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twinkletoes53 specializes in NICU.

I graduated in 1975 with a BSN degree. I worked in pediatrics my entire career.

twinkletoes53's Latest Activity

  1. twinkletoes53

    How many is too many? Medication errors

    Does this mean that patients are not being given the narcotics or psych. meds. that are due?
  2. twinkletoes53

    Small ER VS Clinic?

    I am a retired RN. When I read your note, I was attracted by the fact that Boston was going to certify you in PALS, ACLS, as well as IVs. All skills that you will use now & in the future, no matter what field of nursing you find yourself working in, in the long run.For the educational value alone, I would decide to stay in Boston for now. Down the line, if you decide to work @a small ER, the skills you've learned now will be put to good use, as well. Good luck with whatever you decide.
  3. twinkletoes53

    Under the knife... again

    I have had both knees replaced, and my right ankle fused, due to complcations from arthritis. I was off work for 3 months after BKR. I am sending best wishes & prayers your way. The first month of recovery is hardest. My surgeon allowed me to do my PT. In a heated rehab. pool once my stitches were out. Much less pain, and greater mobility.
  4. twinkletoes53

    what did you do before?

    I had always been interested in working with NICU babies, but the hospital I started my career in had not yet opened one. It was a pediatric hospital, and this was in 1976. I started by working in a Medical-Surgical/ Isolation floor for 1½ years. Whenever I was floated to the PICU, I found that I enjoyed the type and pace of work there. When an opening became available, I transferred to the PICU, and worked there for 2½ years. Finally, the hospital opened its' own NICU, with 15 beds. That was in March 1980. I was the first RN hired to work there. I loved my job; NICU nursing was what I had been waiting for, and I worked in the field for 30 years. I am now retired. Having a solid base in caring for a variety of patients on the floor, then in the PICU, gave me the experience and helped my transition to the NICU. Because at the time, not much was known about NICU nursing. We studied everything we could get our hands on, & had experienced neonatologists to guide us.
  5. twinkletoes53

    Good nurse gone

    In response to the person who asked where the stabbing occurred: The attack occurred at Good Shepherd Medical Center in Longview TX. It happened in their ambulatory surgical center, at around 0700.
  6. twinkletoes53

    Diagnosing versus identifying symtpoms

    Without X Ray interpretation, you cannot state for certain which bone is fractured. You might chart something like this: "Patient presented with 10cmx10cm laceration on inner calf, with edges of bone protruding through skin. Diffuse edema around site of protruding bone. Foot and ankle are swollen. Posterior tibial pulses are present. Toes are dusky in color; capillary refill 10 seconds. Patient states that he is able to feel sensation in all toes." You might also have documented "Per report of Dr. Smith, after viewing AP & lateral X Ray of affected extremity, patient has a compound fracture of tibia. Site immobilized with splint & patient prepped for surgery"etc.
  7. twinkletoes53

    Is it covered under Obamacare? - Cartoon Contest Winner

    I voted for Obama. I have had pre-existing medical conditions for 30 years. I was tired of being turned down for health insurance b/c I had arthritis. Or b/ c I had (and beat) breast cancer. I have tried to obtain long-term care insurance since I was 35. And have been turned down many, many times.
  8. twinkletoes53

    Is it covered under Obamacare? - Cartoon Contest Winner

    I live in the South and love Obamacare. I don't know if it's b/c I have relatives in England, & have visited it 4 times. So I have seen socialized medicine @ work. You are right. Lots of fearmongers here in U.S.
  9. twinkletoes53

    I am scared to do CPR

    It's normal to be anxious about performing CPR. Don't let your fear stop you from initiating lifesaving measures on a patient. The more you practice, the less anxious you will be. When the code team arrives they will take over. Ask to switch out with another staff member. Remember that when you started, the patient was dead. Whatever you do will help to save his or her life. Has it been a while since you completed your CPR course? Would it help you to watch a CPR instructional video? Or to take a CPR course again? That way you can practice your compressions on a mannequin, & ask your instructor to tell you if she/he notices you doing it incorrectly. I used to do CPR on infants, and even on tiny babies, where you use only 2 fingers, your hands would get cramped up & you would need to be relieved by someone else.
  10. twinkletoes53

    August 2013 Caption Contest: Win $100!

