for the unit. It's a trust game; they don't know you or your skill set ( nothing more than what's been presented on paper and most of the time the charge nurses don't even have time to read them). The biggest thing is not to become bitter-its only a temporary assignment and if all else fails, you just go back to a staff position.

I wore regular athletic running shoes for the longest, thinking we do enough running at work-right? But eventually I started getting foot pain after 12 hrs of work. I didn't like Dansko specifically because of how the shoe kinda 'flops' off the back of your foot. I tried Alegrias after hearing good recommendation and LOVED them on first purchase! I don't believe I will buy a different brand of nursing shoe- they last a pretty long time too, comfort and structure wise. But with all that said, going to a quality shoe store that sales different brands is good way to walk around the store and find a pair you like, however its not like walking the floors at work. Its really trial and error because everyone's foot comfort is different. Good luck!

So sorry this happened esp after going through the whole first week. You definitely deserve more of an explanation than "you'll receive a letter in the mail". I would request a meeting with the manager and HR. If they decided your position was no longer needed the manager should have been open and able to say this. I have a hard time believing it's related to the cell phone, or JUST the cell phone. Good luck to you!

YES, your hands will take a beating, but they won't fall off, or least mine haven't after 11yrs! The hospital soap for handwashing varies (as far as how your skin reacts to it) and the sanitizer can be pretty brutal (esp. with cuts *cringe*). The key is to moisturize when you can and even more so on off days. Take advantage of the hospital lotion they provide, even though it may not be something you personally would choose. It will help to some degree after 12hrs of continuously washing/sanitizing your hands. I don't think it has ever been so bad I would quit nursing over it, nor have I heard of anyone else doing so. Good luck to you!

I remember starting off as a new nurse, always being terrified to call the doctor and wake them in the middle of the night. Over the years I've realized that if I'm concerned enough about my patient to consider calling the doctor, I should call them-hands down. I know its different in LTC vs hospital setting where our doctor is often in-house, but they are getting paid to be available..so with that said, it shouldn't be seen as an inconvenience to them.

^^ completely agree with both points and have those very points reiterated every time I work.. and I'm a firm believer that "you learn through what you go through". Being a nursing student, you have to recognize your position. This is not an insult, but a reminder to look at every experience and situation with an open mind and not be so quick to place blame or become the victim. Your position as a student is to apply what you have learned from school 'as best you can' and to also learn more to help you in your clinical practice.. and even with all the preparation and learning, things still will never be absolutely perfect..that's life. Perspective is everything and I hope one day after you've been practicing for a few years that a similar experience is replayed so you can see that this is not the WORSE you will have encountered. I wish you best! :)

I think I would have refused as well. It comes down to scope of practice and like you mentioned it would be absurd to think that a pediatric nurse floating would take a 23weeker assignment. It's not a matter of skill or intelligence because I'm sure you could muddle through the care if you had to, but that wouldn't be the best or the safest for the patient.

Definitely not excusing the nurses actions, but the instructor should have paired you with another nurse. Period. Speaking from experience, it is difficult (but not impossible) when you are already "stretched thin" pouring into a new nurse who has some experience being on the floor, but not quite ready to be alone and then to take on a student nurse who is seeking every experience and wants every question answered and explained- Don't get me wrong, there is NOTHING wrong with seeking every experience and having your questions answered. The demand on the bedside nurse is insurmountable at times, even with no students or preceptees; then you add in double checking documentation, fielding orders from doctor, family interactions, troubleshooting problems etc etc.. The instructor usually arrives early to the unit before the students to determine the best assignment pair ups, and had the instructor done this you would have not had such a rough first day. NOW it maybe that there were not enough nurses for each nursing student, but even then, your instructor could have stepped in or placed you with a nurse not already assigned to a new nurse. I'm sorry for your bad experience, however what I can say is perspective is everything and one day you may be at work and find yourself in a similar situation. Just hopefully you will take the higher road and advocate for your student nurse to have better experience and not let it change your demeanor like the nurse you followed. I'm sure she is a good nurse, just didn't respond to the situation constructively.

Hi HannahMarine30, I can relate to the social "awkwardness" that you speak of, however that which I've found awkward to me, is what God has used over and over to set me apart and draw other people to Himself. I started nursing over 10 years ago with the thought I would work with postpartum women and their healthy babies, after having such a great postpartum rotation in nursing school. Little did I know, God had bigger plans for me. In the last semester, while finishing my undergrad, I looked for an externship to bridge my transition into nursing. Of course, there were no postpartum positions, but there was a (single) NICU position. Before graduating, I did not see myself as an intensive care nurse-just the thought alone intimidated me and then the thought of sick newborns scared me even more. Despite this intimidation and fear, God knew best and He knew what would truly challenge me, intrigue me, bring me growth, and ultimately bring me closer to Him. So I surrendered in the moment of decision and asked of God, " if this is Your will, let it be done" and- it was. I would have never chosen this path for myself, but I'm thankful that God opened the door and guided me through. It hasn't always been easy, but the more I work remembering the example of Jesus , I'm able to accomplish more. I have been able to truly see what it means to "lose yourself in the service of others" and to cast ALL your cares upon the Lord. He always takes what little I have to bring and makes it more than enough to accomplish what needs to be done, the key is to not try to go it alone. I wish you best!í ½í¸Š

I haven't seen a lot of NICUs using CNAs. I know some units do, but it's definitely not the norm. Are you making plans to return for your nursing degree? This honestly may be the best way to get your foot in the door as some units will have nurse extern/intern positions (meaning you can start working alongside an RN in the unit just before/while finishing your nursing degree with the prospect of working independently once you pass state boards). I have worked with some NICU HUCS (health unit coordinators) who are in nursing school and who have gotten their foot in the door this way in hopes of working in the unit after graduation-but definitely nothing set in stone. Good luck to you :)

Inquiry/Rant- Just wondering if this happens in other NICUs. I'm currently in a unit where babies tend to linger around waiting in stable condition for basic procedures ( ie G-tubes) that could potentially get them home sooner (that is the goal, right?) It appears that families that come often to visit are able to advocate for the baby and potentially move things along quicker (pending no complications, of course) but often times this is not the case because of childcare/transportation/back to work demands of the family. I know from my days on first shift, that the bedside nurse can be the biggest advocate for the baby. I work off-shifts now, so I rely on the report/MD notes to understand the plan of care. Many times during report the day shift nurse who communicates with the primary doctor has no idea about the plan of care and generally the night shift doctor has no clear idea- so the babies wait. I feel this is a growing trend, as when I first started in NICU 10 years ago this issue wasn't so prevalent-or at least it didn't appear to be. What happened to reducing the length of hospital stays? Or is it acceptable to now just let the babies take up accommodations/potentially acquire a new diagnosis in the process?