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littleneoRN has 6 years experience and specializes in NICU.

littleneoRN's Latest Activity

  1. littleneoRN

    Parents who are controlling

    One of the unique things about NICU is that in the start, we truly know more about someone's child than they do. That and the fact that we can pretty carefully control this tiny little human and their environment tend to make us fairly anal and controlling. Although this is well-intentioned, I think it also makes us prone to forgetting that this is their child, and they do have the right to be involved in and make decisions about the child's care, even if the decisions aren't always the best ones. Just like I can go to the doctor for some depression issues but then elect not to start taking anti-depressant medication that they recommend, a parent can seek care for their child but not always follow all of our recommendations. I don't believe we should cater to demands that are inappropriate. For example, the physician is responsible for the meds that they order, so they shouldn't order something that's inappropriate, even if the parent wants it. However, if I tell the parent that I am making an effort to keep things dark and quiet so the child gets a good nap, and I tell them why, they can still choose to wake up their child. I will do everything possible to help them make a healthy decision for their child, but in the end some of these things are their decisions. Don't you all ever ask questions about your doctor's recommendations and even challenge or disagree with them sometimes? I have found that variations in the way I phrase things can make a big difference. For example, my new little patient's mom really wanted to hold him today. I could have said, "He's not ready to be held." or "He can't handle coming out yet." We say those things all the time, right? Instead, I said something like, "I would love for you to be able to hold him, and I'm sure you're really looking forward to it. I know it would be great for both of you. The actual snuggling part would be wonderful for him, but I am a little worried though about how he would handle the transition between the isolette and your arms. I noticed that when I do small things like turn him in bed, his oxygen levels drop quite a bit. I think it's going to be better for both of you if we pick a time when he is showing that he does really well with activity before we make a big move." This mom responded really well when she saw that I was paying attention to her baby individually and wanting the best for him. I'm not trying to say that I say everything right. I have just paying a lot of attention to my words lately, and I have noticed that parent responses seem to really depend on how I phrase things. I guess if I was sitting at my child's bedside for weeks on end, I would probably have a lot of opinions (some misguided) about their care too. And I probably wouldn't respond very well to people who were very sure that they knew my baby and what was best for him/her better than me.
  2. littleneoRN

    Breast milk via GT

    I don't understand why anyone would be putting more milk in the feeding bag or syringe than the patient is due to be fed at that specific feeding. Take 135 mL out of the refrigerated supply and leave the rest refrigerated until the next feeding. Next feeding comes and you use the end of that bag and the start of a next thawed and refrigerated bag. Forgive me, but I don't understand why that wouldn't work.
  3. littleneoRN

    Nurse fired over treating Muslim women

    Careful, here. It's not "Our way or the highway." We are a diverse nation. We may have a mainstream culture, but we have a lot of other cultures within our macro culture, and we need to treat each other respectfully. I worry when I see the "us vs. them" mentality start to peek into the dialogue. We are all "us," and just because someone else's ideas aren't displayed prominently in mainstream culture doesn't mean they don't deserve respect or don't have any place in our country. That said, this firing sounds a little fishy. The whole thing sounds fishy.
  4. littleneoRN

    RN Lactation Experts To Be Replaced

    The 5 day curriculum for CLCs does not even hardly begin to cover the issues addressed in the NICU population. I agree that the IBCLC certification contributes much more to the knowledge of breastfeeding than the RN license. However, in my opinion, an IBCLC who works with mothers whose infants are in the NICU should ALSO be a nurse with NICU experience. The range of issues with these infants is complex and requires additional knowledge and attention not required by typical nursing mothers and their infants.
  5. littleneoRN

    Patient dies after nurse administers pancuronium

    Pancuronium, rocuronium, and vecuronium are all pretty readily available in our ICUs, and often there is a multi-use vial at the bedside of patient's requiring intermittent paralysis. This seems to be a case of shortchanging your five rights, unless the medication was mislabeled. I would venture that any patient who has any paralytic available on their MAR should already be sick enough to be on monitor. What I think is interesting is how this article highlights pancuronium only as the drug used for lethal injections. At least twice. Couldn't they have described it as a medication commonly used in the ICU? They sort of make it sound like something that shouldn't even be in the hospital....unless the hospital is in the business of euthanasia. Just kind of weird.
  6. littleneoRN

    little clamps on peripheral IVs and PICC lines. . .

