Anaclaire

In a Georgia NICU Level 3 30 bed NICU I worked in there were 2 LPNs who had been working there for nearly 20 years. They were not transferred to Peds or Mother-Baby Unit but were only allowed to care for feeders & growers. Our policy was that if they left, they would only be rehired if they had their RN. Any new nurses hired into the NICU were to be RNs or RN students in their second year of nursing school. There are only RNs in the the NICU here in my new town in Alabama which is a Level 3, 25 bed unit. Both of these hospitals hire LPNs to work in their Mother-Baby Units and Post-partum and Well Baby Nursery. (One hospital has a mother-baby unit where post-partum and well baby nursery are essentially combined and the other is the old-fashioned separated way.) So, luvbug, this very non-scientific poll here at allnurses neonatal nursing board seems to confirm your suspicions that an RN degree is probably needed if you want to work in a busy NICU. In smaller towns I'd expect you'd have a much better chance of working with babies either in a nursery or in L&D, but I'd bet they'd be healthy babies and any really sick or preemie ones would be shipped away to a larger hospital which is equipped to deal with such illnesses and preemie needs. Good luck and please visit us here often!!! :)

our hospital stopped insisting parents and visitors wear gowns back in the early 1990s after some study showed they made no difference in infection control... seemed to be a hold-over from the 1940's and 1950's. we do however keep gowns available for parents/visitors who's clothes are not reasonably clean (mechanics with axle grease on their shirts, etc.). our parents/visitors must wash their hands well before entering the nicu each time. we have never (since 1991) in our nicu been allowed to wear watches for infection control reasons. our higher-ups say that our watches often touch one baby or one baby's isolette insides and can then transfer bacteria to another baby since we aren't washing our watches between babies. i don't know how true that is, but i simply complied and didn't wear a wristwatch. many of us, especially transport nurses, wear lapel watches. i hang one on my right front chest area since i tend to hold babies on my left shoulder area. i also wear my name badge and anything else that could protrude and bother/hurt the baby, on my right side as well. our nicu has clocks on each wall and they are all set the same and controlled by a central clock in our maintenance area. works pretty well. we are allowed to wear wedding bands if they are plain ones, but no rings with stones in them. supposedly the bacteria is nearly impossible to remove from the area under and around the stones. i used to date a jeweler and he showed me how truly disgusting the layers of dirt, oils, shed skin cells, lotions and other "stuff" that collects in the underside of rings can be. it can be absolutely gross sometimes. lots of our nurses didn't wear their wedding bands either. a couple of nurses lost theirs when they pulled of their gloves in a rush and the ring came off with the glove. one nurse lost hers down the laundry shoot! many nurses use a large safety pin to pin their ring and watch to the inside of their scrubs pocket... in case the pin comes unhooked, the ring/watch will fall into their pocket. as far as the water issue goes, our higher-ups thankfully consulted us when designing our new nicu a few years ago. they designed a counter which fits along one wall outside of the intensive side of our nicu where we can keep drinks including water, sodas, coffee, etc. we have a nice coffee pot on the counter, and our breakroom (which houses our refrigerator, restrooms and dining table), is just on the other side of the counter. also the counter has windows all along the top third so we can see into the nicu when taking a sip. (under the counter is a bunch of drawers and cabinets we use for all kinds of storage.) the counter/window area is not where visitors or anyone else can see into the nicu. osha regulations in our state say we cannot have food or drinks in the same area where body specimens or drugs are handled. we are incredibly fortunate to have the ability to grab a sip of water so readily! another thing they did when designing our nicu was to install our own air conditioning and heating unit which keeps the humidity set at 30% (i believe) which is optimal for the babies. helps us too because humidity can be awful in the deep south! :)

Will one of the 7 lawyers be there representing only you? I've never been in such a situation but it seems like a good idea. From what I've known of in the past, hospital attorneys will try to protect nurses but seem to put the hospital and the physicians first on their list of who to protect the most. Did you have your own malpractice insurance? You could get some great answers and assistance from them if you do. I love the advice given by ?Burnout above. The less you say the better. Taking deep breaths and taking your time will help keep you from being flustered and looking nervous. I'll say a little prayer for you next week too. Wishing you all the best!!!

