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jpeters84's Latest Activity

  1. jpeters84

    Lucile Packard Hem/Oncology Unit

    Hello, Does anyone currently work in this unit or have any feedback about this unit? Are the nurses happy? Is this a good unit to work for, etc.? Thank you!
  2. jpeters84

    Why Do I Care?

    I understand your frustration. Anytime anyone leaves a floor it puts a strain on relationships, on resources, on the overall feel of a unit. I think the reason people leave so early in their career is a multi-faceted problem. I now have three years of experience so I feel close enough to being a new grad but have a little perspective. In nursing school they were doing their best to constantly scare us into thinking one mistake and we'd be fired, one person doesn't like you and you're out, one bad review with constructive criticism and you should fear for your career. I was in a constant state of anxiety in nursing school. And when I was a new grad it was worse. It created an lack of confidence even after I was competent in which I needed positive feedback on a regular basis or I feared that I wasn't cutting it. I constantly had to ask questions even when I knew the answer. And I was in a very supportive environment as a new grad. I wonder if nursing schools couldn't find a better way to impart the seriousness and importance of nursing while imparting a small earned confidence that is both humble and realistic for a new grad to have. Also, nurses are harsh to each other. Especially seasoned nurses that have been at their jobs in that particular hospital for awhile because they're human and they forget what it is like to be new. Being new is so incredibly hard. I think its easy to forget just how hard it is. And when you know your unit like the back of your hand and you can see things coming its easy to get frustrated or not understand why the new person is struggling. We need to change this somehow. Being in a unit where you are constantly precepting puts too much pressure on the staff. Your higher ups should really be looking at this problem and maybe put a hiring freeze on the CRNA swinging door phenomenon. Sometimes people just really need to leave. Its hard to summons up the empathy when its going to negatively impact your unit once again, but sometimes they just can't do it another day. For those people I wish them the best because that's a really hard spot to be in. At the end of the day I think creating a culture of welcoming and supportiveness of new staff both experienced and new grads is incredibly important even when everyone is burned out from precepting. I left a really great job after two and half years for my dream job in a large academic tertiary hospital. The staff was less than welcoming. Sometimes the grass really isn't greener on the other side. It has been the hardest experience of my life. Harder than being a new grad. I definitely see both sides. I wish you and your unit the best.
  3. What does your NICU do to build a good developmental nest with the phototherapy blankets? We have found that the blankets are so stiff, particularly at the bottom with the cord coming out that it has been hard to find a satisfying way to securely nest our micros while on the phototherapy blanket. The last NICU I worked at just build really large nests and used a thin strap over the phototherapy blanket and then tucked under the blanket to create walls on each side of the baby. My current NICU has felt that that eliminates space for lines, transducers, etc. Any suggestions would be much appreciated. Thanks!
  4. jpeters84

    Unhappy in unit

    There's no easy answer here. Different managers and different units are going to have different philosophies. Some will take you right away, some will want you to get more acute care experience than a couple of months, some will have training programs in-place for experienced nurses transitioning over. The problem is that a new grad with less than a year, really is a new grad. So unless this hospital has a new grad training program I think you're going to be doing at least a year in your tele unit. The other problem is your current unit. If your current nurse manager gets wind of this you can really get yourself in a bad spot. I say do some research on your own. If your hospital has an NICU new grad program than I say talk to the NICU nurse manager right away and see if you can't get a spot in the new grad program. If they don't then I wouldn't talk to anyone, do your absolute best to make it a year on your tele floor and then after a year talk to the NICU nurse manager and see if you can't make it happen. But if I were a nurse manager no way would I take someone with less than a year acute care experience into the nicu unless it was to start in a new grad training program for the NICU. If there are any other hospitals in your area with nicu new grad programs I would look into those as well. Best of luck to you!
  5. jpeters84

    What do you do about leaks?

    Sometimes swap for a larger tube, sometimes put them on the Jet because some Neo's believe this helps, sometimes just except it and work hard on positioning. Depends on how big a leak, how well we're able to ventilate the kid despite the leak, and how stable they are.
  6. jpeters84

    NICU Jobs in San Diego Area

    I hear great things about UCSD and you can't beat UC benefits! If you're so concerned about the reputation of one hospital why not look elsewhere? UCSD has opennings quite frequently thoughout the year it seems. I also hear good things about Sharp.
  7. jpeters84

    Is there a book that provides NICU procedures?

