Moondance

Thanks for the reply :) I also listen to all lung fields, all quadrants of the bowel and do RR for 30 seconds (6 sec is too short for a periodic breather in my opinion). It seems I am doing it right, maybe just with practice I'll pick up speed. In my unit, they don't measure girth, but we did at the hospital I did my internship. So I make sure I notice the abdominal shape carefully during assessments as well as palpate to check that it is soft, non-tender and has good bowel sounds.

Hi NickiLaughs check out the stickie at the top of this forum for states that are hiring. Texas is hiring :)

In our level II, the assignment is typically 4 patients per nurse. Two will be on an 8-11-2-5 assessment/feeding schedule and two on 9-12-3-6. Our time parameter for feedings is 20-30 minutes (though some will finish sooner). There is a lot of variability of course with what types of patients we have in the assignment (ex: PO/NG feeds, ostomy care, IVs, etc), but I am curious what tips or shortcuts you may use to help keep to these patients on a workable/timely schedule. When I asked my preceptor, I have been told things such as to count the RR for only 6 seconds and multiply by 10, get the HR from the monitor, don’t feel for pulses (because if their limbs aren’t blue, they’re being perfused). But feeling for pulses is something we chart on the flowsheet that we are supposed to be checking each time. When I ask questions (since it is so different what she is doing from what is taught in school), such as, “What about listening to all the lung fields to check for any adventitious sounds?”, or “Shouldn’t we listen longer in each quadrant of the bowels each assessment to assure there are not decreased bowel sounds?” I get kind of a defensive answer, like I am suggesting she is half-a$$ing the assessments, so I don’t ask those kinds of questions much anymore. I realize there is a world of difference in ‘textbook nursing’ and ‘real-world nursing’, so it is a bit of an adjustment to listen to these tips and wonder about the disparity in how we are taught to do an assessment and what is done in the real world. My orientation experience has been positive overall and we seem to be working well together. Other than situations like I mentioned above, we have good communication between us. She’s good at showing me procedures (ex: IV starts, ostomy care) and she’s understanding that time management is one of the most challenging things to get down pat. I wanted to post this for discussion to receive some advice about how to speed up assessments and keep these patients on their time schedule without constantly feeling like I am going to miss something or overlook something.

I don't know if it's an option for you, but if you can look out-of-state, you can increase your chances. I graduated in May 2009 and could find nothing in Florida, not even med-surg jobs. It was from reading several posts on allnurses that I decided to apply in Texas. I had seen several posts from new grads asking "where are the jobs!?". Many responses mentioned Texas. I applied to one hospital that is located in the Texas Medical Center to a specialty unit I had my heart set on... I had a phone interview, then traveled to Houston, interviewed, and got the job on the spot. The starting pay is very good, benefits are fantastic and they paid for my relocation expenses. The orientation process has been very positive so far. My orientation class was full of new grads starting in Labor & Delivery, Newborn Nursery, NICU, and Postpartum units. Again, I don't know if relocation is an option, but thought I would mention it as something to consider. Best of luck to you! :)

Thanks once again Jolie :) The infant wasn't given Tylenol and I asked about that. They said usually the doc orders it, but I don't know why it wasn't in his case. He did end up having a temperature the next day and Tylenol was ordered and administered. Ouch! Your poor little daughter! That had to hurt! Impeccable timing is indeed crucial.

Thanks Jolie, that makes sense. I just thought of another immunization question... As I was observing a NICU patient receiving his first immunizations, the nurse (and another nurse who assisted) gave two of the immunizations at the same time in the anterolateral aspect of the same thigh. They stated it was to keep the patient from being stuck twice. I just purchased the book "Core Curriculum for Neonatal Intensive Care Nursing" and it didn't specify giving the injections simultaneously, but did state: "When necessary, two vaccines can be given in the same limb but should be separated by at least 1 inch if possible so that local reactions are not likely to overlap." Is it common to give the injections simultaneously in the same limb? Thanks for insight. I'm orienting to the NICU and trying to learn from every patient interaction. It's been interesting and a LOT to learn, but well worth it.

I was reading a couple of research studies regarding immunizations for NICU patients and was curious about your experiences with any reactions or suspected reactions from the patient being immunized. A study from 2008 stated that apena episode(s) 24 hours prior to immunizations greatly increases the risk for apenic episodes for up to 48 hours following immunizations. I'm still looking up information regarding the subject, but was also wondering if it would be better to hold off on giving the immunizations until after the patient was out of the NICU. Thanks :)

Is this regarding just reserves or active duty as well?

I am a SN caring for a set of newborn twins (boy and girl) for a couple during the night shift. They are 2 weeks old and last night, the little girl slept soundly for 6 hours (missing the 3 a.m. feeding), and woke up for the 7 a.m. feeding. At their pedi visit this week, the doctor said they are eating "more than expected" and gaining weight well. My question is if their intake is adequate during the day, isn't it ok for one of them to skip a night feeding if sleeping soundly? The mom stated that she wanted them to be awakened for feedings to keep them on schedule. I will, of course, respect her wishes. I was just curious if one started sleeping for longer stretches of time, isn't it ok? Especially if it is falling in line with sleeping during a night feeding. This 6 hour sleeping stretch may have just been a fluke since they are still so young, but I'm still wondering about the scheduling. Would love to hear your advice. Thanks!

Do you use a new syringe each time you administer a feeding?

Thanks for the responses :) I also use the McCance and Heuther book, which I agree is a difficult read and I just don't like it for use as a textbook, but I will keep it for reference. I am going to check out some of the others that were suggested here...never hurts to have more than one textbook to refer to, especially if it is an easier "more compact" version to refresh with. Thanks again :)

I absolutely despise my Patho textbook and was wondering if anyone could recommend a pathophysiology textbook they found useful. I won't need it for any classes after this semester, but I'd like to get another for reference use. I find that I go online to other sources just so concepts are worded clearly and understandably. P.S. In case you need a really good Pharmacology textbook, I highly recommend the one we are using this semester: Pharmacology for Nursing Care by Richard A. Lehne. Very well organized and the explanations are clear and easy to commit to memory. Thanks

A couple of weeks ago, I Googled "memory techniques" and used some of the suggestions given on this website: http://www.mindtools.com/memory.html

I've read posts that some nurses love them and wouldn't wear anything else, then others didn't like them. I tried them, but couldn't get the sizing right and went with a pair of NurseMates (the style is Dove). They are a soft leather shoe and I find them to be very comfie.

Clee's response would be appropriate, right? I don't understand the reasoning that doctors have that it is permissible to address to collegues unprofessionally. Wouldn't it be against policy for employees to interact with each other this way? Also, if a nurse phones a doctor to inquire about a patient, and the doctor starts yelling because he was called and flies off the handle, why not hang up on him (after giving a warning to calm down). They aren't discussing the patient anyway. This is a question I have had for awhile, and with the OP's experience and posting this, it seems like a good time to ask! lol