aviator411

babyRN: Oh by the way. I neglected to mention that it was a close affiliation with many fine NICU nurses like yourself which inspired me to become a nurse. At age 63. NICU work will probably not happen for me but there is a place in nursing for all to contribute. Thanks again!

babyRN, Thanks for your response. It doesn't appear that there is much we would disagree on. And, please, no need for the apologies. Your observations here have great value for all, especially the many readers who aspire to NICU work. You have just, of course, identified two more of the many moral societal dilemmas present in the NICU. To carry one of your examples a step or two further: Several NICU RNs I know who have 40+ years experience in the specialty now question the merit of much of the work they have done over the decades when they are out in public and see some of the patients they have helped "rescue" being carted around in a semi-vegetative state by aging parents. At some point, sooner or later, someone will be called upon to account for the cost vs benefit to society of such cases, both in terms of dollars and human anguish. Of course, for every case like those above, there are the wonderful success stories which inspire people like yourself and Paco396 to seek NICU work. Like society at large, I am inspired by your dedication and very hard work. Getting back to the point of my original remarks to Paco396, I simply had hoped to call attention to readers here that we in nursing generally have enormous respect and credibility with the general public, news media and legislators, much more so than many of us realize and, being the largest of all healthcare professions, there are enormous opportunities for us collectively to impact all of these moral societal dilemmas if we will only organize ourselves to confront the task. Those who bring specialized experience and training to nursing such as Paco396's legal background should be in a particularly advantageous position to contribute in this area. Of all the things which inspire people to become nurses, political advocacy must surely be very near the bottom of the list. I would hope, however, that professionals like yourself who experience some of the frustrations you have just cited can be inspired to invest some of their time and hard-earned experience in attacking the root causes of some of the many moral societal dilemmas which impact us all. Thanks so very much for your comments!

Hi babyRN, I too am unsure how the irresponsible/criminal behavior of a baby's parents is relevent to whether or not a baby should receive care which differs from the care of any other baby. I certainly did not suggest such. The moral societal dilemma is not the care of the baby, it is the behavior of the parents and the manner and extent to which we as a society condone, allow and even encourage it. We as a society have made the birthing of babies by irresponsible parents who often choose of their own volition to subject their fetuses to lethal and known damaging circumstances a "growth industry". The first time a parent(s) does this, it is the parents' fault in my opinion. Each subsequent time it happens, it is the fault of we as a society at large, in my opinion. We have the means to prevent subsequent occurrences but there isn't a politician in congress responsible enough to even consider doing what needs to be done to prevent this abuse upon the unborn.These people do not meet my minimum criteria to be called "parents". What do you think should be done about parents who knowingly damage their children from before the moment of conception? That is the moral societal dilemma to which I refer. If we as taxpayers are going to pay for the care of children of irresponsible parents then there need to be consequences for such irresponsible behavior, including compulsary prevention. Caring for these often abused babies is and should be inspiring work. But preventing such abuse to begin with should be our focus (again, in my opinion). We as a society are NOT taking this issue seriously. And, by the way, the parents of many of these babies are present in the US in violation of state and federal laws at taxpayer expense (fact not opinion), something which neither major political party seems to be the least bit concerned about. Thanks for your coments; we welcome your thoughts.

