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PrudenceNurse

PrudenceNurse

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  1. PrudenceNurse

    My Inspiration to Become a Nurse

    I write fiction. I could compose a lovely story about the magnificent women who inspired me to become a nurse. I could tell you in poetic prose about their near-saintly lives, deep caring for their patients, and a profound love of humankind. It would not be difficult to embellish this tale in such a way that a tear might come to your eye as you read about these epitomes of professionalism and compassion. I write fiction. But in this case, instead of an idealized nursing story, I’ll tell you what really happened. I don’t really know why I chose to be a nurse. I was a Candy Striper volunteer in middle school and early high school. It has always seemed natural to be a nurse, so maybe I didn’t choose this career; possibly it chose me. However, there were a few women whose presence affected the course my young adult life took; either positively or negatively, their actions motivated me to be a nurse. The First The first person who contributed to my path toward nursing was my best friend in high school. It was the Summer before our first year in college and I had signed up for the pre-requisites to be a Radiology Tech. One day, completely surprising us both, I told my friend I did not really want to shoot X-rays for the rest of my life. Stunned, she asked me what I did want to do. In a rare moment of self-awareness, I told her I wanted to be a nurse, but I was scared I could not do it. She did not hesitate before telling me that I could do it, that she thought I would be a wonderful nurse, and that I should go and change my major the next day. And here I am. The Second The next woman who was instrumental in my career in this field was my grandmother. I have pictures of her in her twenties in a starched white uniform and hat, white shoes and stockings. Her title was ‘nurse’, though what training she had beyond high school is unclear. Her patients were residents of a state asylum for the mentally ill which was founded in 1869. My grandma was born in the first few years of the new 20th century, so she would have worked at the Anna State Hospital in Illinois in the nineteen-twenties. If I was writing fiction, I would tell you that I became a nurse after seeing pictures of my grandmother in her ‘whites’ and hearing how she attentively cared for her charges, thoughtfully ensuring that each of them had daily time outside in the fresh air and natural light in accordance with the ‘Kirkbride Theory’, a popular approach to the healing of the mentally ill during that time. Again, that’s not true. The only stories I have heard about my grandmother’s job in the asylum were that she worked nights and that she met my grandfather there when he began working as an orderly. The words that my grandma spoke that contributed to my 36-year career as a nurse were not ‘inspiring’ as such. What she said to me when life was really difficult and I didn’t know how I was going to manage a full-time job, family, and school was: “If you quit nursing school now, you’ll never go back.” Being the rebellious sort I am, I had to do it then, so though it took me seven years to complete a four-year program, I did indeed finish my BSN--just to prove grandma wrong. That was probably her plan in the first place; though I’m sure she never took a psychology class, she was smart about things like that. If she had not provoked my obstinate nature, I might have gone on to work in a bank, sell shoes, or manage an apartment building, all of which I did while in school. But here I am. The Third The third woman who influenced me was my first med-surg nursing school instructor. I don’t know if she was ‘burnt out’ and needed to retire, didn’t like me personally, or was just trying to weed out as many members of my class as she could, but she bullied and frightened and threatened me and a few other students for an entire semester. The culmination of that class was her question to me, “What are you going to do after graduation, Linda? You certainly are not going to be a nurse.” All these years later it would still be satisfying to call her or write to her and say just one thing: Well, here I am. The Fourth The fourth woman whom I credit for my career was an obstetrics instructor who actually was professional, compassionate and caring to her patients… and her students. She helped me by encouraging me to go ahead with my senior year despite the fact that the due date for my second child—much loved but not well-planned—was the day after my potential graduation. (My son actually managed to time it a little better than that; I received my nursing pin and lit my Florence Nightingale lamp with my class on Friday and he arrived on Monday.) Thankfully, I believed that instructor when she assured me that I could do it, just as I had believed my best friend seven years before. They were both right, because here I am. No Regrets I’ve never regretted becoming a nurse. This job has brought me joy, fulfillment, connection, and friendship. It has helped me to develop self-awareness, integrity, and empathy in addition to giving me a body of knowledge and skills that is still growing. I’ve also left work many days in tears of grief, frustration, or anger. Does all of this sound familiar? It sounds like life to me, and here I am.
  2. PrudenceNurse

    Pulse Oximetry

    In our unit, the Respiratory Therapists have NOTHING to do with the pulse oximetry. We are responsible for rotating sites and for adjusting FIO2, etc.
  3. PrudenceNurse

    HELP! Ostomy bag will NOT stay on!

    How about the "Eakin ring"? It is a moldable pectin-based substance. You can roll it (like playdough) into a "snake" and then mold it around and between the stomas to form a flatter surface that bags will stick to better. I've also tried using a "No-Sting Barrier" on the skin; its not an adhesive, but it makes the skin a bit tacky and things seem to stick better. It also of course is a skin protection, so it's win-win.
  4. PrudenceNurse

    Preceptorship in NICU - waste of time?

