juliachloe

I worked for Banner and a friend of mine worked for both PCH & Banner. I spent over 6 years at Banner and LOVED IT. She however preferred PCH. You will find pros and cons to both facilities. Banner pros: largest NICU in the region - lots of floorspace & lots of staff, lots of ancillary services, friendly staff, cafeteria open at night, really good benefits, great deal of experience with all NICU populations (micros, anomalies, surgeries) with the exception of cardiac. Banner cons: lots of management, lots of head-butting with management both spoken & unspoken, ok RN/neo relationships, NNP coverage ONLY on days, ECMO program started last year in collaboration with the PICU. Now I don't have much info for PCH since I didn't work there myself, so what I have for info is what I have gotten from others. Take it with a grain of salt. PCH pros: lots of experience with ECMO, good RN/neo relationships. PCH cons: source for micros was bought out by Banner hence admissions will be transports, "stuck-up" RNs. Now that last part was a consensus of opinions by fellow RNs that had once worked at PCH. You will find unpleasant people everywhere. Even at Banner. See if you can get some more opinions. I will ask my friend over there if she'd be willing to talk with you.

Thank you so much for the replies and links to literature. Very much appreciated.

Curious to know if any bedside nurses like this device. We started using it in our facility this year. We did not receive any education on it. I understand that intubation can be incredibly traumatizing to a patient's trachea and lungs, especially the tiniest of babies. I understand that the longer they are on the ventilator, the more likely they are to develop BPD. I get the purpose of the device. What I don't understand is why physicians choose to torture these tiny babies by keeping them on this device when they very obviously cannot tolerate it. I watch these babies huff and puff (RR >100), retract like mad (moderate to severe suprasternal, intercostal, subcostal and substernal), eventually exhaust themselves so much so that they become lethargic and eventually start to have apnea...and these doctors STILL do not want to intubate. When is enough enough? How is that any kind of quality of life? They spend the first 2 months in a daze because they are so exhausted from breathing. They have have had thousands of desaturations, and likely hundreds of severely hypoxic episodes in that amount of time. Forget how damaging that can be to their brains. I guarantee that if I was a parent in the NICU and FULLY informed about the care my baby was receiving and the likely outcomes, I would choose for my baby to receive a trach because they simply cannot tolerate extubation rather than them being tortured for months and then wind up being bed-ridden for the rest of their lives because of the insult their brain took while in the NICU. I have spoken at length with our docs and they firmly believe in this device, regardless of how the baby is doing and the outcome. One thought that the only time he would consider intubation is when the baby is coding. He stated that most infants with trachs wind up having CP anyway. I understand they are medicine and I am nursing but at some point the two have to come together and agree on something. I can advocate until exhaustion and it never seems to be enough. Is this just something in my unit or are other nurses experiencing this as well regarding the RAM?

Considering the state of our economy and the new healthcare initiatives, hospitals aren't in a very good position to offer new grad classes. I just recently worked for a NICU in Mesa, AZ that was considering putting together a class, not necessarily for new grads but nurses with some kind of experience in a hospital already (ideally peds, or newborn nursery). It is not a guarantee that they will be able to implement this class but a possibility to look into. Other hospitals might be considering something similar. Hope you get into the NICU. We always need fresh faces.:)

No matter what you read, no matter what others say about this controversial issue, you have to be comfortable with your decision. We can provide you with links to respected and dependable sites, we can send you to sites that do not have the same kind of reputation. You can research parental sites with opinions and facts about their experiences. You can read books and even participate in research. Nonetheless this is your decision. As nurses, we do many things that can be considered harmful by some and not by others. Often nurses advocate for their patients against some treatments that ultimately we feel would be futile and we consider the quality of a patient's life to be more valuable than the longevity. It is all relative. Honestly, I don't think that there will be a definitive answer anytime soon. There will always be valuable input from unexpected sources. "Credible" government agencies are not the only sources of beneficial knowledge. Do your research, don't short-change your gut feelings and make a decision that you can live with. Good luck.

Curious to know if any bedside nurses like this device. We started using it in our facility this year. We did not receive any education on it. I understand that intubation can be incredibly traumatizing to a patient's trachea and lungs, especially the tiniest of babies. I understand that the longer they are on the ventilator, the more likely they are to develop BPD. I get the purpose of the device. What I don't understand is why physicians choose to torture these tiny babies by keeping them on this device when they very obviously cannot tolerate it. I watch these babies huff and puff (RR >100), retract like mad (moderate to severe suprasternal, intercostal, subcostal and substernal), eventually exhaust themselves so much so that they become lethargic and eventually start to have apnea...and these doctors STILL do not want to intubate. When is enough enough? How is that any kind of quality of life? They spend the first 2 months in a daze because they are so exhausted from breathing. They have have had thousands of desaturations, and likely hundreds of severely hypoxic episodes in that amount of time. Forget how damaging that can be to their brains. I guarantee that if I was a parent in the NICU and FULLY informed about the care my baby was receiving and the likely outcomes, I would choose for my baby to receive a trach because they simply cannot tolerate extubation rather than them being tortured for months and then wind up being bed-ridden for the rest of their lives because of the insult their brain took while in the NICU. I have spoken at length with our docs and they firmly believe in this device, regardless of how the baby is doing and the outcome. One thought that the only time he would consider intubation is when the baby is coding. He stated that most infants with trachs wind up having CP anyway. I understand they are medicine and I am nursing but at some point the two have to come together and agree on something. I can advocate until exhaustion and it never seems to be enough. Is this just something in my unit or are other nurses experiencing this as well regarding the RAM?