Our float areas include staying within our "sister" units of the Maternal-Child Department. (Our hospital is a 650 bed hospital with a 26 bed Level III NICU.) Most of us float to the Transition Nursery which is mainly staffed by the Mother-Baby nursing staff. Sometimes we'd find ourselves in the Well Baby Nursery of the Mother-Baby Unit. These are our two main places to float to. Those with experience in post-partum can go to the Mother-Baby Unit and care for moms and their babies. We are encouraged to try to cross train in L&D since we often find ourselves there anyway attending high risk deliveries. We began by doing vital signs, gofer work, and would progress to watching over stable undelivered patients while a L&D nurse practically held our hand. It is also a good way to get to know the L&D nurses on a more personal level which is helpful for increasing teamwork between the units. Our GYN floor, which takes care of mostly women with hysterectomies, D&Cs, ectopic pregnancies, breast surgeries, and other female-related complaints was another place we can go if we have some experience there... this is extremely rare for us though. Although many NICU nurses are uncomfortable with caring for adults, I've noticed that we do much better generally with adults than the adult nurses do with working with our babies. Hardly anyone wants to come to the NICU. Usually its the nurses from the Mother-Baby Unit who already really enjoy and feel pretty comfortable with healthy babies. We give them some easy growers and feeders when they come to help us out. The monitors often make them uncomfortable since they don't have babies on monitors in the Mother-Baby Unit nursery... Although floating can be unnerving and something we don't really want to do, it's still a good idea to do it once in a while. It shows you are flexible and willing to help out your manager and other departments when there is a need. It also gives you a chance to meet other nurses and to learn more about other units. It can be helpful in the future since we never know what the future holds. It's always nice to have a first-hand look at other nursing areas in case a NICU job isn't available to you sometime in the future. Just being able to say you floated to another department can be a plus. Managers appreciate flexible nurses with positive attitudes and often remember this at yearly evaluation time. Just be careful not to be the first one they call when they need to find someone to float away from the NICU. That can happen easily and you can get abused that way. After all, we work in the NICU because we love it there and if our unit is required to float, then everyone should take their turn fairly. Sorry this got so long. Hope I answered your question.

I've been "out of the loop" for almost 3 years, but I remember some of the mothers of our preemies being prescribed Reglan (Metoclopramide) by their OB-GYN doctors to help increase their milk supply. Sometimes it worked. I searched the internet a bit and found a mention of a new drug I'm not familiar with called Motilium (Domperidone) which is approved for use as an anti-emetic (it's a dopaminergic blocking agent) that has been mentioned as being helpful in assisting mothers to increase their milk supply. Check out these links: http://asklenore.info/breastfeeding/domperidone.html http://keepkidshealthy.com/breastfeeding/guide/domperidone.html http://www.keepkidshealthy.com/breastfeeding/guide/breastfeeding_problems_II.html I noticed both of the articles on the drug were written by Jack Newman, MD... one dated 2000, the other dated 2003. One of the links mentions some herbs that can be helpful. We sometimes had OB-GYNs who were reluctant to prescribe medications to moms for increasing their milk supply, even though they had tried everything first. (We considered those OBs as old dinosaurs living and practicing medicine from the dark ages...LOL). I've known some women for whom the herb fernugreek worked quite well. I hope someone else will answer your post because I'd love to know about any new drugs which can be helpful in this situation. Of course we know how important it is to try all the other non-pharmaceutical ways to increase milk supply first... Some moms wanted to take a pill first instead doing all the other time consuming hard work that comes with implementing the non-pharmaceutical interventions. Sometimes it's difficult for them to do the work involved to overcome their depression and/or anxiety of having a preemie in the hospital, their lack of sleep, having to return to work, taking care of their other children, yada yada... I don't blame them a bit! Thanks for sharing your insight! Looking forward to hearing from other posters on this subject! :)

