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Labor and Delivery, OBED, NICU, Lactation

Content by labordude

  1. labordude

    265 questions is almost guaranteed if your a male.

    75 questions in 39 minutes I passed and walked out knowing I passed
  2. labordude

    Is Nursing All About Stress?

    While I do agree that better nurse-patient ratios and your other suggestions have merit, I wholeheartedly disagree that those are really the answers. As nurses and human being, we can't always control the external environment as much as we try, but we can control our internal reaction to such situations. As the OP also discussed internal locus of control is paramount in working through situations where external stressors are high and ability to control the external situation is low. "Life is 10% what happens to you and 90% of how you react to it." - Charles Swindoll Let's also examine my reality having worked in 10+ hospitals in multiple states. The majority of the nurses I have worked have either lost or choose not to use their ability to control themselves to help decrease the effect of the stressful situation. There are certainly those who just need a little time off to unwind, but so many people don't actually have real outlets today. Me? I play ice hockey AT least once a week which realistically takes two hours of my time but has innumerable benefits for my physical, emotional, and spiritual state. More people would benefit from having a physical outlet when working in a job such as nursing that does have many uncontrollable stressors on many sides (patients, physicians, administration, insurance, etc). My argument in total is that the onus in on the individual to consider what their reaction to stress is and understand how to control that reaction rather than focusing on the stressor itself which often is truly out of their control. Though I'm almost certain I just paraphrased what Jerome Stone said.
  3. labordude

    Nursing Salary Survey 2014

    Geographic location - MA Pay rate - $41.70 + diff In which area / specialty do you work? - NICU What type of license do you have (RN or LPN)? RN What type of degree and/or certification do you have? BSN, NRP, CLC How many years of experience do you have? 7.5 Are you full-time, part-time, or casual / per diem / PRN status?36 hours, which is considered part-time What shift do you work? nights, every 3rd weekend Do you receive any shift differential? yes, evening, permanent night, and weekend Are you a manager or supervisor? - ​no
  4. labordude

    Blood products question

    We will transfuse through our 24g IVs or through our umbilical venous lines. Very rarely will we infuse through our PICC lines, though this has varied among different facilities upon the size of the PICC line and the current status of the patient.
  5. labordude

    Staff assignments

    This is what I have so far Gray, J. E., Richardson, D. K., McCormick, M. C., Workman-Daniels, K., & Goldmann, D. A. (1992). Neonatal Therapeutic Intervention Scoring System: A Therapy-Based Severity-of-Illness Index. Pediatrics, 90(4), 561-567. Retrieved from http://pediatrics.aappublications.org/cgi/content/abstract/90/4/561. Mullinax, C., & Lawley, M. (n.d.). Assigning patients to nurses in neonatal intensive care. J Oper Res Soc, 53(1), 25-35. Palgrave Publishers Ltd. Retrieved from http://dx.doi.org/10.1057/palgrave.jors.2601265. Richardson, D. K., Gray, J. E., McCormick, M. C., Workman, K., & Goldmann, D. A. (1993). Score for Neonatal Acute Physiology: A Physiologic Severity Index for Neonatal Intensive Care. Pediatrics, 91(3), 617-623. Retrieved from http://pediatrics.aappublications.org/cgi/content/abstract/91/3/617. SPENCE, K., TARNOW-MORDI, W., DUNCAN, G., JAYASURYIA, N., ELLIOTT, J., KING, J., et al. (2006). Measuring nursing workload in neonatal intensive care. Journal of Nursing Management, 14(3), 227-234. Blackwell Publishing Ltd. Retrieved from http://dx.doi.org/10.1111/j.1365-2934.2006.00609.x.
  6. labordude

    Staff assignments

    There are threads about this everywhere. What there is not is any sort of consensus about how best to assign patients to nurses. I've found several research articles with great information, unfortunately, they often tend to discount the time actually spent performing procedures considered "easy" and "quick". I would love to actually get printed guidelines for staffing from other units so that I can add it to my research to improve acuity based staffing.
  7. labordude

