KK7724

I have been a NICU nurse for 4 years. I recently had a baby in October of 2008. Lately (and even before my daughter was born), I am just burnt-out on NICU. Tired of nights, tired of the emotionally draining chronic babies, tired of ungrateful parents, just tired and ready for a change....too much stress and it's not making me the mommy I want to be. So, I decided to interview in the Main OR. I liked surgery during my nursing school clinicals. I also have 2 co-workers that left and went to the OR in our hospital's newest facility (Heart and Vascular surgeries). They LOVE it! I shadowed over there, but there were no jobs there. I got the one in the Main OR and I believe we have 21 operating rooms, are a Level I trauma center, teaching hospital, many many services etc. I will go through a 5 month orientation. I will scrub and circulate. I will tell my mgr towards the end of my orientation which 3 services are my favorite and I will spend 3 extra weeks in each of those. Now, the reason for posting....I'm scared now! I'm leaving something that is making me feel burnt out, but is at least familiar. I like to do a good job and I don't like feeling stupid. I don't particularly like being yelled at either! The nurse manager is really great and so is the educator, so I am hopeful it will be good. She already warned me it was going to feel overwhelming at first. I really really like the idea of working dayshift, working better hours, and really hope this is a good fit. With my background in Peds/Perinatal, do you guys think I can hack it??

Hi everyone... Well, I have decided that since my husband is in grad school, it is time for me to go back also. I have worked in two Level III NICU's in the past 2 years (we're military...had to move after my first year) The program I am entering is a completely online CNS program which allows the individual to specialize in Adult Health, Community/Mental Health, and Maternal/Child. Of course, I am going to choose the Maternal/Child route because it is basically my background and what I am interested in. I am worried about the program being completely online. I have never taken online courses before and wonder how a medical program/degree can be taught that way. How does one coordinate their clinical experiences? I am taking a 6 semester CNS program, so I will still be able to work full-time while I go. I work night shift, and the program I'm entering has a clinical affiliation with the hospital I work at now...so...do you think the night shift thing will get in the way?? My main motivation for doing this program is to give myself more options and to get away from night shift and working every holiday and weekends! Plus, I wouldn't mind an increase in pay! Advice, Thoughts, Opinions?? Will I be able to find jobs going the Maternal/Child route?? We have a clinical nurse leader and a neonatal educator here at my current hospital already (a large university hospital) Would I have better luck at a private hospital??

Hi, I recently married my active duty Air Force husband in August. We PCS'd to Charleston AFB and I'm working at a large university hospital in the area. I graduated college May 05' and he went to Kunsan AFB the whole first year I started my career. Of course, being a new grad, I worked straight nights and that was fine for me...then. Now that I'm married though, I am feeling burnt-out with the whole hospital atmosphere and most definitely the night shift thing. I have heard that the clinics on base hire civilian nurses, but I've never used base healthcare and I'm not really sure what their duties are. I know they work a schedule that I am desiring. What's a good way to get my foot in the door?? Will the pay be better?? When we PCS again, will I be able to find another civilian nursing job at our new base?? I have a lot of questions and I will be very thankful to anyone who responds. Thanks, -Kristina-

Also, Dash Monitors. These are sooooo nice! Man, I miss my old hospital!! I miss the confidence I used to have, since now I'm at a place where my way of taking care of my babies is not "per ____ protocol".

"Little Suckers" brand yankuers and nose suctioners. Never realized how good I had it at my private Level III; now working in a university hospital.

You know is it the whole country right now? I am struggling to find something in South Carolina myself. I have an opportunity to work in PICU, but I agree with you--I love NICU. I would only take PICU until a NICU came open....is this wrong? I need to keep my vent skills current. Plus, PICU might make me a better NICU nurse??

Thanks Gompers, I'm glad to hear you said try PICU..because that's what happened! The NICU was completely staffed (it must be good!)...and I applied for a PICU position. The nurse manager called and she is wonderful! She was thrilled that I had ACLS...but things didn't work out...I was supposed to be moving in June...but my DH's job won't let us move until the end of August now.....I emailed her to let her know...she said something about possibly being able to "overhire" and that she could be selective about filling the positions. That sounds good huh?? :)