Level III NICU ~ The nurse assigned to the baby is responsible for transcribing the medication order onto the Medex. We also calculate the dosage and write it there too. A second RN or LPN must also check the order in the chart and compare it to what's written on the Medex, calculate the dosage too, and then both nurses place their initials on the Medex. Mother-Baby Unit ~ The primary nurse was responsible for her patient's medication orders being placed on their Medex, whether she or another nurse (LPN or RN) actually did the transcribing. Two nurses had to initial the Medex verifying the order was transcribed correctly. May I ask, what changes has your facility made recently, and what type of facility do you work in?

Thank you all for your responses. It's a very curious thing isn't it? I think I will contact our Alabama Board of Nursing to see what they have to say on the matter. They also use the terminology "CEUs" when telling us how many we need for license renewal, etc. Thanks again. I hope maybe someone else has a clue for us! It's a mystery for now!

I was wondering what the difference is between CEU's (Continuing Education Units) and CNE's (Continuing Nursing Education Credit)... My continuing education credits have always been called CEU's. Could CNE's be a Canadian or some other country's term for what we consider CEU's? The way I found the CNE term was while surfing the net tonight I went to the CDC website and found they offer some free continuing education programs. When applying for the credit you must check a box describing the type of credit you want. 1. CNE's 2. CME's 3. CEU's (The CME's are for physicians... I understand that.) What was interesting is that the CNE's offered larger credits than the CEU's... for example the same course would offer "1.6 contact hours" for CNE's, yet would offer "0.1 hour CEU's". Since I've always used CEU's I will check that box when applying for credit, but I was just wondering... Does anyone know the difference between CNE's and CEU's? Thanks for any information... I'm a curious kind of girl...

I spent 2 1/2 years in the NICU before taking my RNC exam.

I have my certification through the National Certification Corporation (NCC). They specialize in Maternal-Child Nursing areas. Mine is in "High Risk Neonatal Nursing". This certification body gives us the ability to use the initials "RNC" behind our name. (eg: Jane Doe, RNC) Different certifying bodies have different initials, so you may see several different ones through the years. Also, the NCC has a special certification program for Neonatal Nurse Practitioners too. Before being allowed to take the test, we have to have our manager fill out a paper verifying we have had at least 2 full years of recent full-time nursing in our specialty area, so it's not like something you can do as soon as you get out of school. The test costs a lot to take and is very difficult. As a comparison, the NCLEX-RN basically tests for "minimum competency" which shows you are "safe to practice nursing". It's like having to pass the test with a C. Certification tests, on the other hand, test for "expertise" in a "specialized" area. It's like having to make an A+ on the test. At least this is how I understand it. Our hospital reimbursed us for our test fee, travel and hotel room fees if we passed the test. We also received a $500 per year bonus once a year. Our Clinical Ladder Program included certification as a way of reaching a higher rung... leading to more money and recognition. It also looks good on a resume. I was fortunate enough to pass my exam on the first try, but not all people are able until the second time. Some never pass and decide not to try anymore. Remember some of us simply don't test well. Anyway, it feels good when you've been a nurse for a while, to have something to do to help validate your feelings about your work and knowledge. Kind of a pat on the back. We need things in our profession to help us feel like we are continuing to grow professionally. By the way, a person can be certified in many different areas. My sister has her certification in Pediatric Nursing (from another certifying body) as well as her High Risk Neonatal Nursing certification from NCC. Most people keep their certification current by submitting continuing education credits to the certifying body every 2-3 years and paying a fee. We can always let our certification lapse if we choose to. In case you are interested, here is the web site: National Cerftfication Corporation Hope this has answered a few of your questions. Wishing you all the best in your nursing career! Sounds like you are a real go-getter and I'm expecting you to have your certification someday too. :)