    Questions from a staff nurse

    Hi to all managers and staff reading this, As someone with experience in multiple facilities, I see situations come up that are handled in many different ways (or sometimes not at all), so I am looking to see what you do to ensure a unit that runs great. Beyond that, I am a Healthcare MBA candidate who wants to focus on organizational change, specifically the improvement of nursing within an organization. So while these questions are somewhat general, I am looking answers from a professional perspective and for my own personal career gain. How do you ensure your employees feel respected and recognized? There is a ton of information out there including Hardwiring Excellent (Studer is excellent, if you haven't read him) and The New Leadership Challenge (Grossman & Valiga). Do you use thank you notes, instant recognition, public recognition? What would clue you in to your staff not feeling respected? Do you have an open door policy? What does this actually mean? Do your employees actually feel comfortable coming into your office and being honest in a constructive way, without having a single iota of fear for their position? How do you take the "pulse" of your unit to assess morale? Do your yearly evaluations include goals for the employees? Are they position related, career related, or all-encompassing? What do you do to help your staff reach their goals? (Anyone read The Dream Manager by Matthew Kelly, definitely a good quick read on the benefits of helping staff reach their goals) How do you handle problem employees whose problems are only attitude related? Those "bullies" who are technically sound but bring down the morale of those around them. Nearly every organization has some of them but the best organizations seem to have built a culture where these employees weed themselves out because they learn their behavior won't be tolerated by their peers. Thanks in advance, nicuguy
  8. labordude

    Should I call? Or inappropriate?

    E-mail addresses are usually easy to figure out. Once you know the name of the person and the organization, just google "@organization.com" or whatever they are. Most companies are First.Lastname@, First_Lastname@, FirstInitialLastname@ or something to that effect.
  9. labordude

    Should I call? Or inappropriate?

    There is no reason why you couldn't call the unit directly and ask to speak to the nurse manager. Why look a gift networking horse in the mouth when the job outlook isn't all that great at the current moment. You are likely to get a voicemail but if you say something like "I'm very interested in this opportunity, I have such and such relevant experience...I understand you have a busy schedule but I'd like just a few minutes to speak to you about what I can bring to this unit" You have now shown interest and initiative while showing deference to a manager's time constraints. You have EVERYTHING to gain by standing out of the crowd in a professional and courteous manner.
  10. labordude

    New grad 30 weeks pregnant and starting on L&D department

    Just throwing a couple of things out there...keep in mind I am not a lawyer. My interpretation of things going on with you compared to relevant law is this. The company may not rescind the job offer BECAUSE of your pregnancy, however they may rescind if you fail your physical as they can with any condition that affects your ability to perform the role you were hired for, barring reasonable accommodation. You will not have worked for your facility for longer than 12 months and 1250 hours in that time period leaving you ineligible for coverage under FMLA, though your particular workplace likely has short term disability (you might be able to get 6 weeks for vag deliv/8 weeks for c-sec). This isn't a matter of disclosure, you are under no obligation to disclose something that is protected by multiple civil rights and discrimination laws. On the flip side the company doesn't owe you anything either, though they may not use your pregnancy in and of itself or your non-disclosure of a protected condition to rescind the position. Just my two and a half cents and again, IANAL.
  11. labordude

    Any actual connections through "Linkedin"?

    I have been on LinkedIn for about two years now and consistently get contacts from recruiters and other professionals. Make sure that you join appropriate groups and take advantage of open networkers who will connect with anyone to share their network. If you don't take advantage of what LinkedIn has to offer, things aren't going to just come to you.
  12. labordude

    Breast Milk Verification

    Your question is interesting because in my current NICU and in others I have worked, two people (RN + RN/RT/NP/MD/NA/Parent) verified that the milk from the container to the bottle matches the right baby. As far as I know, blood is truly a regulated substance and breastmilk is checked twice as a standard rather than any legal regulation. There is no assessment required in verification of name matching, therefore any scope of practice questions shouldn't have to enter into an equation. There is no special training required in the pre-feeding process that would eliminate others from verifying it unless the hospital itself has a policy stating that they can not. Two of my prior NICUs had both people, initial on a breastmilk log or on the flowsheet to show who checked it. We used the mother/father many times when the patients were in private rooms.
  13. labordude

    Starting off as a New Grad in the NICU--bad idea?