    There is a book called "Atlas of Neonatal Procedures". Amazon has it. Great book.
  8. jpeters84


    You ask a very loaded question. Before going into what you could know about the NICU I think it is important for you to first make sure that they have taken new grads before in this particular NICU and that it is a very supportive new grad training program if they have. I think that is fantastic that you are so passionate about the NICU. Just make sure you're going to start in a unit that will carefully foster that passion and gently ease you into the world of the NICU. I would be sure to ask how many new grads have they trained? How long is the training? How many preceptors will you have? Do you start off with low acquity and then move to high acquity? How long with each until you're on your own? Will you have a NICU mentor? etc. etc. The longer the training program the better. The fewwer amount of preceptors the better to a point you should have at least three to get an idea a couple different ways to do things but not so many that no one is taking a vested interest in your development and progress as a nurse. Now on to what might be helpful for you to know. First off NICU nursing is so unlike any other field that I hesitate to tell you anything. Going in to your interview and just being yourself and letting them know your passion for NICU nursing really should be enough although they're probably going to want to know that you've at least had some exposure to the NICU to know that you're not going to get freaked out and leave early on after they hire you. So if you have had any exposure at all I would definitely mention it. It would probably be helpful to know some broad basics like the different types of infants you will find in the NICU. The preemies-there's micropreemies (Extremely Low Birth Weight or ELBW and Very Low Birth Weight or VLBW) they're genererally the 24-29 weekers. Then there's the later termers which is 34ish/35 weeks-37 weeks gestation. They can be deceiving because they act like they're term but they're not term and can be the sickest. Then there's the term babies generally 37 weeks on. Preemies are generally in the NICU for respiratory issues and well because they're premature but there can be a whole lot of other reasons. Term kiddos can be there for congenital heart conditions, meconium aspiration, congenital defects, delayed transition, infants of diabetic mothers or IDM babies, and many other reasons. Respiratory modes used in the NICU: there are those kiddos on a ventilator- high frequency (usually an oscillator) or conventional ventilaors, there's CPAP, RAM, and high flow cannula or nasal cannula. Different cardiac conditions are PDA or Patent Ductus Arteriosus, Coartaction, ASD, VSD, and many many others. Bread and butter NICU issues are hyperbilirubinemia or bili-babies (those under the lights), kiddos working on feeding and growing, and kiddos with minor respiratory distress needing CPAP and high flow nasal cannula. Everyday nicu nursing issues are worrying about respiraoty issues such as "spells" when a baby drops their oxygen saturation you want to check their positioning, their color, and are they breathing too slow (babies respiratory rate is usually 20-60, heart rate 120-180), are they taking pauses in their breathing, do they need to be stimulated to breathe during the spell? Low blood sugar can often be an issue especially on admissions or babies just born and especially with infants of diabetic mothers. Every unit is different but usually a blood sugar under 50 some units under 40 is considered too low and you will be asked to give a bolus of D10 IV fluids. Gut or belly issues are also huge. There is something called NEC or necrotizing enterocolitis (which its complicated but really condensed down) the issue is that their bowel tissue dies and it is an emergency surgical issue usually and infants can often die and die quickly from it so frequent assessment of bowel sounds, belly color, shape, belly girth, are they toelrating their feeds? When did they last poop, emesis, color of emesis etc. Honestly I could go on and on but... This is a ton of info and I basically mention it so you can go off and research further on these topics at your discretion. I wouldn't really expect a new grad to know any of this and its really hard to put any of this information into the correct perspective until you've seen it at the bedside so I hesitate to even tell you all this. Not to mention I am telling you all this at 3am on a night shift and I may not even be giving you that great of information. But I want to give you some things in case it is at all helpful. But as someone who entered the NICU as a new grad three years ago-I cannot emphasize this next part enough- it is not at all what you know going in that's going to make the difference- it's how good of a new grad NICU training program they have and how supportive of you as a new grad they're going to be. I wish you all the luck in the world. Go into your interview just bursting with passion, humble enough to know you have a lot to learn but driven enough to want to do whatever it takes to learn it. Don't be afraid to say you don't know but you aren't afraid to ask, and I'm sure you'll do great!
  9. jpeters84