The neos do come in for admits and they insert their lines. They wait for the x-ray to come back. They're called if we have to do a code...they have to pronounce the baby dead in that unfortunate event. I agree with you about the too much autonomy thing and if I didn't feel comfortable in what my charge nurse told me, I would go over her head and call the neo. I have done that before. I chart books on my babies! Very very defensive charting. Everything we're doing is legal. We do have legal teams at the hospital. We are joint commission certified and they have been in the area, so we're probably due soon to be surveyed. I do have a lot of issues with the unit, but I just have to be very careful. Afterall...I get to move out of state soon and go to a university children's hospital (hoping there are NICU positions open). I have only been out of school for 10 months, so I question everything and I chart extensive notes. Supposedly...from what I got from Education when I went through NICU Hospital Orientation (this is before going to orient in the unit). We were told about needle aspiration of the chest in an Emergency situation. Basically, the state covers you if it's an emergency only and absolutely no physician around or NNP....(like a transport for example). I know I never ever want to have to needle a chest. That is 100 miles beyond our scope! I think I have only heard of a transport nurse having to needle a chest en route and that was her only one ever.

I'm sorry. I forgot to post that we do have transport nurses. We have an on-call Neo and a backup.

We're a regional Level III...so we do transports and pick up babies that are as far as two hours away. I looked some stuff up: "Although the TIOP designations provide a general framework for classification of NICUs, both interpretation and application vary widely within the United States, and no national definition exists."http://pediatrics.aappublications.org/cgi/content/full/114/5/1341

We're a Level III

I think when I originally replied to the original poster....I was a little stressed with things in our unit. Also....I think you might work in same unit as me BamaGirl and I know your opinion is a lot different from mine???....I wish to clarify a few things.... First...only the experienced nurses will intubate the child if necessary. I won't lie...I have seen countless admissions where the neo is present and he tells the nurse to intubate the kid. If the child is going to have surgery on their eyes for example....the nurse will intubate. I haven't taken NRP yet, but I know that even if I had it, I wouldn't be expected to tube a baby. A lot of times when your baby is doing something bad...a herd of people will rush over and take over most of the time. This is good and bad for the new learner. Also...about "Reading x-rays". No we don't have to "read" them...for lack of a better word I said "read" at the time. Yes, the radiologist writes his comments on there, but we have to count how many ribs are expanded and make sure the ETT is where it's supposed to be. If not...we are expected to push it in or pull it out a little bit. I will tell you....I cannot tell where PICC lines and UAC's and lines are on the x-rays. I am terrible at this. I am also really bad at looking at the KUB's. I usually will just take mine to the charge nurse and let her look at it and tell what she thinks. Seriously...the radiologist might write: "Questionable NEC? Free air. ETT High or ETT Ok". It's not like he writes a detailed report that comes with the x-ray. He comments on what he sees in the form of "ETT Ok", NEC ?" etc. Also, we don't have an in-house Neo or resident or NNP. We have a few NNP's in our unit, but they don't function as such. We have to get several opinions, go to the charge nurse, see if anyone else needs a doc and then make the call. Sometimes we wait till 6 a.m. to call for small things we want him/her to know. Two weeks ago, I had a two-vent assignment. One was a new admit that was a micro premie and on minimal stim. She had issues from the start....hyperglycemia, low BP, needing second dose of Survanta. The other child was a 3 month old active vent that did not receive much sedation all day long! My charge nurse was having to help me a LOT! I was the only person in the room with two vents. Another nurse had two CPAPS....someone overheard me say this and told the nurse who had made the assignment before she left. She said, "It's just two vents!" The evening shift charge nurse sympathized and said the assignment was stupid. Last week, I was in a room with another nurse who had a two vent assignment as well. So...our assignments are heavy...yes. We give survanta without a dr. present. I think this is okay? I don't know. Every hospital is different. We have respiratory therapists...they don't usually tube although some will if the nurse doesn't get it. 1 or 2 of them might adjust the vent....the main ones I work with just hand the blood gas reading to you. I don't really mind the vent settings deal....most of the babies have parameters on their bedside of a range of acceptable pH, CO2, and SaO2.... I know most of the time if they're blowing off too much CO2, to go down on the rate, and when to go up etc.... If I'm confused about a gas, I ask the RT or another nurse and the ultimate--take it to the charge nurse. Our unit does have a lot of autonomy for nurses and we take really good care of the babies. I do agree that we do a lot of things that most nurses are not expected to do. As you can see from BamaGirl's post, she likes the opportunity to be hands-on and get experience from these things. I think I am just a little bit more timid about it. Also, I realize I will probably have to move around a LOT because of my DH's career and the fact that I'm a new nurse...I just want to know what to expect at other hospitals. Hope I cleared things up a little bit better than before. I hope I didn't make my unit look bad. We all work hard and we could work harder on teamwork....sorry...I'm just a little bit opinonated, although I whole-heartedly admit I'm just a nurse of 10 months....I'm still very very very green!

