NICUNURSE

I also live in So Cal and started in a Level IV NICU as a new grad. If you are going to start in NICU as a new grad, I would recommend looking at one of the Children's Hospitals in the area (for So Cal that would be CHLA, CHOC, Miller's Children's, UCI, etc). Those will be the places that (1) will hire new grad directly into a higher level NICU (2) will provide adequate training (3) have a specific new grad training program

Our LC staff does suggest this to parents. And I have been asked to do this occassionally. That being said, this is not something that I EVER do. Like you, I have yet to see research that says this is safe/effective. Quite honestly, I worry about the possibility of aspiration, not to mention, we just don't have the time to do this (I know that sounds horrible, but it's true). When parents ask me to do it, I tell them that they are welcome to syringe feed when they are on the unit, but it is not something that the nurses do. I've never had a parent get upset with me saying that, but if they did, I would tell them that we do not have a policy regarding syringe feeding, therefore, we are not able to do it (which is true).

This is a bizzare question. Does it really matter when you administer it?

I think that depends. Are the private duty and clinic jobs you have, jobs that require you to work under your RN license? If they are, then you prob won't be eligible for a new grad program. Since most RN's that are going back for their BSN, are working either full/part time, I have to wonder if having a lapse in "real" nursing experience will hurt you when you go look for a job. Can you give more details about your job situation? Why haven't you been able to secure a job?

roseorchid: I'd love info on the company you work for also. I'm in So. Cal. Please pm me!!!!

On our unit, we have a PICC line team, made up of nurses, who change and repair all PICC lines. These are nurses who work on our unit, but have taken a special PICC line class. That being said, changing the dressing is similar to how you would do an adult, except, as someone else mentioned, we don't leave betadine on the site. We usually clean with two alcohol swabs, then three betadine, let that dry and then clean with the remaining alcohol. The actual line itself is secured to the skin with steri-strips, NEVER tape. Then we cover w/ tegaderm. Our dressings are changed on a PRN basis. As for removal of the PICC, we as RN's are allowed to remove them unless it was a cut down PICC line, in which case either the NNP or MD removes it.

On our unit, we routinely run our pressors through a central line. PIV's are used only as a backup. And truthfully, I feel a lot more comfortable using a central line, as PIV's are so darn tempermental (positional, blow easily, etc.). One thing that someone else commented on...We run our pressors with our TPN and Intralipids. With a central line, we'll hook up a double lumen connector to the T-connector and Y in TPN and IL to one port and Y in Dopa, Dobuta to the other port. Never had a problem with incompatabilities. Just for clarification..Are you guys saying that you never Y in anthing else to your line with pressors? Because of limited access, if meds are compatible, we will Y in antibiotics to our central lines, even if we have pressors running (never an IVP med, but always on a syringe pump). Never had a problem with administering a bolus of the pressors when using this method.

Before last week, we just double checked meds such as narcotics (when taken out of pixsis), K, insulin, etc. As of last week, we now have to double check ALL meds, po meds included. Evidently, a nurse made a BIG med error. We put up approx 24 hours worth of drip meds (fentanyl, versed, mso4, etc). This nurse thought she was putting up an antibiotic to infuse over 30 minutes. It turned out to be her 24 hours worth of fentanyl that she put up and ran over 30 minutes. Unfortunately, this kid was not intubated, the rapid infusion caused chest wall rigidity and the kid wound up coding. Luckily, he wound up being okay.

I can't lead you to a specific article, but I know our attending said that an article he read stated that a CRP is actually more indicative of the previous 12-24 hours. So like Tiki said, a high CRP would mean that approx 12-24 hrs prior, the infectious process began. So I would think that a high CRP in a baby less than 25 hours would be inconclusive because you wouldn't be able to rule out some maternal factor causing the elevation. That being said, we still routiney check a CRP on all admits, many of whom are less than 12 hours old.

I work at a Children's Hospital, so with that said... The ICU nurses float only to other ICU's and the floor nurses only float to other floors. So as a NICU nurse, I can get floated to PICU or CTICU. It's kinda scary, because even though I work in an ICU, the CTICU is completely different that NICU. Truthfully, I'd rather float up to the floor any day.

Thank you guys so much. I've never heard of the TB syringe or the cath trick! I love my allnurses buddies!!!

Okay, I have a really dumb questions, but bear with me, I'm still kind of a newbie!!! I had an ex- 26 weeker the other day, who is now about 34 weeks (corrected). The other day, the NNP ordered a suppository (glycerin slicer). So as I'm attempting to do this, I'm thinking, there is no way I'm gonna be able to get this sliver in there. I know with adults, you can use your finger to push the suppository in, but what do you guys do with little preemies?

Enfamil has a wonderful parent book. The language used is very appropriate and it goes through just about everything that they can expect to see while their baby is in the NICU. What I like is that they use the medical terms that they will hear, but then explains what those terms mean in lay terms. You might want to ask your rep for one and incorporate it into your binder. On our unit, we have a welcome letter for our parents, telling them what the NICU is, who they will be interacting with (Attendings, residents, RN's, NNP's, etc.), unit policies (handwashing, visiting hours).

Wow, I couldn't have said it better myself!!! Working in OB as a CNA, I had a patient pass a clot as big as a cantelope. Not much grosses me out, but that one got me.