picurn10

we've had more than a few pts on ECMO who were so unstable, or their cannulas were so precarious, that we didn't turn at all, but its more typical to have to do small turns because they are unstable. We don't seem to have one set standard for our kids. We have some pads that have a moldable putty inside, we use gel pads, mepilex, and specialty beds on the bigger kids. We use this stuff inside our radiant warmers for newborns.

why not do trophic feeds and keep them on TPN until they're term, or closer to term?

I agree that it is often the boyfriend, but we've had several recently (and my most traumatic case) where it was mom. That case was so chilling because we did the first brain death exam, and afterward she just asked me for some washcloths, got into her pj's, and slept peacefully all night long. Do you guys see many arrests on your cases? I feel like more often than not, they get away with it.

Thanks, everyone. It really makes me feel better to read your responses.

see, our unit NEVER bans the family. I hate it! They say winter, particularly christmastime is busiest time for it. I've also heard the economy is leading to a rise in abuse lately

It's always the little moments for me. When you can tell you've made a difference for someone. Certainly after a code or a hard fight to save someone. Or even a meaningful end of life case. One that stands out was a baby I had for two straight weekends. He was super sick. On ECMO and CRRT. He was bleeding from everywhere and just looked miserable. We all thought he was going to die. I talked to him all night like I do all my pts, but he was intubated and paralyzed and sedated so not responsive to me at all. Anyway, a couple weeks passed and he recovered! I got to see him the day before he went to the floor. He was in a little hospital gown laying in the crib with no 02 or lines or anything! He looked at me, and gave me the biggest smile ever! I asked his mom if I could pick him up and when I did he laid his little head on my shoulder and just sort of melted into me. It was the sweetest thing. I 'know' he didn't have a clue who I was, but I felt like he recognized me and was like 'hey, thanks for taking care of me" It was priceless. I love my job!

I floated to NICU and my pt got NEC and likely won't survive. I have to float to NICU frequently (usually once a month) but we typically get feeder/growers assigned to us. I feel like I caught the symptoms early, but OMG, it was lightning fast and really sort of shocked me! I don't shock easy and have had pts go south quickly in PICU, but this was like: healthy/stable baby, to dying in just a couple of hours! I don't think I 'missed' anything, but I can't stop worrying maybe if I'd caught it just a bit sooner, her outcome would be different. The only symptoms started in the afternoon: a little tachy (she'd been 160-170's all day, and jumped to 180's) and her belly was starting to become distended. She was stooling, active bs, not tachypnic, she was on 21% @ 1L and sat'ing 100% all day. Normothermic all day. She'd just had 2-2.5ml residual before feeds and then when she got symptomatic it was 6mls. By the time I left she was on an oscillator, had a picc and working on an artline, and putting in drains at the bedside. I gave prbc's and ffp, and had orders for cryo, and more prbc's. Her gases were crap. They were about to start pressors. What kinds of things do you see before they get NEC? What might I have missed? I've taken care of all kinds of awful stuff (kids beaten into a coma, drowning, heart surgery kids, traumas...) but this has me rattled

my thought is that these hospitals with a focus on customer service need to have a pt consierge! They could run around fluffing pillows, bringing ice to pts, snacks to families, and all manner of butt kissing so that I can be free to actually provide the nursing skills I went to school for, the ones that are keeping my pts alive and healthy! Ah, one can dream, right?

wow, that RN tracking thing is INSANE! I think I'd quit at that point. Turnover in our unit is super high as it is. interesting to know that other places do this as well, I though it might just be my director's idea. Sarakjp, I know! huge pet peeve of mine when family with a stable kid get all ****** when you don't come running to fluff a pillow, when your other pt is crashing or some other urgent need. Our unit clerks are also tele monitors so they can't answer lights, but its a small unit and honestly pretty rare for lights to go off. We maybe have one or two a shift, sometimes none. I'm sure this was generated by a pt complaint. What's really irritating is that nursing staff wasn't told about it, just the monitor techs. So basically they are supposed to be ratting us our to our boss and we've never even been told 'hey, we've had complaints about call lights going unasnwered'.

I always knew I wanted to do ICU and work with kids. I thought I wanted to do NICU, until I had clinicals and realized there wouldn't be much variety (NICU babies seem to have the same set of problems). I LOVE what I do because I never know what I'm going to get, I can have a newborn or an 18yr old, a DKA or a gunshot victim, I really like the autonomy that comes with ICU and the stress of it. I love helping families through such a difficult time, and especially seeing a really, really sick kid recover! I have to float to NICU from time to time, and I know I made the right decision for me, but its fun that I sometimes get to dabble in that world too. Not sure I will always be in PICU, but I have no idea what else I'd like to do. Honestly, the plan is to become a NP and work in a peds clinic when I get tired of the stress and bedside thing.

Any one else dealing with this at their hospital? We were told that our call lights were being audited from now on. In ICU we rarely have call lights (we're typically in the pts room or very close by, and the pts can't usually use them). Now anytime a call light goes off, the unit clerk is supposed to visually locate the nurse and make a note of what he/she was doing when the call light went off and where they were in the unit. I'm trying not to be irate about this, but I'm having a very, very hard time with it. The whole point of using a call light is that your nurse is not in the room, right? So basically we're going to be reprimanded if we have too many call lights during a shift. Management believes we should either be in our pts room or directly outside their door at all times during a 12-hr shift. We don't have enough computers to chart outside our rooms so we typically chart in the nurses station in the middle of the unit. Anyone else encounter this?

our hospital's NICU just picked black for their scrub color and I was shocked! It seems like such a harsh, non-kid friendly color. Honestly, there is tons of research into colors and public perception and even specifically when working with kids. I'm really surprised hospitals haven't weighed in, but just let the staff pick the color.

In the ICU, everyone can typically handle high acuity. If the pt is just a train-wreck from the get go, they will typically reassign the nurse's first pt to someone else so that nurse only has one pt, or the charge nurse ask us to help take care of pt 1so the nurse can focus on the new, very sick pt. If it were a total newbie, then the charge nurse would likely reassign one of the more experienced nurses pts so he/she could take the really sick pt, and the newbie could have two low acuity pts. But ICU we only have two pts assignments, so its not too much of a juggling act most of the time.

hmmm, that sounds terrible. Our physicians write an order and a paper order prints, and an electronic copy is sent to pharmacy. At most it takes 10mins for it to show on the emar and the pyxis. If its longer than that, I just call to pharmacy and they fix it while I'm on the phone. Cancelled orders show up the same way, except that they fall off the emar, and you can see it at the bottom of the screen in yellow as a "d/c'd med" If you try to scan the med, it will give you a pop up that its been d/c'd. The stuff your describing sounds more dangerous than papers mars!

In my unit we typically have one nurse "open for an admit", meaning one actual assignment, and one empty bed. They don't actually decide which room until there is a pt on the way, but its near the nurses other pt. I'm in ICU though, so that may be different from floor nursing.