KatRNC

If you feel ready to take the test, then DO it! Good luck! I did mine in 1993 after 5 yrs working in a busy NICU. I was surprised at how hard the test was, even with that review book, but I passed, and I am proud to have done so. You GO girl!

To be successful working in a NICU, you MUST be able to be the absolute advocate for your patiens! You can't be that person for your own sons? I would stay where you are...

So, do I understand that you have 2 Kardexes or do the charge nurses go from bedside to bedside for shift report?

I think I asked this question a while ago, but I didn't get too much back from members, so I figure I'll ask again. What kind of "kardex" to you use in report, if any, and what types of specific information is on it? I was used to the kardex being used for charge nurse to charge nurse report in my former facility, and the nurses used their own ways of looking at orders, and flow sheets and lab results, etc to give shift to shift report. My current facility uses the Kardex for shift to shift report. Things like the TPN rate are written there, as well as cycling CPAP to NC timings, and feeding amounts, which change daily (or sometimes more often than that) can be erased and rewritten. My feeling is that if I'm giving report at the bedside, I can look at the tpn rate, and compare it to the orders and don't need to "update" the Kardex with that information. Also, the flowsheet, is looked at, and the Order sheets, and the MAR, so why do we need to be so specific on the kardex? Don't we have enough paperwork to do? With all the "specifics" on our Kardex, there are never any lab values. I took report a few weeks ago on an infant who had been transfused, and when I asked what the HCT was, I was told the nurse didn't know! I would think that the latest lab values are important to include on a kardex? (and in shift to shift report?) My previous facility had that information on the flow sheet. The facility I'm currently at is trying to come up with a new Kardex, and after months, we seem to be no closer to finding what works for us. Any suggestions or examples would be greatly appreciated! Thanks! Kathy

Steven, Thanks for the reply, we can't seem to get the docs to give narcotics unless the infant is intubated. I will keep trying, of course! I started NICU nursing when "infants didn't feel pain" was the thought of the day, so I guess there IS some slight improvement... As for what you said regarding sucrose with NEC? Patients who are no longer sick with NEC, but just hungry, if the sucrose is absorbed in the buccal mucosa, which is what I've always understood, and shouldn't cause NEC, why would it be inappropriate in that type of infant as well? Kathy

(Oh, and I don't mean chest tube insertion, I mean chest tubes in place, ok?)

I wonder... is cpap considered a painful procedure? How about chest tubes? How do you help those baby's with the pain?

I haven't looked at the Sweet Ease site in a while, but the last time I looked, it said .1 to .4ml administered into cheek. The baby doesn't get enough to get to the gut, if it is given that way, right? I'm asking a question here, people... This is an ongoing issue where I work.

WOW, we have this whole complicated protocol for weaning, and yet there is no where to post the humidity levels on our flow sheet. Wean by 5% after a few hours, etc etc, based on gestational age. You just know when to wean.. the skin is intact, and the baby is HOT! NO?

Oh, and don't waste your time in the adult ICU, just GO to NICU! :)

Go to the NICU as a new grad. I did and I don't regret ONE second of it! Good Luck!

Hi, I've been a NICU nurse for over 20 yrs. I thought I would like pediatric nursing when I began school, b/c I love kids, but the minute I walked into the NICU I was hooked! I've never looked back. Although I've had to work in different fields for a few months while I switched cities. I love my job! It's really neat to be able to say that. (I've worked 12 hour night shifts all this time, too!) Good Luck in finding your place in nursing! Kathy

Please share with me how you wean babies from CPAP to RA? Do you cycle them, or do you just give it a try? Who makes that determination, MD or RN? Thanks! Kathy

Hi, Let me guess, Columbia Presbyterian? Regarding the cpap head issue, do the babies heads come back to normal at some point? Kat PS: Don't you just love ecmo? I miss it!

Does anyone use bubble cpap in their units? If so, how do you monitor it, since there are no "vent alarms" if the cpap isn't "bubbling"? Do you use Hudson prongs for this? Are there many issues regarding "cpap head"? Thanks Kat

Please send me an email with the information you spoke about. In my unit the doctors are in charge of feeding schedules and po trials. Thanks, Kat [email protected]

I would love any copies of kardexes that work. I have a fax number, but I can't figure out how to send it privately. thanks Kat

When I began, the theory was that preemies don't FEEL pain. Now it's come to that they don't REMEMBER. Too bad we can't talk to the former premies to hear what they felt and remember... Hmm, maybe we can... I think I will search for them. Kat

Sounds like sepsis. Or reflux? Do you know what the end result is from the hospital the baby was transported to?

Ages ago, when I began my NICU career, I was warned it could take 2 years to "feel comfortable". They were right. It took just about that long before I could go to work without that nervous feeling in the pit of my stomach. Ask questions always. The only stupid question is the one you don't ask. I still ask! And yes, NEVER trust a 35 weeker!!! That is great advice! Kat

Good luck in your new specialty. I love it. As for people who ask hard questions, I think once you're in the NICU you will be able to answer them better. For me, I would answer that question by replying that I do whatever I can to NOT hurt them, but pain is a part of life, and the goal is to unite the infant with the family in the best possible manner, so I do whatever I have to do to make that happen. Kat

Thanks to the few of you who replied. Unfortunately, there are no team meetings. The staff has no idea about the plans. And the mom is now in house and 25 weeks gestation! I wish I knew what the delay was. I have tried to ask, but I've been shot down by management and accused of slander, etc. Anyway, I guess it will be what it is, when it happens. I have done my best to make the care be excellent, but budgetary constraints prohibit that. I'm very discouraged. After 22 years as a NICU nurse, this is the first time budget has ruled over outcome. I was told today that the chief neo must know enough about this to plan for supplies and staff. When did the neo docs become involved in that sort of thing? K

Hi all, My small Level III NICU is preparing for a quintuplet birth. Mom is currently admitted and is at 24 weeks gestation. I was wondering if anyone here would be willing to share what specific preparations you made for the impending birth, and how it all worked out in reality. Thanks, Kat