NicuNightRN

Supine first 72 hours of life. Can log roll at 72 hours side to side. Prone after 1 week. Hands on with first assessment and then get vitals off the monitor and bed for every other feeding. Diaper change every other feeding.

I passed out last year during a circ. I'd been an RN a little over a year, and so had assisted with more than one circ. I remember I had on my jacket, so I was a little warm, but figured I'd wait to take it off until after the procedure, since I was holding the baby with both hands and he was doing pretty well with my hold. Well, the next thing I knew, I was on the floor trying to get up. I didn't realize at this point I had passed out, and still wasn't entirely there, and I ended up passing out again! It was so embarassing, because this was at shift change, so EVERYONE saw it happen. I hit the baby's open crib (which was empty, since he was strapped to the circ tray) and the rocking chair and had quite the bruise on my back for awhile... Anyway, I've done everything I can to avoid circs since then. I never liked them anyway, but now I REALLY don't like helping with them!!!

We only use the in-line where I work. I've never had any problems with it! I feel like it is easier because when I was an intern in the NICU in school, you had to disconnect the baby from the vent and needed a second person there to hook the vent back up between passes to maintain sterile technique.

I had a baby this week with a PAC in his right arm. When I came on, the waveform was dampened, it had a really narrow pulse pressure (like 36/32 (34)) and I could not draw from the line. Day shift had been having problems with it and couldnt fix it. I changed out my fluids and everything and totally lost the waveform...about 20 minutes later, the kids fingers were turning white, so we pulled the line and saw that the catheter wasn't even in the artery anymore, and it didn't even bleed more than a drop. We then saw that his arm was white halfway to his elbow and he didn't have a pulse in the wrist! We weren't sure if the heelwarmer trick would work on the arms, but it did, and pretty quickly too. It took a while for the cap refill to be anything better than sluggish, but it was amazing to see how fast the color returned to his arm.

We chart that the auscultation is deferred due to HFOV. The Neo's and NNP's will pause the vent to auscultate, and I have seen RT's listen over the vent. I just look for a good chest wiggle.

We have a charge nurse and a clinician, but no other kind of "support RN." We try to avoid them having assignments, but it is sometimes unavoidable if we're understaffed. We're the neonatal referral center for our area, so we do a lot of transports from the rural hospitals into the city. The clinician goes on all transports and deliveries within the hospital, but other nurses go on deliveries also if we get multiples or if the clinician is out on transport. Both of these nurses are our resources for advice, IV starts, assistance when all of your kiddos want to eat at the same time, etc. Our system works pretty well, and everyone in the bay always helps out whenever we get an admission, or one nurse is overwhelmed with her assignment.

*chapstick (most important item in my pocket!!!) *pen and sharpie *scissors *hemastat *elastic band for my hair *calculator Our babies each have a cart at their bedside with everything we could possibly need - alcohol swabs, IV supplies, sucrose, etc., so I don't worry about carrying that stuff around - I just have to make sure the cart is stocked when I get to work, since the previous shift doesn't always do so! Each baby also has their own stethoscope, we don't carry our personal ones around.

