33Weeker

Some units are more toxic than others. Sounds like you have the right attitude and are doing what you need to do, are teachable, etc., and that the problem lies with the unit, not you. If you can stick it out, maybe you can be the one to change the culture, once you are established there. I'm doing that where I work right now (relatively new job, new hosp. system). I kept being kind, enduring the crap, and doing my best job. I finally got noticed for the person and nurse I really am. I'm still not 'one of them,' but I've got 30+ years under my belt in the specialty. Then, a management change allowed those of us who wanted to improve things have a supportive person who is willing to stand up to the bullies and make it happen. Sometimes you have to be patient and wait for the perfect storm.

I watched the video, skipping over much of the first part to about 32 minutes in. (RaDonda telling her story). I still believe she acted carelessly. There's no excuse for not following the 5 rights. And above that, even more care should be taken if you are in a situation where you can't scan. A nurse needs to know what med she's giving or look it up first. Period. That said, RaDonda spoke more intelligently than I expected. Though it doesn't absolve her, the circumstances surrounding the mistake were interesting to learn about and were thought provoking. I charted on paper for many years, therefore, I have experienced practice both ways. I agree that technology can catch and prevent a lot of errors, but when it doesn't work properly, it can increase the chance of them. Problems with pulling or scanning meds cause the nurse to focus on troubleshooting the problem instead of focusing on the medication itself. It also slows the work down, forcing the nurse to rush to catch back up with his or her time management. As RaDonda mentioned, she was accustomed to the old system giving warnings for dangerous medications, and the new system did not. Again, *that doesn't absolve her*, but it would give a false sense of security and be one less flag to warn the nurse s/he was pulling the wrong medication. This is one of the cons of computerizing everything. We begin to rely on system safeguards too much, and that is dangerous.

I don't blame you for changing jobs, The point you make about pay increases is interesting. I work nursery/NICU, so things are a little different. We are better staffed than most other units in the hospital. I am not a control freak. Since my care includes the baby's parents, I like to maintain a relationship with them. Continuity of care is important, and so is making their baby's first few days memorable and special. Sometimes I've made a plan with the mother to help her with a breastfeeding difficulty or to ensure the father can be present for the first bath. If someone jumped in, they might not know our plans and might handle things differently than the way I had managed the parents' expectations. It's not a huge deal, but I try to follow through on what I've set them up for. As far as getting to work a few minutes early, I do that for ME, not for my employer. I have a better shift if I have a few minutes to put my bag down and get my head in the game. I refuse to start work before I clock in unless there is a code or some similar crisis. I treat others the way I want to be treated. I prefer the open ended question, so that is usually the way I phrase it. A nurse knows what the priority task is among her patients is (a baby needing its blood glucose checked would come before one needing a bath) and what would help her most. It isn't always the obvious thing.

Level III NICU is intense. You will have to learn a lot, as everything in the neonatal world is different from adults, and level III cranks that up even more. There will be unstable micro preemies, and long-term chronic kids that stay there for months to years. You are more likely to lose patients than in a level II, though coming from oncology, that might not be that much of a change, but they will be infants. Night shift sucks in some ways, but it pays more and is often a slower, easier shift. Although I prefer level II, I love NICU and wouldn't work anywhere else. Some things to consider... It is a special thing to get a chance to go into NICU, esp. level III, from the adult world. NICU nurses usually stay in that specialty, so these spots don't open up often. Think long and hard before saying no. If you can't move to day shift later when you want, you can take that Level III training and go to another hospital, so long as you've satisfied any time commitment you agreed to in exchange for the training. You might decide to become a neonatal NP

I guess I see some things differently. I'm a nurse who feels I haven't done a good job with time management if I have to delegate. I often fall into the trap of feeling like I have to figure everything out and accomplish it all myself. I have to remind myself that asking for help and delegating when I really need to is okay. I've had to take the same advice you were given and apply it. If you are hearing the same feedback over and over, maybe it's worth listening to. Why not set your clock 5 or 10 minutes earlier so you can get to work on time? The few times a year I walk in late, I feel like I'm behind rest of the shift. I disagree that other nurses should just jump in, read orders, and do things without checking with you. Not only is that disrespectful of your autonomy and your relationship with that patient, IMO, it could cause errors, like a med or treatment getting done twice because you two didn't communicate. Also, the other nurse didn't get report on the patient, so they may not have the necessary clinical info to make sound decisions. If you ask for help and are met with resistance, then go to your manager and tell her that.

This case has many aspects for discussion, but her med error was avoidable. You can't just pull a med that starts with the same letter and hope you got the right one. You need to know what you're giving. She should have looked it up.

Thanks!

First, make sure the policy is in writing and enforceable. Then approach them privately and make sure there is not an economic barrier to them following the dress code. If so, help them out. If not, make it clear the rule will be enforced, even if it means them being expelled from the program. 30-something years ago, when I went to nursing school, we followed the rules for fear of the consequences. Our society has gone soft.

Sounds like they are the ones who need to get turned in to the board.

Our hospital just added Braden scoring to our NICU charting. It's been a minute since I've done it, and I need to pick your brains regarding scoring. (Before you tell me to go to the educator, I just took over as the educator.) I can't find the cheat sheet from my previous job. Do all newborns get a 1 for sensory and 1 for friction/shear (or only if HOB elevated), and what about nutrition? Does plain D10W score a 2? Does TPN/IL score a 1? Do the wires for the ECG leads count separately than the sticky pads? The info I found says yes, but my previous job counted it all as 1 point total. If it's counted all together, is it a 1 or a 2 score for the set? Thanks in advance.