    Don't listen to anyone who tells you to have med-surg experience before going into the NICU. If you want to do something and you have the opportunity to do so, why wouldn't you take it? As for being stuck in the NICU, remember that as an intensive care nurse (of neonates), you are learning valuable critical thinking skills, organizational skills, time management, crisis management, technology including ventilators and monitoring (many hospitals use the same models of equipment throughout the facility). Hiring practices have changed significantly in nursing and everywhere else with companies looking to hire, train, and promote as much as possible from within. A nurse that wants to transfer internally always has a leg up on getting an interview and if you are strong in the key characteristics needed in the specialty, they should be willing to invest in training you in the patient specific knowledge. At least, companies worth working for thinking this way. It is less expensive to retrain you than to seek out and hire someone from the outside.
  14. labordude

    what's the difference between mom/baby and new born icu

    These are two very different units in terms of well..everything except the age of the population. Newborn ICU is a unit for neonates (those less than 28 days of life typically) that require an increased level of care because of illness or prematurity. It can be a very stressful environment and requires a strong understanding of neonatal physiology and fetal development. This is not information typically learned in-depth in nursing school, but rather learned during formal orientations into the neonatal ICU nursing position. Here is a link to information about NICU nursing. http://www.discovernursing.com/jnj-specialtyID_108-dsc-specialty_detail.aspx Mother/Baby is a well-baby floor for those newborns that have no need for specialized care interventions and are able to stay with the mom after birth. "Couplet care" or caring for mother/infant combos is a common way of assigning patients. In this situation, the infants and moms are there only for a very short time and there is always a lot of teaching and things to get done. Each specialty is stressful in its own way and they require a different skillset, but also a different focus. Here is a link to mother/baby nursing information, also known as perinatal nursing. http://www.discovernursing.com/jnj-specialtyID_105-dsc-specialty_detail.aspx It is hard to list pros/cons because one person's pro is another's con. For me, I love working with high acuity, high technology patients in the NICU, but at the same time enjoy helping the family bond and learn how to care for their infant. I get to wear both hats, but I don't provide nursing care to the mother. The facility you work in has a lot to do with what benefits you will get in terms of weekend schedules, shift rotations, etc. Not every NICU or M/B unit is going to be 12-hr shifts, every third weekend, etc. Finding out WHAT you like to do is more important and if you get a chance to try both, DO IT!
  15. labordude

    What kind of nurse are you?

    I've been a NICU nurse since I graduated from nursing school. I absolutely love working with this population. Since then I have started doing work with lactation and infant transport as well.
  16. labordude

    Bendy Bumpers

    The product typically has a lead core which will break if bent too hard, such as when trying to store them in a folded position. Our unit has had several break because of this and now we store them straight out and have not had additional problems.
  17. labordude

    working maternity

    I firmly believe men have a place in every specialty. If women can work in a male urology clinic, why not a man in OB? I would love the opportunity to work in L&D. I did actually get an interview once, but was not offered a position (had a friend that worked in the unit, the manager took a poll about hiring a male and when more than 50% said no, she didn't offer me a position). I currently do NICU and am certified as a lactation counselor. It is very rare that I have any kind of discrimination, with the exception of the scowls of some of the olde..ah hem..more experienced OB nurses. I love floating to the well-baby nursery and spend tons of time in the rooms with the moms and families. I'm glad you have been well received and hope you continue to enjoy your experiences. It just bodes better for the future for the rest of us who want similar positions.
  18. labordude