    Our Level 3/4 NICU does hire new grads, and we would probably be more likely to hire someone who had done an internship (or preceptorship as you called it) in our unit over someone who had not.
  5. PrudenceNurse

    NG/OG tube verification policies

    We don't have a written policy (perhaps we should), but we teach that aspiration is the best way to verify placement. Auscultation is not very accurate, especially in the micro-preemies, because if the tip of the tube is in the esophagus, you can still hear the air when you listen over their stomachs.
  6. PrudenceNurse

    Urine culture in micopreemies

    We have an "in and out" catheter kit that comes with it's own little test tube/collection device attached. It is clear plastic and comes in size 5, 6 and 8. Sorry I do not know the brand, but can find out for anyone interested.
  7. PrudenceNurse

    Skin care for Premature Neonates

    What exactly is a "bio-occlusive dressing"? Tegaderm? Please give more details/examples?
  8. PrudenceNurse

    Skin care for Premature Neonates

    We have Extremely Low Birthweight Guidelines that include: no leads; "soft touch" pulse ox probe with no adhesive; mist tent for 72 hours; after initial bath, water only (no cleanser) for two weeks; remove all Betadine/Chloraprep with sterile water ASAP; Extra Thin Duoderm under ET tube tape;and AVOID ALL TAPE and TEGADERM on the skin, which goes for all of our patients, not just the ELBWs.
  9. PrudenceNurse

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

    I started in a NICU as a new grad 27.5 years ago, and have no regrets. I would NEVER want to do any other kind of nursing. I have never had a problem finding a job in any part of the country. I got an MSN in Nursing Education in 2007 and have done some clinical teaching (in Peds) at a community college in addition to doing a lot of staff education in my NICU through the Best Practice Commitee. Listen to your gut; you will make the right decision for you!
  10. PrudenceNurse

    How often do you change clear fluids? Pressors in particular!

    We zero all fluids on pumps at midnight each night.
  11. PrudenceNurse

    How often do you change clear fluids? Pressors in particular!

    We change all lines/tubing only twice a week on Saturdays and Wednesdays as a part of a CABSI initiative. New syringes/bags of course must be put up every day. For the extremely fragile baby on pressors, you can make a whole new set of fluids and meds in their tubings on a different set of pumps, get them running and then just do a quick switch of everything down at the clave. Then disconnect and discard all the old stuff and take away pumps. This gives the baby basically NO time without his/her pressors or prostin or epi or whatever.
  12. PrudenceNurse

    Feeding Protocols

    One of our NNPs developed a great feeding protocol that the nurses "order" everyday after calculating volume based on mLs/kg/day. We have the same stops and starts with the micropreemie, but it has made it very easy because it is nurse-generated. Readiness to feed is sort of individualized and different from attending to attending, but basically we feed EARLY unless the baby is on pressors or Indocin, or is having a lot of As and Bs/decompensation. They are divided into 3 protocols based on gestational age at birth. I can get a copy, but I assume I must ask someone's permission to "share". Also, how would be the best way to post these?
  13. PrudenceNurse

    What to use on the nares to prevent breakdown of skin

    We have the same problem with RTs in my unit. I do what you do--put on Duoderm and switch from prongs to mask frequently myself. The other compliance problem we have with the RTs is their refusal to put ExtraThin Duoderm on baby's cheeks under their ET tube tape. We have had bad skin tears when the stretchy brown tape is removed from the face during retaping or extubation... What do you do to protect the face?
  14. PrudenceNurse

    What to use on the nares to prevent breakdown of skin

    We actually DO use Duoderm, but we use the ExtraThin Duoderm that is "breathable". If you cut it into an inverted T shape you can put the horizontal part of the T over the philtrum and run the vertical part of the T over the septum, securing it at the middle of the nose. We have also had good results from using a product called Cannulaide. It is a hydrocolloid like Duoderm, but it is already cut to fit noses. It comes in 4 sizes, I think. The only problem with it is if you use a "mask" or "pillow". The holes cut in the Cannulaide are for prongs, so you may get some occlusion when using the mask. Also the humidity builds up under the mask and makes the Cannulaide gummy. This could actually end up leading to maceration of the skin, so watch out for that.
  15. PrudenceNurse

    I NEED ADVICE on URINARY CATHETERS

    What antiseptic is everyone using for insertion of urinary catheters? Betadine? Chloraprep? CHG handsoap? For daily care, just baby soap and water like a bath, or more antiseptic? Also, is anyone using an actual Foley catheter and blowing up the balloon? Traditionally we have used feeding tubes and just secured them externally. But we now have Foleys (with balloons) down as small as 6 French. I am concerned about the safety of blowing up the balloon. Am I just an old overcautious nurse? :) Thanks for your help.
  16. PrudenceNurse

    preventing CABSI

    We are doing a quality improvement program in our NICU to decrease our Catheter Associated Blood Stream Infection rate. I would love any information from other units about how you do line changes and how often, closed medication systems, sterile versus clean, etc. Please respond directly by email if possible; it is sometimes hard to follow these threads for this old nurse! ldenton@unch.unc.edu Also does everyone filter their intralipids? And what type of filter is used? We have separated our HAL from the IL and find that the filters on the lipids are clogging up. Thanks for any help you can offer.
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