The other night, I had 3 kids: 1 rooming-in with Mom, getting ready to go home 2 days later; 1 feeder-grower in a crib, parents didn't speak English; the last a 36 week twin with hyperbili and apnea issues. It really shouldn't have been a difficult assignment. My baymate had similar babies, 1 rooming in, and 2 fairly easy kids, only they both had IV's. I spent forever early in the shift trying to communicate with the non-English speaking parents who had many questions about their baby, then both of my baymate's IV's went out at the same time, so we spent a good couple of hours working on these kids, trying to get IV's in them. Things finally calmed down and I went to lunch. When I came back from lunch, the charge nurse told me I was getting a 34-wkr. I expected this to happen within the hour, so instead of weighing, drawing lab, and feeding the baby that was due to eat then, I just fed him, figuring I could do the rest with the next feeding, after the admission was over. Of course the admission didn't come for another 2 hours, and when it did, turned into a 2-hour long admission. The baby was relatively stable - came up in room air, but throughout the course of our hour or more of attempts to draw blood cultures, start an IV, etc, he started grunting, retracting, and desatting, and earned himself a cannula (continued to do so after we left him alone). During the admission, the baby I hadn't weighed or drawn lab on was due to eat again, and this being the last round of the night, I needed to do all that "extra" stuff with this feeding). I found another nurse to do all that, and then the next kid was due to eat. And during this time, the mom of my rooming-in baby called and wanted me to bring him back inside then to weigh him and do his lab. My baymate somehow managed to do both of those kids before I even realized it, and I was still working on the 34 weeker. My charge nurse was nowhere to be found (but thank goodness for the transport nurse who brought the baby up, she stayed and helped). Eventually I got everything done, went to check on lab results for one of my kids. The results weren't even pending on the computer, some 2 hours later. Lab denied ever receiving the specimen. Well, eventually, it turned out that lab had THROWN AWAY the specimen (second time they've done that to one of our babies in a week). Anyway, it was a hectic night where I barely managed to get everything done, despite having the help of 3 nurses. The next night though, I got to finish up discharge teaching on parents who couldn't be happier to take their kid home and listened intently to everything I said and thanked me profusely for everything I had taught them over my 3 nights that week (we spent a lot of time working on breastfeeding techniques)...I took the time to give a baby a nice long tub bath, which she thoroughly enjoyed, before pulling out her NG tube not once, not twice, but 3 TIMES! (but she was cute, so I forgave her...eventually)...and gave the new admission from the previous night a bath, and got him a matching knitted blanket and hat from our volunteers and had him snuggled up looking very cute when Mom came and saw him. I guess the hectic nights are evened out by the nights where I have time to do a few little extra things! I just saw how long this is...congratulations to anyone who made it all the way through!!

Thanks everyone. I'm surviving work, but still finding people that I haven't seen since this happened, and they ask things like how many weeks I am now, etc. I'm not sleeping through the night yet, but I think part of that is because I came down with a cold, so I've spent the last few nights waking up to blow my nose, sneeze, cough, and roll over and try to go back to sleep. At least I'm not having that dream everytime I fall asleep. Thanks for all of your continued support!

My first night back was not what I expected. Our unit has been pretty slow (we're at about half of our normal census), so on my first night back, I had to float to the other NICU in our network! It is in a hospital that I had only ever seen from the freeway, and suddenly I had to find the hospital, parking, the NICU in the hospital, and then work with an entire group of people I'd never met before, as well as locate supplies and such within the unit. It wasn't quite as bad as I expected, but it was definitely not what I wanted for my first night back...but I didn't have any choice but to float. There ended up being 2 other nurses from my "home" hospital who had also had to float, and they knew about my situation and were super supportive. So, I got my feet wet, I guess...but tonight will be like my first night back, all over again...

Well, tonight I go back to work after having had some time off, and much like last week, I am starting to panic a little bit. My boss did say she would help pass around the info to make it a little bit easier for me, and after running into a coworker who lives in my apartment complex, I do know that the information is out. I'm worried though that people are going to look at me differently (like giving me sad looks, or something like that) and that I'm still not going to be able to deal with it at work. I haven't been sleeping, either. It seems like I can fall asleep so easily, especially if I am just cuddling with my SO on the couch watching tv...probably because my mind is away from it all. But when I'm in bed at night trying to fall asleep, I have such a hard time. Even though I fall asleep pretty quickly, I can't stay asleep. The only way I have been able to get a decent amount of sleep is by taking something to help me sleep. I've been dreaming about the baby, which I think is the problem. This was my first pregnancy, and even though the plan had been to start trying to get pregnant a couple of years from now, finding myself pregnant made me realize just how much I wanted to be pregnant NOW. In these dreams (nightmares would be a more appriopriate term, actually), my ob would tell me that something was wrong with my uterus, and I would never be able to carry a baby long enough for it to have any chance at survival. I then start panicking and crying in the dream, and even kicking and punching at my SO in my sleep because I'm so upset. Don't get me wrong, it has gotten a *little* better. I'm just worried about how tonight at work will play out. I know my coworkers will be supportive...I've seen how we've all come together when other nurses have had to deal with hardship in their personal lives. I'm just used to being the strong one, not the one needing others to be strong just so I can make it through.