Paco, As you and I learned long ago, there are two sides to every coin. Glad I have not discouraged you, perhapes even strengthened your resolve to make it an enjoyable adventure, prepared with some realism. I wish you the best with nursing school; I have no doubt you will get accepted somewhere. I did a similar thing. Retired in '07 and did a 12 month second career BSN program here in Michigan. I'm working on a master's now for FNP as well as OHN (Occupational Health Nursing). The OHN part of the program came with a NIOSH grant which covers much of my school costs. So I have yet to actually work as a nurse but am very excited about doing so. Gotta have something to do for the next 50 - 60 years. LOL! I think the most engaging courswork I've encountered in my nursing education so far was my public health undergrad course & clinical and my graduate course in healthcare policy strategy. Both courses focused my attention on the health of populations, not just individual patients, and gave me a different mindset on the nursing profession. With your background in law I'm sure you'll discover, if you haven't already, that we have a lot of great clinical people in nursing but a dearth of people willing to engage the political system as needed to optimize the effectiveness of the nursing profession. There tends to be a mindset in the profession that we are mere pawns in the grand political scheme about which we can do little. Too few nursing schools are making their students aware that they are joining the largest group of health care providers in the world and that we have enormous potential impact upon our own destiny and that of our patients if we will get organized and exert our influence upon the system. During my graduate healthcare policy strategy class I learned that many politicians, like much of society, have such enormous respect for our profession that they will often go out of their way to satisfy our requests, sometimes without even being asked to do so. I encountered examples where such things had actually happened during this course. One senator, when visited by a small group of nurses from his district, actually said to his aid, "What can we do for these nurses? Let's see what we can do to help them." With your legal background, I predict that you will find enormous opportunity to influence the impact of our profession to the betterment of the healthcare system and the patients for whom we provide care. You'll recognize these opportunities when you see them. Again best of luck. Thanks for your dedication and enthusiasm. I guarantee you will not regret your decision. Let me know if I can ever be of any help.

Hi Paco, Haven't seen activity on this thread for some time. Enjoyed reading your post and looking at your background here, etc. Not sure if you're in nursing school yet but you will certainly prevail if you haven't already. Thought I'd offer some perspective on NICU work, not for the purpose of trying to discourage you (which probalby isn't possible; and that's good) but for the sole purpose of "perspective". A "very close" member of my family has been a NICU nurse since almost the beginning of the specialty; practicing NICU for 40+ years now. Gotta tell you he/she is getting very burned out. In the beginning NICU was new and exciting, forging "new frontiers", etc.. A high proportion of the parents were average folks who just had extremely rotten luck. Saving their kids was both rewarding and exciting. Things have changed over the last 40 years. Yes, there are still very good parents who are the victims of "rotten luck" and those are the clients who continue to inspire NICU nurses. That bad news is that a rapidly growing proportion of NICU neonates are in NICU because their parents should never have become parents and their kids are there because their parents have discovered the benefits of hatching babies at public expense. For these parents, often well-known to the police and other authorities, often addicted to every known illegal and legal drug and for whom the best service is not good enough bringing another infant to the NICU is an annual event and, why not, after all this "fun" is "free" (except for you the nurse who will be contributing their support with every paycheck). But of course, few nurses are wont to punish the infant for the sins of the parent (or "parents" in those instances where the mother actually has a clue whom the father is). As a new nurse you are sure to find the work inspiring. As a taxpayer nurse you are likely to eventually come to appreciate the futility of this moral societal dilemma. And with your legal expertise you will quicky recognize the abuse of our system which takes place in this environment many times daily. By all means, new nurses are as entitiled to enter this nursing specialty with enthusiasm and excitement as seasoned veteran nurse/taxpayers are to see disillusionment. I can only hope that your legal perspective may someday inspire you to help our society find remedies to the abuses inherent in the moral dilemma so often observed in the NICU. And I've only shown you the proverbial "tip of the iceberg. Feel welcome to PM me if you would like further insight. Best of luck to you. Please keep us posted about your progress with nursing education and your observations from the NICU or else where. Thanks for your own insightful contributions here! Go for it!

Well, at 52 you've got at least a couple of good years left. I just became a nurse this August at 64. In grad school now for FNP & NMW and mean as ever! You may find it a little difficult to overlook the youthful flaws of some of your classmates. You'll find that some of the younger ones are not very good listeners and that they have not discovered the value of life experience. Can get a bit annoying when you have to do group projects with them but they'll grow up some day. You've probably found, however, that most instructors do recognize the value of life experience. Good luck with it!