    Need 2 men to volunteer for class paper

    I'd be happy to help out.
  19. labordude

    New manager seeks input

    Hi ahleesejo, Congrats on your move up to the manager level. I have had many different managers at multiple facilities and have seen good things and bad things. One of the most important things you can do is deciding what kind of "manager" you want to be. Remember that the type of manager you are will likely be linked to the way people describe you in the future in terms of "she was a horrible/okay/good/great/THE BEST manager." Some managers end up being a small cog in a big organizational wheel and losing sight of what actually matters, their employees. I would recommend you read two books and they are short quick and very enjoyable reads: The Dream Manager by Matthew Kelly - Amazon Link - The gist of this book is that we all have dreams and helping those around you to reach their dreams makes them more productive because they feel they are invested in and in return will display investment back to the company. It also can help alleviate those situations where people are stuck in a rut because they feel they are not achieving anything when it is likely they simply just do not know how to go about it. It is one of my absolute favorite all time books. The No A-Hole Rule: Building a Civilized Workplace and Surviving One That Isn't - by Robert Sutton - Amazon Link - The title says it all, building an environment free of A-Holes and working to rid it of ones that are already there. The book uses a two test to determine if a person is acting like an A-hole Test 1 - After talking to the alleged a-hole, does the "target" feel oppressed, humiliated, de-energized, or belittle by the person? In particular, does the target feel worse about him- or herself? Test 2 - Does the alleged a-hole aim his or her venom at those are less powerful rather than at those people who are more powerful? First off, if you even think people consider you an a-hole, fix it. Otherwise you won't get anywhere. Second, every unit I have worked in has bullies/term for female dogs because of stupid censorship filter/jerks, those nurses who intimidate others. They are a-holes; find ways to get rid of them as they absolutely impact on productivity, morale, and cohesion. It is far cheaper in the long run to have a cohesive happy team than to let a-holes ruin it. Besides, once they are gone and the team has built cohesion, there will be a natural barrier to future a-holes. You will notice that a new employee (who has a-hole tendencies) will simply just not work out because they won't be able to build cohesion with other people who have learned not to tolerate those behaviors anymore. To really succeed and be the best manager, you have to learn to be a great leader. Do not confuse the two. "Managers are people who do things right. Leaders are people who do the right thing." - Warren Bennis and Burt Nanus. Actually that whole book is great, The New Leadership Challenge: Creating the Future of Nursing - Sheila Grossman and Theresa Valiga - Amazon Link. Lots of great insight by those two writers. Above all, don't get so wrapped up in any one thing that you lose sight of those who are currently working for you. Remember that the corporate loyalty that existed 30 years ago is not the same as it is today. Do not assume that your employees are engaged simply because they show up. Find ways to get them engaged in the work (notice I didn't involved or participating, there is a difference), and you will start off so much stronger. Also, watch the number of near-miss and heads-up incident reports you get as well. There is a growing amount of social psychology research that says that when an employer or manager has built an environment of trust where people are not afraid of things being held against them, the number of reports goes UP. Interesting! At least I think it is. A measure of something people assume is bad goes up when things are going good. Anyway, good luck! nicuguy
  20. labordude

    Closed system for ABG draws from UAC?

    I have used multiple systems at different hospitals. Several have started implementing a closed system similar to this one http://www.accessmedicalsupply.com/content/bp3_competency/educational_program_for_bp3_closed_system.pdf. It basically uses vented syringes and two ports that allows enough blood to be pulled back so that your draw is clear of heparin, but then uses a pre-connected bag of whatever you are using to flush back down without changing syringes. I'm a fan
  21. I received this scholarship back in 2005. I am not sure if they have changed the paperwork or if it was just life experience, but I knew full well that I would have to pay taxes on this money as none is taken out and it must be counted as income. You may not end up owing as much, especially if you have deductions and make little to no money while you are in school. I didn't have to get any hospital or facility approved and other than one "check-in" at six months, I never heard from them again. Remember that underserved does not necessarily mean poor or impoverished. Almost every hospital will qualify especially non-profits and those that do a lot of medicaid and state aid care.
  22. labordude

    Nursing Stereotypes and a Dumb Society

    I'm a NICU nurse and I've been asked if I just hold and rock the babies all night long.
  23. labordude

    PICC TKO Rate

    Having worked in a couple of different NICUs, I have seen it done differently. Currently we leave them running 1ml/hr on a syringe pump with 1 unit of Heparin per ml. The PICCs are 1.9fr, mostly single lumens. In the past at other places, I have run 0.5ml/hr with 0.5-1 unit of heparin per ml (into a 1.9fr double lumen PICC). The first place I ever worked did not run continuous fluids and flushed q8h with 2ml of NS containing 2 units of heparin per ml (into 2fr PICCs). I have had more PICCs clot off using the continuous method as compared to the q8 flushes. Sorry for more confusion!
  24. labordude

    Male Nurses in the NICU

    I've been in the NICU for almost 4 years and have also done travel nursing. I spend a ton of time at deliveries and got a per diem position doing L&D/OB/Nursery. In addition, I'm certified as a lactation counselor. At my current hospital, I am the only guy but it has never bothered me. As someone mentioned before, it really can make a difference when working with the fathers. There really is nothing quite like the NICU, it is a special place and the people I know that do the best there are the ones that are the most passionate about it. Good luck!
  25. labordude

    Accredited by who?

    The previous poster is correct. The two accreditation bodies that matter are NLNAC and CCNE. Each one has a search feature to find out what schools they accredit. CCNE - http://www.aacn.nche.edu/Accreditation/ NLNAC - http://www.nlnac.org/home.htm