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)

I'm hoping to find out about different avenues for pain control in other NICU's. Trying to help better our pain control in our unit & was asked to find out what other units do. We use the NPASS here & compared to another place I've worked it's ok. What pain scales do you use? Does your unit give pain & sedation medication just for being intubated? If so how are your numbers on IVH down? Do they have bad withdrawal from the narcotics or are they weaned? Do you give sucrose for all invasive procedures (IV starts, blood draws, heel sticks)? What do your neo's give for chest tube insertion and maintenance? What do your post-op kids get for pain & for how long? What about ibuprofen, are there rare cases when you utilize it for pain? Your input is very appreciated.

I would do the clerk position also, paid foot in the door always helps. And you're getting paid. Plus most of the time you'll be able to do your homework while you work. I was bored most of the time with my homework already finished. As far as the BSN vs. MSN, I would go BSN. Nobody cares about where you get your BSN from. All they care about is that you pass the NCLEX. I used to think that I would have an edge with a BSN over an associates but the associates had more time and grade than me. Granted I learned the reasons why we do the things we do, which not all associate degrees get but they still have the clinical time. If you go straight to MSN you won't have any bedside nursing other than what you got in clinicals. Bedside nursing is important. It gives you experience in your field. I've worked with MSN's that have been bedside nurses and those that haven't where they are straight out of school. And I'll tell you I'd rather work with the one that's been in the trenches with me. Not only because she's been where I have but mostly because she's got the applied critical thinking skills when it comes to those sticky situations - she's not just book-smart. That goes for any MSN whether it's NNP, CNS, or nursing director - you're more likely to get the respect if you've done your time. Then your staff knows that you know what you're talking about. You shouldn't be ruining your chances at getting into MSN later. If anything there should be more places offering an MSN in the future. GOOD LUCK!

I appreciate everyone's replies regarding this matter. It has helped. Granted I didn't find out about any other NICU's that had that one policy but it has lit a fire:idea: that maybe the unit shouldn't put pregnant nurses with these babies until we get the cultures back - we'll see what happens. Thanks again.

They did do CMV & parvo cultures among others & they came back negative which at first put my mind at ease but then the doctors ordered more CMV & parvo cultures since they couldn't determine the cause.

Cobedding twins hitting each other or sound asleep with one's hand in the other's eye. Oxygen-filled eyes since they hate it in their noses. Future rock-climbers that manage to get up and out of their nests and into the portholes. Toe-sucking. Turnip heads - always pooping while their eating and turning so red. A 23-week vented kid that just got a pacifier for the first time and sucking like mad.

Mom's shirt soaked with tears because you just told her she's gonna hold for the first time. Truck driver burps - always from the little girls. Elation that your kid pooped for the first time in 3 days. Daddy gets pee'd on. Knowing you make a difference - I miss that.

It sickens me that neonatologists are striving to resuscitate 22 weekers. Even 23 weekers don't have a great chance. Can't they still refuse? They used to. We had one come in right after that one in Florida and I'm guessing they resuscitated because parents were throwing a fit to save him. We had to use a 2.0 to intubate and at that we had nothing small enough to pass through it for suctioning - we used an umbilical catheter rigged up to suction and a paperclip for a stylet. Needless to say he didn't make it. But why allow such suffering in the first place? And where are the ethics in these fertility docs?

Our NNP's insert and we have a PICC team that does the dressing changes. Currently our unit does betadine (3 swabs) and then saline wipes (3 to 6 wipes). NO ALCOHOL AND NO CHLOROPREP. We do dressing changes if it's bloody after the first 24 hours and then ONLY if it's bloody or non-occlusive. Don't fix what ain't broke. Though they typically get changed at least every 5 days because they become non-occlusive. We do a steri strip on the hub, never on the catheter, tegaderm (or opsite) it over the hub, then chevron with a steri strip at the end of the hub onto the tegaderm, and another steri stip over the end of the hub or start of the line onto the skin.

I've talked with our clinical managers and all they do is listen and say they understand my frustration. Team leads (charges) do the same. I would really like to get our older nurses involved in this, I just don't know what to say. And we can't have a meeting unless a committee calls it and it's been okay'd by management. Maybe our clinical excellence team could help out.

I have to say the unit isn't terrible with developmental positioning. Older nurses have more trouble with the positioning than newer. But seeing everyone be so rough with the teeny ones is tough - they don't give time-outs and let the baby calm down. They go so fast and have abrupt movements. Midline positioning isn't maintained, there is no IVH protocol to protect their little heads. And pain, oh my gosh. Our developmental specialist has tried to tackle pain but we're getting nowhere - she's scheduled a meeting with our hospital pain team and the NNP's but she isn't sure any of the neo's will show up. That's where our problem lies - the neo's. They totally ignore pain - they think that maintaining the blood pressure or respiratory drive is more important than pain. When half the time, I believe, if pain medication had been ordered in the first place the blood pressure issue wouldn't have come up and the respiratory thing, well that's why we have ventilators. The kids typically have a rise in pressure & then a drop and they wind up on pressors (HELLO IVH). The NNP's are expected to do what the neo wants for everything - don't rock the boat. And nightshift is not allowed to think for themselves - just get them through the night and let them deal with it in rounds. Our pain score means NOTHING to them. They do not care. I can say more than 3 times in the past year, I have had either a fresh post-op or 2 or 3 days post-op with only Tylenol ordered either q 6 or q 8. You have to beg for pain meds. Rarely are nurses obliged with PRN Morphine or Fentanyl orders. Versed is given out more often - not touching pain! I wonder what these kids turn out like. How is their development later on since they suffered so much pain as a preemie. It kills me.