My apologies then. That puts the matter in a substantially different context. While you may have some difficulty meeting the standard for a NICU, you can certainly strive to bring in improvements and it sounds like these could be quite substantial given the resources that you already have. I'll inventory my own resources and see what I can come with. I'm sure there others here who could be of substantial help with references, etc. Best of luck to you!

glimpses, You might do your patients some good by telling us more about yourself and the support available locally. When and where did you receive your nursing education. What sort of medical staff do you have available. What experience or training do you have in respiratory therapy, hemoperfusion, neonatal cardiology? Without a neonatologist and some well-equipped respiratory therapists, your ability to establish an effective NICU are slim to none. CPAP is over 30 years old. These days you need oscillator vents, etc. to be effective. Do you have a lab available to give you arterial blood gas analyses? What you are proposing to do is well outside the scope of practice of an RN in the US. What is your liability exposure in India for attempting to practice in a discipline for which you appear to have no training? How is the nursing profession regulated in India? Are you familiar with the nurse practice act or it's equivalent in India? India is a very bureaucratic nation; if you look into it I'm sure you'll find a substantial body of regulations and legislation pertaining to nursing practice there, especially in such specialties as neonatology. If you are unfamiliar with such basics as jaundice and phototherapy, you will be in serious trouble dealing with anything beyond those subjects. Almost any pediatric nursing or neonatology text will tell you enough about phototherapy to get by, lacking these, google will quickly tell you what you need to know. Be realistic, you can't help your patients by subjecting yourself to the liabilities of practicing beyond your qualifications. I wouldn't assume that my scope of practice is unlimited just because I'm practicing outside the USA. Here's wishing the best of luck to you and your patients. Thanks!

NB, et al, You certainly can't do any harm working peds med-surg for a year or two. Assessments in NICU are so very different, however, that one could easily argue against the relevance of such experience in other contexts. To be sure, if you spend a career in NICU you will find it difficult at best to do other nursing work late in your career. My wife has been in NICU for at least 38 years. She wouldn't consider anything else at this point in her career and would have great difficulty adapting to other environments, just as others would have great difficulty adapting to hers at the same point in their careers. The appeal of nursing is that you have almost unlimited options these days. Do what works for you and don't lose sleep over what others are doing. Best of luck!

Zoobyli, At least you're now aware of some other places which hire new grads in their NICU's so you should be able to use this knowledge as "leverage" in your local interviews. You can tell them "I'd rather work here but it doesn't make any sense to invest a year or two working outside the NICU somewhere to satisfy your requirements when I can go somewhere else and start right away and receive better pay and benefits. Good luck, I know you'll get it done!

Boratz, Wow, a grandfather at 40; you've got me beat by 24 years at this point! I don't expect to become a grandfather before 70 or more. What state are you in? I should caution you; you may find it difficult dealing with 19 y/o mothers with a history of 7 or 8 pregnancies and their entourage of boyfriends, etc. You'll probably be contributing heavily (& involuntarily) to their hospital bill! Good luck; you'll be a great NICU nurse! John

Salaries, by name, for everyone who works for UM can be viewed at: http://www.michigandaily.com There are several links near the bottom of the page to "UM Staff Salary Supplements" for several years. The documents are downloadable and in Excel spreadsheet form so you can sort them any which way you like; by job title, salary, name, whatever. Interesting reading for anyone considering a move. Good luck!

Bigg, You'll never know what you missed if you don't try it. I'm just finishing up a second career BSN program and have loved every second of it so far. Your management training will not be wasted in nursing; it will only expand your opportunities. Go for it!

Zoobyli, Come on up to Michigan; plenty of NICU jobs for new RN's up here, especially with your LPN experience! Sent you PM w details. John

Steve, Indeed, every place seems a bit different. I appreciate you sharing your experiences and observations; it's all very interesting. I've enjoyed reading and have benefitted much from your informative posts in recent years, hope you will keep it up. When I learn more about the division of labor here I'll pass it along for all to share as well. John

Many thanks! Nice site. Don't think I've used it before. I took a look and the information seems to agree with other local info sources.

