Humbled_Nurse

Thanks Ninjanurse51!

Hello everyone! I've recently started doing some pediatric telephone triage from home. My background is NICU nursing where I still currently work PT. I do have some experience in pediatric nursing but its been awhile and it was a specialty outpatient clinic so not general peds. So far I really like the job but figuring out what protocol can be a little challenging. I know it will get better with time, but my question is does anyone know of any practice call/scenarios that use the Barton Schmitt protocols that I can practice on? The company I work for did have some, but I would love to do more. It was very helpful. Any other advice from anyone doing pediatric telephone triage? Thanks!

Just curious to see if ya'll have heard about the revising of the levels of care and what your thoughts are on this. I think we can all agree on what Level I and Level IV entail, but Level II and Level III can get a little "gray" and it looks like this is where most of the revisions will be. There is such a wide spectrum on what Level III's can do. I think it can be misleading when Mom's see that where they plan to deliver has a "Level III" NICU and she assumes that they can handle just about anything which we know isn't necessarily true. I've heard with these revisions that it will be harder to obtain Level III status. Thoughts?

There are 2 hospitals in Denton. They are medium size community hospitals. One of them is Presby Denton which is part of Texas Health Resources (THR) which is a non-profit and operates several hospitals in the Dallas/Ft. Worth area. The 2nd hospital is Denton Regional which is for profit and is part of HCA which also operartes several hospitals in the Dallas/Ft. Worth area. For the most part THR has a better reputation in the Dallas/Ft. Worth area, but I definitely would look into Denton Regional as well. The market is tough for nurses in the area, but I think with your experience you shouldn't have too much of a problem. Here are the links for the 2 hospitals. Texas Health Presbyterian Hospital Denton | Denton, TX http://dentonregional.com/ If those don't work out there are a ton of hospitals in the Dallas/Ft. Worth area to look into.

Agree with everyone! My biggest pet peeve as Tiffy mentioned is disorder. The clutter drives me nuts. Messy bedside carts and especially cluttered beds. The bed may not necessarily be dirty, but there will be a ton of blankets, developmental items, etc... I like my beds simple and neat. They don't need 20 million blankets in there.

Thanks for all the responses. Very interesting stuff. I definitely see us sharing our "interesting cases" as a learning opportunity. I would much rather read a "case study" in a journal rather than a research study. I learn best this way. Looks like I will be changing jobs in a couple of months. I will be working in a much higher acuity NICU. The babies will definitely be much more interesting. Very excited and nervous :) Early in my NICU career I remember seeing lots of interesting babies. Things like superior vena cava syndrome, severe chylothorax, cor pulmonale, lots of syndromes. I was a new nurse at the time so I just assumed every NICU saw that, but that really isn't the case. I do think the babies were much sicker then though and it seems the preemies had many more complications then. This was the late 90's. I think the preemies tend to do much better now. Our approach is much less invasive now. Back then everyone had lines, were intubated, had chest tubes, kept NPO for weeks, etc.... I do think there has been progress. The age of viability hasn't changed much, but I do think the rate of complications have gone down some which is good. NEC doesn't seem quite as common either. I have seen a baby with the Harlequin color change. Very interesting, but it wasn't quite as dramatic as Bortaz's case

That does seem unfair to me. At my hospital PRN, PT, then FT gets cancelled in that order and it goes by turn. We also have a list of people that are requesting "EO" so they would get cancelled 1st, but the problem with that is even if you get your "EO" you are still required to take call. It seems like a waste of PTO to me. Some people would try to use an "EO" day instead of calling in sick so it wouldn't be used against them. We have a strict call in policy. The problem with that is if we get busy you could get called in so you are taking a chance, so if you are truly sick you better just call in sick. Also if PRN gets cancelled they aren't required to take call, but they can if they want to.

Wow. I'm surprised that such a high level NICU wouldn't follow best developmental practices. I would start with the manager and/or educator and see what they think. I agree that too much change at once would probably get a lot of push back from the nurses. I would make a list of all the problems/issues that you see and prioritize them and just start working your way down the list very slowly. Initially I would only address 1 or 2 things. Maybe the manager and/or educator could get an expert to come do an inservice/presentation on the importance of developmental care in the NICU. Do you have PT/OT/ST services available to the NICU? They should be able to help you as well.Good for you for recognizing this problem and taking initiative!Good luck!