    Hey friend, where's MY cup of coffee? Did you forget to get me one, too? :coffee:
  11. twinkletoes53

    August 2013 Caption Contest: Win $100!

    What? You didn't bring me a cup, too?
  12. twinkletoes53

    What do you think of 12 hour shifts?

    I started my nursing career a long time ago, and we worked 8 hour shifts, 5 days a week. I did that for 8 years. When our unit introduced voluntary 12 hour shifts, I decided to try them, and loved it. I always worked nights, 7pm-7am. And yes, you really are at the hospital for longer than 12 hours. It was worth it to me to have the 4 days off in between. Some nurses worked Mon,Tues,Wed. one week, then Wed, Thurs, Fri, the alternate week. So they would have 6 days off in a row every other week. When our hospital started offering Weekend Option, I signed on to that contract, working every Saturday and Sunday. Nurses could also opt to work every Friday/Saturday. When I developed arthritis I worked every Friday and Sunday per MD orders, with 24 hours off between shifts. It was exhausting. I always had a cold drink with me, and snacks in my car to munch on during the drive home. Luckily I only lived 10 miles away from work. But we did have a nurse and her mom who would drive in from out of town to work weekend option + one extra shift each week. They were involved in a car accident one day on their way home, and after that they stayed at a hotel for a night after their shifts, so they could rest.
  13. twinkletoes53

    Abdominal IV

    I worked in an NICU for 30 years, and I know that if we could not get an IV in a baby that needed one, we would stick an abdominal vein. This was not a routine occurrence; rather a decision that was made, usually by an experienced NICU nurse, when it was the middle of the night, and the infant desperately needed the IV for fluids and antibiotics. Surprisingly, these IVs would last. No need for an armboard; and we carefully monitored and taped the site. We did have PICC lines placed in the infant as soon as possible, but sometimes an abdominal vein was the best vein we could see. Another unusual place that I've had to place an IV was in an infant's axilla. If the baby was small enough, the veins were easy to locate. And I've had an axillary IV last for as long as 3-4 days in a baby.
  14. twinkletoes53

    You know you've been a nurse too long when...

    Uh oh...That's me! We also washed and starched our own caps, and wore these thick white stockings with our uniforms, no matter how hot it was!
  15. twinkletoes53

    Start at a Level III or Level II?

    I would definitely start working at a Level II NICU. You will get the basics of what neonatal nursing entails. You need a good background and experience working with infants who are less ill, so that you know what is "normal" behavior, vital signs, and activity patterns in a neonate who is stable, vs. going right in and starting to care for critical infants. Caring for critical infants is intense, labor-heavy, and can be exhausting. You are caring for sicker infants, and will not have time to study why certain procedures are done, drips started, care restricted in particular ways, or why certain medications are given. It is doing one task after another, quickly, while monitoring the infant's vital signs and how he is reacting to what is being done to him. Observing changes in his overall state, some of which may be small and seemingly insignificant, takes practice. You will get that practice and experience working in a Level II NICU. You will learn to care not just for your baby, but to offer support and guidance to his family as well. Remember, too, that babies in Level II NICUs may suddenly become sicker. As you gain experience and knowledge, it will help you to detect changes in a baby's condition earlier, so you can see how an infant reacts when he is first decompensating or getting sicker, & can act appropriately. You will learn why certain things are done to a neonate, vs. only learning a list of tasks associated with care. It would help you a lot to have an understanding of pathophysiology, anatomy & normal behaviors associated with a particular gestational age. You will learn time management skills, multi-tasking, and delegation. These are all skills that you will take with you throughout your career. You will need experience in a Level III NICU before applying for NICU flight training. Different hospitals have different requirements. In our hospital you needed a minimum of 2 years Level III nursing before applying to be a flight nurse. Good luck in your nursing career!
  16. twinkletoes53

    You know you've been a nurse too long when...

    When you can't watch medical shows on TV without yelling @ the screen "How the heck can he be on room air? He just had a crushed chest repaired? And where are the chest tubes? And the IV pumps?" Or you're watching a medical show, and there's a ventilator hissing in the background, but the "patient" is on room air and talking. My friends know better than to watch TV with me! They say I drive them nuts.

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