Good thoughts; I'm going to investigate a bit further. It's a level 3, one of the first in the country, pretty well established. I know the NP's do these things to some degree but the herds of residents and fellows do more of it. The residents learn to do these things on the job; little reason why NP's can't do the same. RT does most of the vent management; even the residents don't handle that equipment much. NP specialization/fragmentation seems a bit overdone to many and a large percentage of NP's work outside their specialty according to last month's AANP journal. Supply and demand seems to dictate this at the moment. There will probably be a time when nursing becomes less fragmented like the medical profession is. Fragmentation/specialization within NP ranks was no doubt a political necessity to overcome resistance from the likes of the AMA initially. That doesn't mean it has to remain that way. Although I'm not a strong advocate of the doctorate in nursing as a clinical credential, it may be the most expedient route to a scope of practice more nearly resembling that of the medical profession. If MD's can be broadly trained, there's no reason why nurses couldn't be similarly trained as long as the training is adequate and appropriate. I agree, if you like where you are, why leave it. I would prefer to maintain a somewhat broader skill set and pt mix but I am extremely impressed with the work you folks do in NICU.

Thanks. Not familiar w salaries in MD. If NP salaries in Michigan are of any interest to you, you can download an excel spreadsheet of salaries for everyone who works at the Univ of Michigan and sort by job title to get all NP's, PA's, whatever. The list includes everyone from the president to the janitors by name, job title, salary, appointment %, etc. Local newspaper sued the university many years ago for release of this information and won the case so now the university just publishes it on the web for everyone to examine. Source: http://www.michigandaily.com A link on the above page will take you to salary schedule. It's interesting reading. Last time I checked, most NP's were making $84K w a few in the $90's or slightly above. That may have changed by now. Good luck.

Where are you located?

I'm finishing up a second career BSN in August and starting FNP program in Sept. I like the broad age spectrum this program offers. I'm adding in the few special courses taken by the PNP program so that I will be able to get certified as both FNP and PNP when I'm finished but I'm told it is unlikely that I will ever need the PNP credential since my FNP program specifically addresses infants-peds. There is little difference between the programs at my school; only a few additional courses are needed to do both. Few of the NP's working in our NICU are NNP's; they just aren't that plentiful. If you value versatility of options, I think FNP makes a great deal of sense; it will not prevent you from doing NICU work most places. NP positions posted for our NICU never specify NNP certification and few, if any, have such. My wife has been a NICU nurse for 38 years. I will never allow myself to become that "narrow"; it would be extremely difficult for her to work anywhere else now. But if you've got a sick kid, she's the one you want telling the residents what they can and cannot do! The psycho-social aspect of NICU nursing has become a nightmare since the field was born several decades ago. You often spend as much effort managing "outlaw" parents as you do your patients. Our NICU actually has to lock up the meconium to prevent drug addicted parents from stealing it before it goes to the lab for drug screening. Good luck!

My interview was very informal. Two others interviewed the same day. There were very few questions other than a few about my plans such that the curriculum could be tailored to my needs. I'm sure it varies somewhat depending upon whether or how well the program reps know you. I'm a second career BSN student at the school so had already gotten to know most of the people, including the FNP program secretary a couple doors down the hall from one of my frequent classrooms. It was more like a visit than an interview. But the other two applicants seemed to get treated similarly and they were from other cities. These programs rarely bother to interview people they're not willing to admit and my impression (based on conversations with the program secretary) is that none of the graduate programs are anywhere close to as competitive as the second career programs where there are often 5 to 10 applicants for each seat in the class. Go in with some idea about what you want to accomplish. You should have some familiarity with issues affecting the NP profession. All grad schools want to produce graduates who will go out and "change the world" of advanced practice nursing. Think about some things you could do to bring about positive change for the profession and it's patients. Know what the obstructions to such progress are and be willing to assume a role in helping overcome them. Good luck!