I am a a NICU nurse of one year. (Level III). I am moving out of state to a great city with a university children's hospital. Their NICU sounds fabulous...however...there are no positions open. There is an opportunity to do an RN internship in PICU. I just want some advice on going to this type of unit. I know that in PICU I would get a broader skills range and be able to keep my skills current on vents and critical care...etc. I am nervous about the age ranges of the patients and that I won't love it as much as NICU. I think the chance to get into an internship program and really get molded and shaped into a great PICU nurse is a very great opportunity, but I am scared....should I just go for it? I think even if I decided to go back to NICU that I would go back as a much better nurse?? Please give your input and opinions. Thanks.

Thanks for your advice about PICU. I am definitely interested and I thought that it would give me a broader skills range too! I will check into the committment involved. I know at my current facility, it's 6 months. I'll keep ya updated! Thanks for the encouragement. :)

Well everyone... Just wanted to type a quick update. I did call the Nurse Manager at the hospital in Charleston. She said that they are fully staffed at the moment and have no positions open! I prepared and wrote a list of questions down. I asked her and she was very nice and answered all my questions. It is the dream place to work! Kangaroo care, in-house residents and NNP's, great patient/nurse ratios.....university hospital etc. I am bummed! I asked if I could still email her my resume` and she said yes. I don't know what to do. I can't see myself doing anything other than NICU....Level III Nicu.....i'm not sure what to do. There is a pediatric ICU position open....maybe I could do this until a position became available?? I don't want to lose my skills and I have to hold down a job....the nearest Level III Nicu besides the one I want is an hour and a half away. My fiance does not want me to do this...and I understand why. .......bummed!

Becky, Have you worked for MUSC?? I am trying desperately to get on with their NICU, but their website doesn't list any positions that are open. What agency are you with? I will only have been a nurse for 1 year at the time we're moving, so I'm not sure if I'm really ready yet...but I am interested in this in the future. Please send me an email about what you know about the area hospitals. I'm a Level III NICU nurse. [email protected] Thank you!

To the orginal poster - are there any other NICUs near your home? It just sounds like this is a bit of a toxic unit. Talk to your manager, and let her know that you are not having a supportive experience. Maybe don't outright say that you want to leave if things don't get better, but you could imply it. Well...not really. It would be about an hour's drive. I haven't told anyone on the unit this yet, but I am moving out of state in the next several months to South Carolina. There is a fantastic university hospital there with a Levell III that does ECMO, but it seems very hard to get on with them. They currently don't have any NICU positions open according to their website. I got the nurse manager's name and number from the recruiter, but I"m not sure if it's okay to call and let her know I'm interested and when I'd be coming to the area?? Like, I said...I'm new to Nursing and especially the whole market yourself kind of stuff. Here in Alabama--it's no problem getting a job anywhere! Also, I am nervous that if I do get the job, I won't be as proficient as they'd like. I have never been given an oscillator yet in an assignment and I'm still learning things every day. I really want to work with the higher acuity babies. I do like to be sent to work with the grower-feeders every now and then because it is a nice change of pace sometimes. By the time I move, I will have been an RN for a year. The one thing I have going for me, is that this university hospital does NOT hire new graduates into the unit...so, that is one good thing I have going in my favor so far. Any suggestions?? I think you mentioned your hospital was a university hospital?? Thanks-:balloons:

