texas2007

We use the same type of "open" system OP describes. Have you tried letting it drip a little more before you take the sample? I was always taught at least 5 drops but I usually count to 7 just to make sure all the art line fluid is gone.

My strength is being a nurse in a clinical setting, it is what I do when I go to work. I am terrible at answering contrived scenario questions in an office setting, I only do that a handful of times a year. There's only so many situation type questions you can prepare for before someone throws you a curveball. I moved last year and I spent quite a while researching these type questions and rehearsing my answers and situations. When the interview came only a few questions that I had even practiced for were asked and there were several others where I had to make something up on the fly. Perhaps I came off unprepared but I HAD prepared- just the ones I had prepared for were not asked. Instead of focusing so heavily on these kind of interviews, have you thought about placing part of the interview in the setting where the interviewee would be in the clinical setting where they would work? Have them shadow someone for an hour or two. I really think you'd be able tell so much more a candidate's abilities in that time rather than evaluating how well someone is able to BS their way through silly interview questions that are only minimally correlated to how good of a nurse/employee someone may be.

We get a lot of calls to transfer babies who are "24 weeks" or "26 weeks" etc. When our transport team gets there, it is quite obvious that the baby is no where near "26 weeks", more like 22 weeks with thin, plethoric, gelaneous skin and eyes fused etc. You have no idea how often this happens. These babies rarely do well (bouncing around in an ambulance or helicopter isn't the best for head bleeds). It is frustrating to say the least.

We've been slow since January-ish, about 20-30 babies below normal. People getting cancelled and floated left and right. Actually, it's not that we don't have admissions bc we do, it's just they dont stay very long.

Not here either. I'm too nervous to even weigh these kids with a bedscale muchless get them out of bed...

We're not allowed to chew gum at my hospital...it is a violation of the health dept. and you can be fined $250 if caught!!

what do you think the top 3 traits a neonatal nurse must have to excel? 1) ocd-like 2) not afraid to ask questions 3) good social skills to deal with families what do you enjoy most about being a neonatal nurse? babies getting to go home least? babies that will never get to go home (or if they do, will have no quality of life) on life support for months due to misc. reasons. what is the typical salary of neonatal nurses? depends on your location, years of experience, how much ot you work, but new nurses start around 50k here. what hours do you work? 630p-7a what are your daily responsibilities and duties? can vary depending on the assignment but i always do my assessment and vital signs as ordered, change diapers, draw labs, keep an eye out for any funky behaviors, notify md/nnp if there is a change in pt condition, carry out any orders and question orders as necessary. i also get to pat a lot of bums to sleep, chase a lot of pacifiers around and sometimes hold the fussy babies (if i have time and they are stable). some days i don't speak with an md, other days, the md is camped out at my patient's bedside all night. why did you choose nursing as a career? i liked that even though the overall routine is the same, every shift is different. what advice would you give someone considering this nursing job as a career? sometimes it is hard to not get emotionally involved with your patients and families. some days really stink but the good days outweigh the bad. and any other information about neonatal nursing you would like to leave! if you dont want to email it you can post it back on here. thanks! tasha

Does your facility normally run Dopamine by itself? The only thing I can think of is that perhaps the line was starting to clot off (thus the pressure increasing alarm.) and then the clot cleared and the kid got a mini bolus due to the syringe having to push harder. When we have rates less than 2 ml/hr (the standard KVO), we will usually get an order to run them with carrier fluids with heparin to prevent the line from clotting.

If we have a line available to draw the lab from, we will use that. If a kid has a line, they probably have some lab to draw along with the screening as well like a blood gas or chemistry panel for instance. We do not delay our screenings for any reason.

At my facility, we set our alarms to alarm for apnea after 20 seconds. Now if a baby is apneic and doesn't self correct, the bradycardia alarm pretty much goes off before the apnea alarm ever does. Most of the time that the apnea alarm goes off is due to the leads not picking up, not true apnea. Either way, don't go completely by what the monitor is telling you...you MUST look at your patient!

You still have it going at 30%?? You must live in a low humidity climate! Our normal air here runs ~40% humidity (on a good day!) so when we get to that is when we turn it off. I've also occasionally seen the MD's D/C it earlier than the standing order is written for whatever reason.

It could just be a coincidence too...I don't have any literature to back me up but I feel like I've seen several spontaneous perfs in fresh micros that had either never eaten or weren't eating at the time. At lunch one day we were actually talking about how it's a miracle that they don't perf more often. Their intestines have to be paper thin...