    When in the process you clamp (before or after removing flush syringe) depends on the brand of cap. Some are positive pressure caps and require a different process than the other ones, which I think can be neutral or negative. I do now know the ins and outs of all this, but it makes it important for you to know what brand cap you have and the specific process for that type of cap and the associated line. Check with your unit educator on this one!
  7. littleneoRN

    car seat challenge/test

    Manufacture or expiration date....whichever the seat has. The standard they use is 5 years unless otherwise marked.
  8. littleneoRN

    Fighting Infections with Duct Tape and Q-Tips

    With contact precautions, per policy, we've never had to gown if we're not touching patient or environment....so to peek in and ask a question, no prob! No duct tape needed either.
  9. littleneoRN

    Research for NICU Tourniquet

    We use rubber bands too. We also cut tiny strips off big kid blue tourniquets. Either works fine. Sometimes it's hard to get it tight enough without pinching their skin, I guess... ETA: Any buckle or velcro would have to have quick release cabilities, just like the good old fashioned rubber band.
  10. littleneoRN

    One in four RNs wants a new job

    I like my job, generally don't mind my hours, generally get my breaks, and have adequate supplies and resources to do my job. Staffing isn't always perfect, but it's only when we're crazy busy and can't find more nurses to pick up. I love what I do and am 100% satisfied with nursing.
  11. littleneoRN

    NPO/clear liquid status during labor - evidenced-based?

    No one said anything about continuous monitoring. Maternal and fetal monitioring in hospital could include physical assessment, maternal vital signs, cervical assessment, intermittent monitor or auscultation, or continuous fhr monitor. Expert assessment and support without unnecessary intervention will certainly improve outcomes. Advising moms who desire a hospital birth and care to stay at home til near crowning is potentially harmful advice. Will you be there to catch the baby born on the side of the interstate?
  12. I'll be the first person to admit that I have just a scrap of the knowledge that our docs do due to their education and experience. That said, I know what they will order/do in most of our daily situations with our typical patients. I feel confident that I could provide the basic appropriate care given no legal limitations, but I also feel confident that the situation turned atypical for any reason, I'd be VERY glad to have one of our docs there. And I'm perfectly happy to contribute my suggestions as part of the team...and have them right here doing there job.
  13. littleneoRN

    Can I carry my own pulse ox?

    Our unit is actual quite high acuity too (despite the fact that some people don't think we do anything except rock babies). Most parents are pretty good about staying out of the way as needed. They have a fold down couch and can be there pretty much any time....we ask them to leave for x-rays and sterile procedures. Codes...it depends on the situation. We have been known to bring a parent to the head of the bed to hold a hand, talk to the kid, pray, whatever, if space and logistics allow. Space can get tight with 2 or 3 vents, a big IV tree, nitric, a cooling blanket, etc... An ECMO pump pretty much maxes us out for space. But visiting for parents is unrestricted 24/7. Having only worked in peds, it's hard for me to imagine not involving family in everything all the time. Sometimes certain family members can get frustrating, but I don't think I could ever work in a unit with such strict visiting guidelines. Even for adults.
  14. littleneoRN

    Can I carry my own pulse ox?

    Anyway, this has sort of hijacked the thread...feel free to carry on with the original question. :)
  15. littleneoRN

    Can I carry my own pulse ox?

    We have high risk moms on bedrest for weeks/months. They tend to feel better if they can take care of themselves like they would at home. And in a pediatric facility we have parents who room in with their kids who use many of those things. I guess I will consider us lucky to have a very family centere policy on this. We have dads who sit at the bedside of their sleeping babies and work remotely on their laptops. I'd hate to tell them that laptop wasn't allowed in. But I'm dealing with a whole different crowd here....long term stays, patients who come with parents, and every attempt to encourage their presence and involvement.
  16. littleneoRN

    NPO/clear liquid status during labor - evidenced-based?

    Actually, most of the babies that I've cared for who are born by emergent CS under general were not born at our center. Rather, they are women previously identified as low risk and laboring at small hospitals. Because, by nature, if the CS was unexpected and emergent enought to require GA, you probably didn't have any reason to plan to deliver at a high risk place. The elevated CS rate at our center would be due to identified conditions, not emergencies. (i.e. placenta previa, maternal CHF, etc.) We don't see many women go under general in our hospital. Once again, I haven't researched this and don't necessarily advocate NPO. Just throwing my 2 cents in about who ends up with crash CS.