Well it depends on what you are passionate about. Are you drawn to 1 particular area more than the other? Is this an area you have wanted to go into before? When I was in nursing school I was only interested in kids or babies. I pretty much had no interest in adult care. I was lucky enough to be able to go straight into the NICU and have had no regrets. There are some similarities between these areas but there are several differences as well. Here is a breakdown. Remember I have only worked NICU. I have no experience in the PICU. 1) The PICU has a very wide range of ages. Anywhere from newborn to age 18 and it isn't uncommon for some PICU's to have patients older than 18. Usually the "adults" in the PICU have a defect/disease common to children such as cystic fibrosis, congenital heart disease, etc... These kids are living much longer now and adult doctors really don't know what to do with them. 2) The PICU has a wider range of diagnoses. Depending on the type of PICU you are in you may see trauma patients, post surgery patients, and of course a wide variety of medical issues. In the PICU you will see a lot of kids with chronic illnesses that get admitted often. In the NICU you generally see the same type of diagnosis. LOTS of respiratory issues, but if you work in a large, high acuity NICU that does surgery you will see more variety. 3) The level of acuity varies between these units as well. Generally if a kid is in the PICU they are very sick and need the higher level of care. In the NICU not every baby is critically ill. Some babies are in the NICU just for a 48 hour rule out of sepsis and may just need antibiotics for 48 hours. A lot of babies are just a little premature and just need some time to grow and learn to feed. They really aren't "sick." Does that make sense? On the other hand you can have some very sick babies in the NICU. You could be taking care of a 1 pound baby on the oscillator with multiple drips. Also, those babies that don't seem "sick" can turn on you in an instant and become the sickest baby in the unit. Generally speaking though most of the babies in the NICU do pretty well. 4) There is tons of teaching in the NICU. Remember these babies haven't gone home yet so everything is new to mom and dad. Especially if they are 1st time parents. Throw in the fact that their baby is sick or premature and there is much more teaching that goes along with that. It may be as basic as teaching them how to change a diaper or it may be more complicated like teaching about the ventilator, trach care, etc.. In the PICU there will be a lot of teaching as well, but if the child has a chronic illness/disease the parents may be teaching you instead of the other way around. They know there child better than anyone else. Regardless, you will be dealing with the parents A LOT whether you are in NICU or PICU. I would suggest that you request to shadow in both of these units so you can get a feel for what may be a better fit for you. Regardless of which unit you picked you want to make sure you get an extensive orientation. Everything will be new and different. You will probably feel like a new grad again. You also need to consider what you can handle emotionally. I am a mom of 3 small kids so at this point in my life I don't think I could handle working in the PICU. Don't get me wrong the NICU can be very sad and heartbreaking, but I just don't think I could handle taking care of a 2 year old that was severely injured in a car accident or had a near drowning. I just think it would be too much for me. Also you have to put your judgments aside which can be hard. Think of the child in the PICU that was abused and is now neurologically devastated or the mother that just gave birth to her 8th child at 24 weeks and has a positive drug screen and she doesn't have custody of any of her children. There can be some very heartbreaking situations in both units. Also in the PICU you would likely encounter a lot of former NICU patients. If you are in a Children's hospital that has a NICU and a PICU you usually are required to float between the 2 units so that would give you experience in both. Hope that helps Good luck!

As far as I know the baby with Legionnare's disease didn't make it. I have always found the genetic anomalies and syndromes very interesting and of course sad. I have always wondered why some hang on and make it to term rather than being naturally miscarried by the Mother. I find genetics very fascinating and complex. Yea, haven't heard of Trisomy 9. Interesting. Glad you were able to make a difference in her life Bortaz!

I work in a medium size nonsurgical level III NICU so sometimes things get a little boring. Sure, on occasion we get a really interesting case, but for the most part it is preemie land. So does anyone have any interesting cases from NICU, PICU, or CICU? I know with all the privacy laws you can't give too many details. I recently heard of a case where a newborn contracted Legionnaires disease from a home water birth. I really enjoyed when Janfrn would do her "case studies" as a topic. Hint, Hint

I think this is where critical thinking skills come into play. Yes, having a blood sugar of 42 in the first few hours after birth can be okay, but after 24 hours this is not okay. If a baby had some blood sugar issues initially because Mom was diabetic or baby was IUGR, preterm, etc... then blood sugar issues are very common those 1st 24 hours and they should be correctable with feedings, but if the blood sugar isn't resolved by 24 hours then the baby needs to be in the NICU for closer monitoring. If it is a baby that isn't at risk for blood sugar problems and like you said previously you decided to check a blood sugar at 26 hours of age because he is "jittery" and you get a result of 42 the physician needs to be contacted because something else may be going on like sepsis, etc....There really shouldn't be a need to have anything "written" about when to call the doctor about a low glucose after 24 hours. The nurse should know that it isn't normal and the doctor needs to be notified. I hope this makes sense. Hope this helps some.

I think you most definitely made the right decision. Any experience is better than none. I know the job market for new grads is really tough right now especially for specialty areas like NICU. I think your experience as an L&D tech will be very valuable. Do they have a lot of high risk deliveries. If yes, then you will likely see the NICU team in action. NICU usually attends all preterm and high risk births. I think this experience will look great on your resume. If something opens up in NICU in the meantime you can always request a transfer.

Okay so this is totally off topic. Just wanted to say that your avatar is the exact Origami Owl locket I designed. I posted a picture of it back in Feb. or March on an Origami Owl Facebook group and it amazes me how those pictures get around on the web. It doesn't bother me one bit. I think it's great. That is my Origami Owl necklace that I designed for work. I am a NICU nurse. Anyway, I am certified in Neonatal Intensive Care and I just used the Core Curriculum book for Neonatal Intensive Care. Not sure if they have a Core Curriculum book for low risk. I would just go to the NCC website and there should be an outline on what the test will consist of so you can start with that. Good luck!

We get the circ question a lot while still in the OR or DR. It's fine to ask, but can you at least wait until the baby is breathing.