The best NPs I've worked with had 3 to 5 years experience "in the trenches" before continuing their education to become NPs. They were much more aware of the reality of patient situations and how their orders and input would assist the patient and staff to do the best job possible. They also had excellent technical skills and could come to the rescue when a difficult procedure needed to be done. They seemed to be calmer and more in control during crisis situations also. Needless to say, they instilled confidence in their co-workers and were much more respected by the staff. I know it doesn't seem fair, but in general, people expect an "advanced practice nurse" to be more knowledgable, more 'together', and more of a role model who earns respect of their peers. Also, I've heard many of the NPs complain that they don't receive the pay or respect they deserve for the work they do, and I know a couple who have quit being NPs because of it. They tend to have to work off shifts and pull long hours... our physicians tend to use them as their "fill-ins" and from my point of view, they were often "used". We loved our NPs and supported them in every way we could. Just sharing my experience... Wishing you only the best in your nursing career!!! Warmly, Anaclaire

My husband works for the post office (not a letter carrier) and I posed your question to him. He said, "Go for the nursing. The future of the post office is grim... becoming obsolete... and benefits are in major jeopardy even with the union." His two cents. You must ask yourself which YOU prefer to do. I suggest everyone do what they love and the happiness and material things will follow. Good luck on your decision!

My husband works for the post office but isn't a letter carrier. He's been there 16 years. From what I've seen, I'd rather be a nurse. In the post office you are nothing but a number... government... you know... Tough decision though. How much do you want to be a nurse? My husband just walked in the door. I asked him your question and he says to go for the nursing because the Post Office's future is shaky... becoming more and more obsolete... benefits will be decreasing, etc. So, now you have two people's opinions... Good luck!

MattsMom, That's a GREAT saying!!! First time I've heard that one and I will commit it to memore immediately! Thanks a bunch! Anaclaire

Albirdie, I agree wholeheartedly with everything MattsMom said. I worked in a hospital while in nursiing school as a Nurse Tech which is what I think an extern is today... anyway... my point is that I ran into basically 3 kinds of nurses: One absolutely horrible, mean, smart-azz who made me feel like a pure pain in her bum. I'll never forget how mean she was to me! A bunch who were friendly and nice but never seemed to have much time for me. Sure, they'd answer my questions but the answers would be brief or not fully complete for my needs. There was usually one who was "assigned" to me and that one would be the most helpful. And then there was the warm, bright light of a nurse who made me feel confident, worthy, and needed. She set a shining example for me to follow, always had time to answer my questions, show me things, teach me tricks, the whole shebang. Of course she didn't work every shift I did, but Gosh I was sooooo glad when she was working my shift. I found this general group of nurses to be the same in every different unit I've worked in... they just had different names. Some personalities mesh and others don't. Seek out the people who are helpful and make a mental note of those who are less than best for your needs. I do believe that my experience with the nurse from heck caused me to understand what "nurses eating their young" meant and also made me be especially aware of how NOT to be when I became a nurse. I should thank her today because she had a lot to do with me wanting to become a preceptor and mentor once I became qualified to do so.... I want to be the helpful nurse, not the battle ax! Hopefully you will learn something about group dynamics and how the real world is during this time. People are people... not everyone will like you and you won't like everyone else. That's only natural. Just don't burn any bridges.. if you can't say something nice to a co-worker then don't say nothing at all.. never let them know they bother you in the least! Hang in there! It sounds like you are a very caring and consciencious person and will make an Excellent nurse for many years. Oh, by the way, I hadn't made my decision about where I wanted to work when I graduated while I was an extern... for all they knew I wanted to work on that unit. Thankfully working there I learned my personality didn't mesh as well with theirs, so I cut my losses and took my chances in another unit when I graduated. My nurse manager was disappointed, but when I got to my new unit I was as happy as a clam and found more nice nurses, a fantastic preceptor/mentor (who I am still in contact with 14 years later although we live in different states now) and the battle ax nurse on the new unit was much more bearable!! LOL. Warmly, Anaclaire