    ABO Incompatability is one keep searching on allnurses. An old post literally lists like all the possibilities. But the only thing that I could think missing from your list is ABO incompatibility.
  10. jpeters84

    AMA Discharges

    We've had a couple parents threaten and our charge RN let me know that the police would arrest the parents the minute they left the hospital and the child would be brought back immediately to the NICU. The arrest is for child endangerment/neglect and it would immediately become a CPS as well as a criminal issue. I've never had parents actually go through with it though.
  11. jpeters84

    I think I want to be an NNP....

    A couple of things...It's always good to look to the future and think about long-term goals. But at times it can be, let's not get ahead of ourselves here. Becoming a neonatal nurse practitioner is not as simple as going to nursing school, getting your BSN putting in your 1-2 years as a nicu nurse and going to get your master's and bam you're an NNP. That's the bill of goods they sell you in nursing school. You need to work as a nicu rn first ( in my opinion for at least 5 years or 3 years minimum in a large level III lots of acquity academic medical center nicu) and make sure that not only do you like it but that you love it and do you like the role that NNP's play as part of the NICU treatment team. Because being an NNP is a whole lot different than being a nicu rn. Quite frankly I knew all along I wanted to be an NNP but was still very surprised to get a true understanding of what the job really does entail. It's not for everyone. Also getting your master's to become an NNP is not like getting an MD. You will be calling on your solid foundation in neonatal nursing (read: expert level nursing skills) as an NNP on a daily basis. When you go to get your master's its assumed that you have the skills and past experience to back it up. If you don't it's on you. If you have only had a year or two or spent most of your time in a level II nicu but now you're an NNP for a level III nicu you are going to struggle. You do not want to be an NNP that none of the nurses or MDs trust. They will throw you under the first bus they can find. I wish you all the best. I hope this is helpful. I was an older, 2nd degree nursing student. So don't worry about ebing in such a hurry. You have time. This is one thing you can't rush. There's not cheating the experience you need in the nicu to be a truly good NNP. If you're motivated, hardworking, and truly love neonatal nursing I am sure you will make a wonderful NNP in time.
  12. I moved out of state to get a job as a new grad in a specialty that I love. For the most part, I really like the hospital that I currently work at and I am so grateful for the experience and all the training. I am coming up on my two year mark and I'm starting to get itchy to make a change. First, I'm single living in a smaller city with mostly married young families. Secondly, we don't have the consistent acquity that I know that I need to be able to learn and grow within my career. Thirdly, there has been a lot of changes on my floor recently and the moral is low and the relationship between NP's and RN's is not the best. On the positive side my current position is a day position which is so important to me. I just do not function on nights. I really like the other RN's that I work with. And the thought of packing all my stuff and going through another move just does not sound good. I started to apply for positions in my home state but my dream hospital there won't even look at me until I have at least two years of experience and endoresement in that state (CA board of nursing said that takes 13+weeks). I have an offer for a job in Colorado which is one place I've always wanted to live but I find myself so indecisive, so unsure of what to do. On the one hand the job offer in is at a hospital with high acquity. There are lots of young professionals. But it's a night position (as any new job would be). I would have to make an expensive, tedious long distance move. And I would be moving away from my family again. Part of me thinks I should just stay where I am, put in more time, and make the move back to my home state in due time. Part of me thinks that this offer in Colorado is an excellent opportunity and I'd be crazy not to take it. Advice?
  13. jpeters84

    When do you follow your heart?

