littleneoRN

Curious about people's opinions of and experience with transports that do vs. do not include providers (NNP or physician). Our unit has a high transport volume, and all our transports are staffed with an NNP. I know that some of the transport skills are technically within the scope of practice, depending on your state, but I have a hard time believing that outcomes are better ( or even matched) when nurses are running transport rather than NNPs or MDs. But, I don't actually have experience with a unit like that, so that's why I'm curious. This is not to critique transport nurses. It just seems like with all the additional skills required, you're basically trying to make a functional nurse practitioner out of someone and be able to pay them less money. Feel free to refute me!

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.

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.

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!

What kind of place only offers a 30 minute break in a 12 hour shift? We get 1 hour and 15 minutes worth of breaks in that time period.

It seems unlikely that when floating to post-partum you would have a baby-only assignment. Most places do couplet care, so if you've got the baby, you've got the mom. I thought separate baby and mom nurses (after delivery of course) had gone by the wayside. For continuity sake, as a patient, I would prefer couplet care.

I called a nurse manager...not for the unit I really really wanted, but one I thought I would like and thought would be hiring. Turns out they weren't hiring, but she was impressed (with who knows what) over the phone, so she got me an inside contact in HR and insisted that person find me a job. I have now been at that hospital for almost five years and LOVE my job to this day.

One thing I have learned over time is that with *most* deaths in the NICU, we have given everything and the kitchen sink to help this baby have a chance. By the time the baby passes, their chance of a positive outcome is extraordinarily low. This doesn't diminish the loss for the parents, but it helps me to think about the baby experiencing peace after a likely difficult road that wasnt going to improve. I am generally not so much sad for the baby but moreso sad for the hole this will leave in that family's life forever. My spiritual beliefs probably paint broadstrokes into my views on death too, and we all see those things a little bit differently.

I'm not going to judge what's done in other settings, but I have never seen or heard suggested in my unit to "borrow" a med for another patient. I would go as far to say though, that if I were inclined to do this in another setting, I would draw the line at any controlled substance.

NPs have an ESSENTIAL role in my unit. They don't have as much autonomy as other settings, but we would not be able to function without them. They round on stable patients. They place lines, intubate, do LPs, etc. They manage patients on transport. All for a heck of a lot less money than the additional physicans that would be necessary if we didn't have them. Families know and love them. If you don't like the role, don't be one. But you sure as sugar better respect their position in your facility and follow their orders. If you truly just felt that the role didn't have legitimacy, I don't know why you'd be so fired up about it....since it has nothing to do with you. So do you want to fess up a real reason why this bothers you?

2 hours worth of breaks??? How long is your whole shift?

I work in a union facility, and while the union (like anything) has it's downfalls, I thank my lucky stars. Some days when I read things on AN, I hope that people are exaggerating. Sure we are being asked to do more with less, and I don't have any fallacies that upper management gives a care about me. Staffing is not perfect, but I never ever have more than 2 true ICU patients or 3 stepdown. Period. I can make time to pee. I've missed breaks, but I've never gone an entire shift without one. I get paid til I leave, even if it's late. I get paid a healthy wage for my work. I've never been forced or even coerced into working involuntary overtime. I my hospital perfect? No way. But I think some of my worst days sounds like some other peoples' best days other places. Generally speaking, my nurse friends at other local union facilities have simliar experiences. I can not say the same for the one friend I have who works at a non-union facility. I'm not a crazy union person by any means, but they have done a lot for the way nurses and patients are treated.

[quote=NurseKellyH;5535339 *Edit* If you'd really like to look things up to know more about them, write them down somewhere to reference later when you aren't at work/clinical or perhaps even on break and out of sight of people who don't want to see you on your phone at work. Yes and no. I agree that you want to breed confidence, but I'd be more confident in someone who looks up a dose or side effect than someone who writes it down to read later...after they give me the medicine. I tell parents all the time...I don't know, but I'll find out. I am not in favor of the IPod exactly, but I'm even less in favor of discouraging lookning things up. There is just too much to know.

Also, babies are more sensitive to fast infusion rates. We give a lot of meds over 15 to 30 minutes that you would push on adults. Lasix, morphine, etc. Not sure what other places do. We run these on a syring pump. We don't hand flush anything at all into our little 26 g PICCs. Even push type meds use a pump over a few minutes as these lines don't withstand pressure well.

Our pressors run in bags, but they runto a trifuse right at the bottom by the baby. I've never piggy backed anything. I'm not sure how one would piggy back antibiotics on a large volume pump unless it cam in a bag too. Might small bag of Ampicillin for 750 gm kiddo.