Sun*shine

Congratulations on your interview. I'm an Adult Nurse who started in neonates last year. Are you a nurse in the UK? Someone on the forums suggested I read The Department of Health Toolkit for High Quality Neonatal Services. It's from 2009 but gave me a good insight into the goals of neonatal units and might give you an idea for your presentation. Part of it is about the family experience. As a neonatal nurse you'll spend a great deal of time giving nursing care to the grown ups as well as the babies, which is great because you're highly experienced in this as an icu nurse. It was a topic I found I could get my teeth into.

All your comments have been really intersting and helpful. Honestly it's so good to get people's insight into suction practice in different units. I feel more confident now with it, although I'll still be asking someone to stand by me until I feel ready to do it on my own.

Yikes Ah, so would 'sounding crunchy' (love that term btw) alone give cause for suction, or would you not go there until you've got other clinical features alongside it?

Thank you all for making me feel better about asking for help with suctioning. I felt like by now I should be able to do such a basic thing as this on my own. Reading your comments has helped me realise that suction is neither basic nor straightforward. I couldn't fathom why we didn't have in-line suction but when I asked around the nurses said that in-line suction doesn't work as well as disconnecting the vent. I've never used inline so I wouldn't know. Nicugal I'd love to read through a protocol like that. I don't have that clinical judgement yet as to when not to suction if I'm asked to. Generally every time a baby has a bad gas the first intervention the doctors would like is suction. I've known them to want it doing even if it was only done recently "just to see what's there". So I can see where you're coming from Bortaz. When I ask people if I should be suctioning or not they often tell me 'have a listen to their chest.' Fair enough if anything clinically has changed or if they sounds particularly bad then I'd suction them. But if their ventilation and Fi02 hasn't changed and Sp02 is steady away...then do you suction just because you can hear secretions? I think that in some babies you can always hear them, especially when they've got bad RDS. Do you wait until the secretions become a problem?

I wish we had in-line suction. We don't have chest physios based on the unit, they'll only come if there is a real concern about an infant's respiratory state. Physios don't see ventilated babies as routine. Now I think about it I find this odd, because chest physios would see everyone in an adult icu. Thanks for explaining the saline part I know now not to use it every time.

Thanks for your replies :) Nurse4sale that's reassuring to know, if anyone offers to do it for me I leap for joy and let them. Not good for me in the long term. And I feel embarrassed asking for help now because I don't want anyone to think I'm incompetent. Well done for getting over your fear. K+MgSO4 yes we have a clinical educator and I think I'll have a chat with her about it. She’s not based at our hospital and it’s rare that we see her so I guess that’s why I’ve not gone to her yet. But she’s brilliant and I’m sure she’d make a point of coming to see me though if I asked for help. Cerriwin we don't use in line catheters, so it's quite 'fiddily' in my opinion. I think it adds to the pressure when you're having to take the vent off. I really could be done with a third hand.

That's an excellent idea Never thought of that because I don't think we stock them.

Hello. I'm really new to neonates and I'm loving it so far. My main concern is I'm underconfident when it comes to suctioning a Et tube. I know how to do it, but I struggle with when to do it, if I should use saline, how many times I should do go down etc. I ask for help every time I need to suction a baby but our unit is really busy and at times no one is available. I'm also aware that the more I ask for help, the more I'm finding myself never wanting to do it on my own. Does anyone know of any resources online that are helpful in this topic?

Interesting topic, thanks for bringing it up. Our unit does this, but not every baby with a CVC gets Nystatin, there are a set of risk factors that indiciate its use. We put 0.5ml down the NG and 0.5ml in the mouth. I feel that 0.5ml in the mouth of our tiny prems is a large volume. We use pink oral sponges to apply it (same size I used on adult wards) and so most is soaked up by the sponge anyway. Often the ET tape obstructs the mouth so plenty ends up on the chin lol, and being inexperienced I'm really scared to squeeze anything in there that'd risk dislodging their tube. Sorry to go off topic, but speaking of this does anyone have any tips on good quality mouth care for really tiny ventilated babies?

Best of luck! I'm sure you'll love it. I just had my first week in NICU, and I've also got no previous experience. Although I can't be too helpful, one thing I can say is bring in a notebook to write things down in as you learn. I read mine back today and had forgotton a lot of what was said it me. And bring in a pocket calculator. I'm so glad to have had mine with me. :)

What a super topic. As an adult nurse due to start in NICU, literally the only thing I feel confident in is being able to care for the adults in the unit. I hope when I'm overwhelmed with all the learning and adapting that I don't lose sight of the care and attention the family needs.

Excellent! Congratulations and very well done you.

Good Luck for tomorrow!