We have different levels that we will transfuse for based on resp. needs, age, gestational age at birth, discharge expected soon. We go by Hematocrit, not hemoglobin. Generally, our room airs/cannulas have to be

Our unit also has milk techs that make up all the special formulas and any fortified EBM daily. I think to make 24 cal EBM they will use HMF. To make 27 cal EBM, they will mix the 24 cal FEBM with 30 cal formula to make 27 calorie FEBM. We rarely use 30 cal. in general and I don't think I've ever seen it just by itself. The docs will also write for 1-1.5 g Beneprotein/100 ml to be added and if the weight gain is still poor, then they will also want corn oil with each feed (not mixed with the formula). In response to Allison's questions.. 1) Do you do this rinsing with formula? Never heard of it (2) Do your coworkers do this? Don't think so (3) Has your hospital educated RNs about avoiding formula exposure in breastfed infants? nope (4) Do many NICU moms ask about avoiding formula so they can exclusively breastfeed? Very rarely. This is mainly in the term TTN or rule out sepsis crowd. With the preemies, I think the parents just hope the baby survives at all. (5) Is anyone using donor breast milk (from a certified human milk bank) in NICU? Nope.

I don't see anything wrong with how you gave report. I would have done the exact same. Heck, we don't even usually talk about a current PDA (or Apgars) unless it's a current concern (MD's thinking about indocin or ligating bc the baby's lungs are flooded, or significant Apgars of 0,0,0,1..). I guess we will say that a baby was ligated or indocin X 1 or whatever just for history but NOT if it spontaneously closes! Sounds to me like that nurse probably had other issues going on outside of that report and blamed it on you.

You don't measure at all? Not even counting wet diapers?? I thought measuring output was a standard of care While our kids are on IV fluids, we weigh diapers. We aim for at least 1-2 ml/kg/hr; 3-5 is considered good. Once they are off fluids, haven't had issues with output for a while and are close to moving to level2, then they will write to just count diapers.

I had no idea those mattresses were supposed to do that. Sometimes we'll layer it so we have a bottom sheet, a sheepskin, then a blanket that the baby lays on, but we don't always have the sheepskin. Then we started using these cool jelly like pads called Z-Flo that mold and conform to the baby. We also start wearing clothes when stable and/or ~1500 grams. Then out to open crib ~1800 grams, but each baby varies on that.

Ya I think ours are a bit on the small side. Sometimes even if it is centered on the isolette, I still have to bring it down on one side due to light shining on the baby's face from the next bedspace over.

I hear nothing but horror stories about that place...

Well, the charge nurse didn't know what to think, but at least she helped me find a new monitor. I'm not sure if management ever got wind of it since it happened in the wee hours of the morning during a holiday weekend. Yes, our level 2 has brand new monitors. The unit was expanding, creating private rooms. These rooms went to the most stable kiddos and were outfitted with state of the art monitors. Many of the kids don't even wear a pulse ox. Needless to say, level 3 felt a bit...shortchanged.

Did I tell you about the time a few weeks ago when I came back from lunch and discovered one of my monitors to be dead? As in pitch black, nothing on it. Luckily it happened with a stable RA feeder/grower (who was fine) and not someone really sick or had frequent A/B's! I've heard rumors from mgmt that we're supposed to get updated ones like they have in Level 2 but I'll believe it when I see it.

I have a hard time with animals, too. I would guess that you feel even worse because you have been "mom" to the kitten. I work in NICU and when a patient passes, it is usually (99% of the time), a relief to me. Sometimes I am even happy for the patient. My unit is not really good explaining long term stuff to families so as a result, we have a lot of kids that look sad and miserable for months and months, plus they have all the iv sticks, lab draws, suctioning, pain etc. So to me, it is really easy to come to terms with the death by knowing that they are in a better place. The ones that really get me are the ones that have been doing great and suddenly they aspirate and go into full blown PPHN, or they NEC out, and always the term HIE kiddos. I hope that helps!!

Your

We flush our unused ports with 0.5 or 1 ml (10 u/ml) of heparin q12, depending on the size of the kid.

1) That's how I measure 2) We use common sense...smaller ogt for smaller babies. No specific weight. 3) I do like 1 ml, if I don't hear it then pull that out and put in a little more. I usually go more by if I aspirate gastic contents though, since you can hear the air all over the belly in the tiny tiny ones. 4) We call if the residual is >25% of the last feed, or a funky color. What we do next depends on what the MD wants. Sometimes we chunk the residual and start with a fresh feed, sometimes we chunk the residual and make npo and get a kub, sometimes we give the kid more time to digest, sometimes we subtract that amount from the next feed, sometimes we keep feeding...sometimes the MDs will actually write an order to not check residuals (usually on kids that are recovering from NEC or what have you)....but I will still check it just for peace of mind. We do have a lot of NEC FWIW. 5)We use the orange anti-iv feeding tubes and are supposed to change them every 3 weeks.