    Med-surg/tele is a really hard way to start your career, no doubt. Almost everyone that starts on a med/surg floor wants to go to a specialty floor as soon as possible. But two months? You need a little more sticktoitness than that. The first year everyone is just white-knuckling it through. It's tough, demoralizing, and everyone cried uncle at one point and time or aother only to realize that they need to continue to put one foot in front of another and keep going because it does get better. I also imagine you're hitting that point in time when the dream you had of what you thought nursing was going to be slowly fades away and the reality of what it really is presents itself. Running to a new floor may help for a little while but will only be a temporary band aid for what you're feeling. Plus- You were hired and trained you owe it to your manager and yourself to stick it out for at least 8mos-1year. It's great that your true passion is NICU, mother/baby, L&D and at some point in time you will get there. But just because it's your passion doesn't mean working on those floors is going to be all sunshine and roses. As a NICU nurse who always wanted to be a NICU nurse, let me tell you that even when you're working in a specialty that is your passion you hit a wall and start fantasizing about other specialties, other units, other hospitals, other careers. This is the ying and yang of nursing. This is the natural ebb and flow. Sometimes you love your job and sometimes you're looking for the first exit out...Hvae heart. Keep your head down, put one foot in front of the other, and keep going at your current job. Things will get better and before you know it you will be celebrating your 1 year anniversary and you'll be ready to move on.
  14. jpeters84

    Terminated at end of orientation.

    It's interesting that new grads go into orientation thinking they can't be fired. I knew during my orientation that the easiest (in legal terms) time for a hospital to get rid of you is during orientation. The first three months of employment in most states are considered a "try-out" and a company can fire you with needing as much proof as to why you aren't working out. With that being said...I am so sorry that you are having to go through this. I can imagine after all of the hard work of nursing school and dreams that you had for yourself getting fired at the end of orientation is a big disappointment. Instead of getting down on yoruself and asking yourself if you're meant to be a nurse why not look at this as an opportunity to step back and find a more humane first job. I started out in home health and it was a wonderful way to get my feet wet without the immense stress, workload, and time management required of you in the acute setting. Why not try a LTC? There's one thing we always forget in the beginning which is we should be enjoying our careers. The acute floors do not allow for much enjoyment. Taking things slow and giving yourself time to build confidence, skills, and time management in a manageable situation is nothing to be ashamed of. I know a lot of new grad nurses pooh pooh working in long-term care but some of the best nurses I know were smart enough to start their careers that way and make the transition to acute care floors much better than new grads. Just ebcause this one job and this floor wasn't a fit doen't mean there isn't a nursing job out there that will be a good fit. Have heart, keep trying, and keep your good attitude going and you will be just fine!
  15. jpeters84

    Book for new grad in NICU

    It really comes down to personal preference. I much prefer the Core Curriculum for Neonatal Intensive Care Nursing. It's expensive but it's likely what you'll use for review for you're certification (when you're ready) and I found it much more user friendly as a new grad than merenstein and gardner. I would wait before you buy and either check them out at a library or ask to borrow from an educator and see which one you prefer before purchasing. I tried to study before I hit the floor but until you're there getting experience it was hard to place the information in the right context so don't worry too much about hitting the books before you start. Good luck!
  16. I have been one of the lucky new nurses who got my dream job soon after I graduated nursing school. I absolutely love where I work and what I do. I love the people that I work with. I work in an incredibly supportive environment and have some co-workers who have worked for my same unit for 20-30 years that are always helpful and full of knowledge and pearls of wisdom. And believe it or a not there is a really supportive administration at my current hospital. The problem being that I moved out of state for this job. The town where I know work and live is a conservative, religious city where people get married and settle down at an early age. There are literally no signle-young professionals and I'm single and in my early thirties. Also my floor does not get a steady stream of acquity and when we do it goes to the nurses with seniority. I really want to get my master's after I have at least five years of experience but at the rate that I'm getting exposed to acquity at my current hospital I feel like it will take me ten years to get the experience I need to be a good NP. So after just over a year and a half I'm thinking it's time to leave the very comfortable nest at my current hospital and venture to a large city with a large academic hospital where I can get lots and lots of acquity and start dating again. The problem is I'm afraid that I will 1)get my butt kicked since I have it soo good here(not too crazy busy with lots of humble, helpful co-workers) 2) my co-workers won't be nearly as helpful and wonderful 3) I might end up hating my job from the stress 4) that I just won't cut it anywhere else 5) that it's too soon, I'm being impatient, and that I need to continue getting a solid foundation before I move on to a more demanding position 5) that I won't be considered a new grad if I move and I won't get the support that I might still need. I'm not really sure what to do but I can't stop daydreaming about what hospitals I want to apply to and where I might live next. But then at work I realize just how good I have it and I become torn. Thoughts?