Thanks Raye! I'll add Bliss to my reading list. Are the current levels of care 1:2 hd and 1:4 sc, or is this a new aim? Will this mean less staff or more staff per infant? The unit I'm applying to is Level 2 and Level 3. It's a specialist centre and it has medical and surgical level 3. I'm not sure if I'll be based in a particular unit, or if staff rotate. But anything with 'neonatal' above the door will be just fine with me.

Thank you for your advice It's so great that nicu welcome adult nurses.

XB9S me too haha . Gem, wow...thank you so much!! That reply blew me away. All this information is wonderful, and I'd never have found that on my own. Good luck with your masters. I'd love one day to do my masters in nicu. Best get the kettle on and start reading.

I have an interview soon for NICU Nurse. I'm an adult nurse with no nicu experience. I was wondering if anyone knows of any current challenges, research, or developments within the nicu setting that I can bring into my interview? Even if it is just something to mention in a question to the interview panel. I can think of things to say for the area I'm currently in. I've had a look at policy and guidelines and found things about the jaundice pathway but I'm struggling to get an insight into the current drives and practice focus of the nicu care setting. Thank you in advance for any suggestions you might have.

Thank you for your reply. That's a stinker. I was hoping PICUs would welcome ICU Nurses and let them do the branch conversion course. I know NICUs accept adult nurse applicants with critical care experience, there were plenty when I qualified but these days they are few and far between. With few children's nursing posts it's easy to see why. This is why I wanted to go down the ICU route, to help me get into nicu or picu. Which would have more transferable skills to PICU...being a icu nurse or being a nicu nurse?

I potentially have an ICU job offer (nursing cohort...just waiting to hear which ICU it'll be.) Does anyone know how long it takes to complete the necessary post-grad courses to be classed as a qualified critical care nurse? Ultimately I want to be a NICU Nurse. At first I was hoping to go straight into this, however I'm an Adult Nurse with no critical care experience, and that hasn't worked in my favour in previous neonatal applications. I'm hoping that qualifying as an ICU nurse would open more doors for me rather than going straight to the neonatal route (it'd be great to work in PICU, and I'd love to work abroad and can't help but think having an ICU qualification would make both easier?). I'm just curious as to how long it'll be before I'll have enough ICU experience to make to transition to NICU or to PICU.

The final step after all that drama is seeing them return from xray with the tube now coiled around their hand.

Thank you MaryAnn. I did email her and she replied to say they'll be advertising for a Band 5 in a few weeks time. So good news! The odds are well stacked against me but I'm so pleased to hear they're finally putting jobs out :)

Just wondering if I could have your two cents I've checked nhs jobs every day for over a year waiting for a neonatal nurse post to come up at work. So far only one has and I was unsuccessful. I'm working as an adult nurse on an acute ward. I'm very lucky to work in a team of wonderful people and I try very hard at my job, but it's very stressful and I'm more than ready for a change. I don't want to have to relocate but if it's a choice between waiting another year or moving cities then I'd sooner move. I don't want to appear unprofessional but was wondering if I should email the matron and see if she thinks any jobs are likely to come up in the near future. I'm not even sure she'd be allowed to say if there were? Anyone been in a similar situation.

Actually Queensland is top of my list!! But anywhere where the rugby is good will do :) I love how Oz seems to welcome international nurses with open arms. If I'm going all that way then then I'd be willing to stay for a few years, particulary when the opportunities there are greater than here. It's surprising that they'd take internationals with no experience into that area. I've done placements in icu so I know it's where I belong, but like I say I've got no post-graduate experience there. What hospital do you work in Talaxandra, and do you have internationals who work in your unit? I'm still working the uk at the moment.

Thank you for your reply :) Right I didn't realise they were designed for people finishing their graduate programs. It makes sense that they'd be very popular courses and only offered to people willing to stay on. I'm from the UK, I've graduated with my BSc Adult Nursing and have 18 months post-grad experience in surgical and acute stroke nursing. I wouldn't mind using this experience to find a similar job in Oz, but I'm very determined to go into a nicu/icu career and I'd soooo ready for a change in terms of job area and location. But then from what I've read up on the nursing opportunities and work standards in Oz are greater in Oz than here, so either way I'd be a winner =] Graduate Nurse programs and transition programs just don't exist here, wish I'd trained in Oz!

I'm just wondering if anyone has had experience of bridging programs into icu/nicu/other acute areas. I'd love to come to Oz on a temporary visa, and it'd be excellent if I could find a job that would kick start a career in either icu or nicu. Two birds with one stone kind of thing. However post-graduate courses seem to have steep international student fees. Does anyone know if people accepted to introduction to speciality practice courses are expected to only do these in view of long-term employment within that orgranisation or commitment to completing post-graduate studies? Or are they happy to let people work there for the 4-6 months or so that the programs are offered for and then go elsewhere to find employment.