Dayonite, I always enjoy and learn from your generous contributions here and this is no exception. How may I thank you for the superb lecture you have provided here? We (it's a group project) ended up with this for a nursing diagnosis statement: NANDA: Altered Tissue Integrity r/t injury of left thigh AEB infected wound with large qty serosanguinous drainage and yellow film-like substance covering lower wound. I think it's not so much a matter of misunderstanding the intent of the process as much as feeling a need for a more systematic method of routing out all the possible and most appropriate outcomes and interventions. Sometimes it seems a bit random at this point; hoping that the references we consult aren't missing something important. We want to be as thorough as possible and often don't feel we know where to look for everything we need. The cases given to us often include some ambiguity with regard to our roles and access to the patient and with regard to what outcomes we can reasonably expect and how soon we can expect them. Sometimes this information is less easy to come by. I still have McCance & Heuther from patho; it is a great book. I won't be selling it any time soon. We are gradually feeling more comfortable with all of this and your kind remarks have definitely contributed to this progress. Thanks again for taking the time to share your hard-earned knowledge and experience with those of us who aspire to becoming the best nurses we can be!

Shannon, Hard to believe this book would be that helpful; it was last published in Mar of 95. Next edition not due until Jan 08. Wish I could look at a copy. Will look around. I'm a beginning nursing student also and I have yet to find a decent book on this subject. For example, our latest case study was a trauma injury, broken femur w very large wound. The closest NANDA in all the books I've seen is impaired or altered tissue integrity but they all focus on NOCs and interventions for pressure ulcers, not trauma wounds. They just don't fit the problem very well. I know, pressure ulcers have some things in common with trauma but there are substantial differences which none of the books seem to deal with. Seems like all of the books I've seen never quite manage to list classifications which directly apply to the problems we're studying. We use the Nursing Diagnosis Handbook by Ackley, currently in print and recently but the outcomes and interventions never seem to apply to cases we encounter. Surely someone should be able to publish a coherent book on this subject. Thanks for any feedback.

I can add some male perspective to this discussion, rather "old" perspective at that. Several female contributors here offer the advice that it takes substantial "stimulation" to produce an erection in a male, especially an "old" one. Sometimes this is true but often times it is NOT. The production of an erection is as much mental/emotional as it is physical even among older males. The physical appearance and demeanor of a female care giver and/or the condition or state of mind of the patient can produce an erectile response with little or no physical stimulus, again, even among older male patients. This can even occur in the presence of a male care giver and, no, it doesn't mean either is gay; only that the situation is probably very awkward and unfamiliar. Female care givers should especially know that the erectile response tends to be much stronger and more sensitive upon waking and when the bladder is full; naturally both of these conditions tend to occur simultaneously in the AM so consider it. A female care giver might consider an erectile response a "compliment" without implying encouragement or blame. I don't know any male care givers who feel uncomfortable if female peri-care produces an arousal response of some sort; why females would feel otherwise is not clear to most of us. It may be a function of comfort/experience level with the opposite gender so if you conduct yourself as if you've been doing it all your life, you're probably less likely to evoke arousal. Most females have probably had to learn, consciously or unconsciously, to manage the effects their presence and appearance have on males long before entering nursing. Some of that same strategy could apply here. But remember, it isn't entirely a matter of physical stimulation or even personal attraction; there is an element here over which neither party has total control in all situations and you should recognize, probably even acknowledge such to your patient as you perform your professional care. Some of these responses are hard-wired (no pun intended) into the male brain and nothing either party does may prevent them so you need to expect it to happen occasionally and recognize it as an unavoidable response, not necessarily something that you or the patient have any control over. A healthy and appropriate sense of humor can be useful in such situations. Don't overlook the influence of waking and a full bladder. Most males of any age are far more likely to experience an erectile response under these conditions without any physical stimulation at all. The more time you spend "worrying" about it the more difficult the situation will be for you. Hope this helps. Best of luck; you'll do just fine!

Jonty, This is perhaps a bit off-topic but would you be willing to offer a comparative opinion of the socialized UK health care system vs the way we're doing it here in the US? Perhaps our moderator will route your response appropriately. John, student nurse, age 63