Well, I guess this is more of a "vent" your frustration kind of post....so here are my gripes. (Background info: I am a new RN of 9 months and graduated at 21 with a BSN...also..I do look like a twelve-year old) (the unit is a Level III) At my unit, it seems like special treatment is given to some new grads over others and that assignments are not always fair. Also...my unit manager seems completely out of touch with everything really....I don't think if I voiced any concerns with her that she would heed them....also...I don't want to go to her with anything because she is friends with lots of the people I work with and has betrayed one of my friends before and disclosed her personal information. Our unit is set up in a way that basically...whoever is assigned to your room pretty much determines how your shift is going to go. I mean...some people can pretty much ignore the fact that one of your babies is satting in the 50's...or if they acknowledge it--it's just to yell it out to you while you are at another baby's bedside...some people are really cool and will bump your FiO2 up for you, or just tell your family that's calling what your baby's weight was..etc..others are hopeless. (basically....not everyone wants to be a team player) A lot of people leave the room without saying where they're going....a lot of times they leave you alone in the room without telling you. It seems sometimes that "your baby" or "my baby" are the terms used...aren't they ALL "our" responsibility?? And where is teamwork?? Also...I'm having a real problem with people not being helpful as far as answering valid questions that will help me take better care of my patients. I find myself often times having to leave my room to find the Charge Nurse to get answers that an experienced nurse in my area could have given me. I also feel like my care is being questioned any time a baby regresses.....and I have found lots of charting errors and missed assessments that senior nurses have done (not measuring abdomens on post-ops and my absolute pet peeve---not giving sedation while on the vent!!!!!) I was even told by one RN that she had in fact pulled my chart before when an incident happened to a baby I had and I caught it. Also...I have been in a situation before where I stopped what I was doing to help a nurse who had an admission by writing the admit information on our sheet....I was just trying to be orderly like what I had observed other nurses do and go down the list and call out what needed to be filled out on the form...the admitting RN turned to a favored new graduate and said, "did you hear that...we need to get her a blood pressure. What else do you need?" I just responded..."well...I'm just trying to make sure you have everything you need when you are able to sit down and chart on this new baby." Sometimes it's like people don't even try to hide their disgust or dislike of you because you a new grad...I just can't believe the nerve sometimes. People wonder why I am stressed out. People think it's nothing that one of my babies is on the vent septic as I don't know what...and they don't know why Im behind until they see the m.d. come in and transilluminating my baby. Also....our techs....that's a whole new thread right there. There is no initiative. I feel like if I do ask the tech to do something as an RN, first of all...I have to put up with rolled eyes and attitude, so I just try to do things myself. I don't see why our techs can't come write the admit info down...anyone who can read can call things out to the admitting nurse. Why does another RN have to stop what he/she is doing to be a "scribe" for an admit when you have an m.d. and an r.t. at the bedside with you as the rn??? I am probably going to regret writing this thread later...but I just have to know...is it like this everywhere????!!!! Also....any books that anyone would recommend that are better than the Merenstein one?? I need something a little more practical. Also...what is your unit policy about art sticks?? I am determined to learn how to do these (i.e. get "checked off" on it by a charge nurse) so I can do them myself because they come up so often. I guess I am glad to have this website because I really do not have anyone that is medical in my family. I have some good friends I went to nursing school with that can relate to the whole "nurses eat their young" thing...but...please tell me it's not like this everywhere. I'm sure people reading this might think I sound like a big complainer, but I love my job and I love NICU. I would like for senior nurses who dislike new grads in a unit to stop and think for a minute that he nursing shortage has made it permissable for new graduates to start in high acquity areas like NICU and that for me to learn, I have to be taught and NICU is a continuous learning experience. 10-12 weeks of orientation does not allow for every situation possible to be covered. I welcome any comments or thoughts~

Hey, Anyone know of any online NRP programs?? I have been at my unit for almost 7 months now and I have no idea when my manager is going to allow me to go....soon I hope since I am moving in June!

What are the visitation policies in your units?

Hey, I really want to get on with this unit. I don't have any contacts and I really would like to hear some inside info about the hospital and unit. I'm only going to have a year's experience when I am moving to the area. I want to know what kinds of policies and procedures they have in place, what assignments are like, charge nurses, prn options? etc etc. Pay?? I have contacted the nurse recruiter via email and in her response she gave me the UM's name, phone number, and courtesy-copied her on the email too. I am new to the whole working world...but would it be wrong for me to call the UM??? So far the hospital's job posting site lists zero positions open for NICU.....what do I do?? Thanks,

It sounds like maybe we work for the same facility???

I definitely know which one I want to work for....currently their job posting website does not list any openings for NICU. I got the Nurse Manager's name, phone number, and she was courtesy-copied on an email I sent to the Nurse Recruiter....I may call her up this week. I'm nervous...still don't feel very proficient at all and certainly not comfy with admits...HFOV (since I've never been assigned one...and only took care of one 5 months ago on orientation once!) I'm keeping my fingers crossed.

Does it help the babies relax and let the CPAP work?? I'm telling you...our babies that are on CPAP HATE it! I think I would too! It looks sooo uncomfortable! ~Kristina, RN, BSN~

We first use betadine to clean the hub. Then let it dry. After that, ETOH to wipe the hub off. Then clamp off your fluids...then using a 25 gauge needle, let about 4-5 drops fall onto a 2x2, then collect your gas or lab. Afterwards, un-clamp and let your fluids run back through....you can squeeze the yellow apparatus on your transducer to kind of flush a little bit extra through. There is big debate over a lot of nurses in our unit that say "NEVER EVER flush a PAL"...but you can in fact, slowly and carefully flush if you have blood backed up into the line. You do not want to be calling your Dr to tell him you screwed up the art line and have to pull it--at least not at our facility because ours are not in-house! ~Kristina, RN, BSN~