In a female-dominated field you are almost guaranteed to experience some kind of .... crankiness. We are emotional beings and we tend to vocalize our thoughts moreso than the majority of men. Of course I'm generalizing, but when we have a problem with something, even if it is a small one, we tend to voice it to one another. Unfortunately ruminating on the negative aspects of our jobs only makes it seem worse. I have experienced burn-out. Not from my job but everything that went with my job (management, politics, doctors, equipment, supplies, etc.). I have complained. I have tried jumping to other hospitals. I have considered changing departments. But the only thing that has worked is to adjust my own attitude. We contribute to your own happiness and if we choose to focus on how awful our job is then our job will be awful. Bottom line is, do not allow others and their negative opinions modify your goal/dream. You can still be happy with the field you you choose, even if others aren't. Sometimes trying a new hospital makes it easier, and sometimes it doesn't. One thing I've learned is that no matter where you work, whether a hospital or law firm, negativity exists there. Changing your career will not change that.

How do you go about trying to get a union into your hospital? The past 6 months have brought about cutbacks at my hospital. Recently, there was a hospital-wide layoff and now, despite management's reassurance, everyone is walking on eggshells worried about their job. One particular person in management has made the unit a terrible place to work. This person hasn't been very supportive of the staff in response to this layoff. They think we should suck it up & move on. They don't want to be bothered with the staff's unhappiness. This person has also been making changes to policies/procedures without informing the staff but yet still holding us accountable. Nurse-patient ratios went up and everyone worries that the patients' safety may be at risk. Everyone is afraid to report these actions to upper management for fear it will cost them their job. What can we do?

"Let's go get wasted." - documenting in Pyxis the wasting of narcotics.

:barf01:No matter how thankful you are that we took such good care of your baby while in the NICU, do not wait to tell us that the homemade cookies you brought in for us were made with your breastmilk. Do not say to your 2-day post-partum wife, in front of your NICU nurses, "that's all you got" after she has finished pumping. The nurses might try to extract breastmilk from you! Do not try to help your NICU nurse suction your intubated baby's mouth by pulling on the ET tube to get it out of the way, she might be inclined to slap you. After DHS calls you at home, don't claim that the nurses invaded your privacy and violated your rights by obtaining the ordered meconium drug screen from your baby after your wife tested positive for meth.

Amby Baby Hammock Motion Bed at http://www.ambybaby.com/ Vented bottles by Dr. Brown's at http://www.handi-craft.com/ Vented bottles free of bisphenol-A by BornFree at http://www.newbornfree.com

Can you tell me how I can find the literature to support that. Or even the name and location of the NICU that has implemented that precaution. I would like to inform our management of that, because since I've gotten pregnant I seem to have an iNO kid every other week. But they tell me that if anything, it will help me to avoid getting pulmonary hypertension - never knew about the vasoconstriction.

Full feeds at 23 weeks? Is this at the very least half-strength breastmilk? I thought all of the research out there indicated that advancing feeds too quickly posed great risk for NEC? Our unit is notorious for feeding too much too quick & we've got lots of NEC. To add to it they'll start kids out at 24cal. I'm interested to know what kind of feeds he/she is getting. And if I'm behind on my research knowledge someone please let me know.

My husband used to ride. He had his motorcycle for less than 6 months and lost it on a turn. Bike was totalled (sp?), luckily he only hurt his wrist. A guy he rode with was wearing a helmet but the helmet contributed to his skull splintering into his braid - dunno if he died or not, last I heard he was in a vegetative state. His best friend had been in numerous accidents and still continued to ride - in one accident he broke both hands, wrists & forearms & was casted past his elbows. Even after his wife had to wipe his butt everyday he tortured her even further by going out and getting a new bike after he healed - they're divorced. Anyways, my husband now sells motorcycles but does not ride. They always say in their business that it's not a matter of whether or not a rider will be in an accident, it's when and how bad. He's been with the company for 2 years and thus far there have been 3 motorcycle accidents right in front of their store. If you look at the NHTSA's website, they have a report that indicates since 1992, more fatalities have occurred with helmets worn. Granted it was like 45% no helmet, 55% helmet. Same for speeding: 37% not speeding, 63% speeding. Alcohol intoxication: 66% not intoxicated, 34% intoxicated. These were statistics for 2004. There's a lot more factors in their report like engine size, driver age, proper licensure, weekday vs. weekend, crash type, roadway type, etc. I personally think a helmet is important and so does my husband but obviously others don't. I don't understand how most, if not all states, have and enforce the law that all bicycle riders must be helmeted. And yet motorcyclists don't have to. Where's the logic?

I haven't had too many funny ones but the trendy ones are getting ridiculous: I swear we've had at least 30 just this year of either a Jayden, Kayden, Aiden or Cayden - boys & girls. Nyvaeh (heaven backwards & with a Y) Chloe (pronounced Shiloh)