Thank you all so much for your comments and support. I did return to work that night as planned, and it was an extremely emotional night. My coworkers asked all night long how I was feeling, since I'd been so nauseous the last time I had worked, and every time I had to explain myself, because my eyes would well up with tears. Being around babies the entire night was extremely difficult for me, because there was no way to really escape the only thing that was really on my mind. I did stay the whole shift, but spoke with my manager as I was leaving in the morning. She told me to take the rest of the week off (I can take longer if I need to), and asked if it would help if she kind of spread the information around for me. I will return to work on Wednesday, which will be a little over a week since I lost my baby. It's still not going to be easy, but I know I have the support of my coworkers - and everyone who responded. It's so nice to read such caring words from people I've never even met, thank you all! I am at the point now where I can at least think about it without immediately bursting into tears, so I have come a long way in the last week. I still have a way to go, but things have improved and I know that time will help.

Thanks, Sarah. I know that a few of the girls I am close to at work are working tonight along with me, and I did consider telling one of them and asking her to tell the rest of the staff. Every time I think about it though, my eyes well up with tears, so I don't know if I can even make it through telling one person. No matter what, I think it's going to be hard for awhile being around so many babies. Like I said, the pregnancy was unplanned, but it made me realize how much I do want a baby, even though we didn't plan on it for a little longer. My bf has been so supportive through all of this, and there's no way I could have gotten to this point without him. I know that my coworkers will be supportive, also, but it's the initial shock of being back at work and surrounded by babies that I think is really going to get me tonight. But,I guess that no matter what I do, tonight won't be easy...and now I'm just rambling.

In the last 3 weeks, I went from suspecting I might be pregnant, to finding out I was, to having a miscarriage. The pregnancy was unplanned - my boyfriend and I didn't plan on having kids for another couple of years, but we wanted the baby. Being a NICU nurse, it was hard for me to be at work while I was waiting to see if I was actually pregnant or not - it was like I couldn't escape what was on my mind. Well, it turned out that I was pregnant, and just as I was starting to get excited about it, over the weekend I lost the baby, and I've been taking it really hard. It turned out that this happened in the middle of 8 nights off of work, so I was able to cry to my bf about it and not work through it. Tonight I return to work, and I'm wondering how I'm going to cope. Everyone at work knew I was pregnant ("morning" sickness for me meant feeling nauseous about 95% of the time, and I had to get people to help with xrays, etc), and now I have to tell them that I miscarried. While being at work and around people that I know care about me will be a good distraction, I'm worried that being around the babies is going to be too hard for me. Does anyone have any advice for me, or has anyone been through a similar situation? Any words of encouragement you might have will be GREATLY appreciated. Thank you!

I actually started as a new grad in Austin last June, after graduating in May. I did have some trouble getting my foot in the door, but I was very persistent. I applied online late one night, and the next day started following up with phone calls. The hardest part was getting my application to the manager of my unit...I had to keep following up with HR to make sure it got there. Eventually it got there, I interviewed, and got the position - and I did not go to ACC or UT. In fact, in the last year we have hired 8 or 9 new grads, and I believe only one person went to school in Austin. I had always been under the impression that getting a job in nursing would be easy because of the shortage, and I hate to say it, but it was NOT easy. But, I was also very specific about what I wanted to do, and I only wanted to work in the NICU (which is where I did end up). There is hope, you just have to be persistent! Good luck! :)