palesarah

a little late to the party, but... MMC's is a 51-bed, single room model with the exception of the "transitional nursery." The NICU consists of 3 pods- 2 with 10 private rooms each, one with 8 private rooms plus the 3-bed transitional nursery. All babies born 35 weeks & under are directly admitted to the NICU. The transitional nursery is for babies 36weeks & over that don't really declare themselves right away... or maybe they need a septic workup but are acting appropriate so can go to mom's room after, etc. It's extremely short-term- 6 hours or less, then admission to NICU or transfer to mom/baby. The other 20 beds are two, 10-room pods in CCN, which is basically a level 2 step-down nursery. Mostly preemies in the NICU, 23weeks+. The occasional cardiac kid needing stabilization before surgery, term babies with term baby issues, etc. Feel free to PM me for more info.

double post, sorry

Funny how something so simple has so many solutions. What we typically do: one blanket to completely cover the isolette mattress like a sheet, edges folded under. Second blanket, slightly smaller, to place baby on. We use cloth diapers to roll up for barriers- one for each side, 1 at the feet- and place those under the second blanket to make a little baby nest. We fold a cloth diaper in half and place under the baby's head (babies We neaten up the edges of the second blanket however we can, so the diaper rolls can't be seen usually, but most importantly however is necessary to position the baby properly. Sometimes instead of diaper rolls I'll roll a regular receiving blanket into a roll and use that for the nest. Sometimes I add more diaper rolls on one side or the other. It all depends on the baby. We can get really competitive about our beds, though, lol- it's kind of a running joke. The standard issue hospital receiving blankets are white with bunnies. Once the baby is stabilized (or stable enough) and clean, we usually change the blankets to something cute and matching, or at least clean bunny blankets is the nice blankets are all in the laundry (sometimes happens on the weekends). And a pox is wished on any nurse silly enough to make a bed with the bunnies facing the "wrong" way or with unmatching blankets, lol. Some people truely can't get through the shift without changing the bed if the bunnies are in the wrong direction! I think the NICU attracts a lot of us with little OCD traits, like that

Thanks for asking because I couldn't figure it out, either, but figured I must just be tired and brain dead too and didn't want to ask!

The Build-a-Bear outfits are perfect for those 3-5 pounders! Last year one of the babies' parents bought a Superman outfit, complete with built-in muscles, it was adorable. Another baby got all dressed up as a Patriot's cheerleader for one of the games. It was adorable! Recently one of the baby's grandmothers found a stash of perfectly fitting DOLL clothes at a dollar store- she ended up using some of them for patterns to make even cuter outfits out of less scratchy fabrics. We didn't do much for Halloween on our unit, today. One of our big chronics got dressed up and a few had hats and such, but that was about it. i wished I had made some things to bring in

I don't know about lotions that are compatible with latex gloves (or even why your hospital still has latex gloves at all!) But I've gotten half the nurses on mu unit hooked on Goldbond Ultimate Healing lotion. I have extremely sensitive skin and if I don't use a good lotion, my hands are falling apart halfway through the shift.

I work in a 24-bed Level 3 with a separate 11-bed Level 2. We do pretty much everything short of organ transplants and ECMO, but cardiac surgeries (besides PDA ligations) go elsewhere in the hospital to recover. We're moving to a 50-bed, single room unit in less than a year.(with Level 2/Level 3 still somewhat serapte but no longer separated by other units!) I don't know our actual rates, but I'm told our NEC and IVH rates are low. Something our docs are VERY good at is not supporting futile care. The Neos and Neuros are very upfront with the parents and most of the time, when it is appropriate, the parents choose to take these kids off the vent- and are supported by medical & nursing staff. Evidence-based practice is encouraged by medical and nursing, but a lot of change has to be nursing-initiated. If a nurse is willing to make the effort to find the evidence, changes can be made. We have a strong core of experienced nurses- some who have been in our unit for 20-30+ years. Many of the experienced nurses are the ones who initiate these changes- unlike other floors/other hospitals where it is more common (in my limited experience) for such experienced nurses to just go with the flow, awaiting their retirement. Areas of change: Developmental care. Going to the new unit in itself will help. Nursing input has been valued in the development of the new unit, BTW. One of our most experienced nurses is also waging what was once a one-woman war to make these developmentally appropriate changes. Pain control. We have a new Neo who came from a unit that was more aggressive about pain management and I was joyfully surprised to see that our other Neos are not just allowing him to practice as he is used to, but taking a page from his book. Family-centered care. This is a hospital-initated change... change comes slowly. People seem to be waiting for the new unit to magically "cure" this. Initiating breast feeding. The level 2 nursery nurses are excellent at teaching & supporting breastfeeding. Most of the level 3 nurses are scared to death of breasts. We really don't recieve any training in breastfeeding teaching and support during orientation. I came from a "Nipple Nazi" LDRP/Level 2, and even I am loosing my confidence and having trouble with teaching. Apparently the hospital has FINALLY agreed to "give" us a part-time LC when we move to the new unit. Right now, we have to pratically chase them down and drag them over to the unit, when we need their help (not their fault, there's too few of them to meet the need) so that will help. The rest of the change has to come from us.

I've been working on nipping the "family rumor" mill in the bud. If a family primarily makes contact on night shift, I tell the dayshift so as part of report: mom and dad live an hour away, both are back at work, they call in the in the morning and call or visit every evening. AND I pass it on to social work. Parents appropriate, bonding well, etc but have transportation issues, whatever. I'm tired of other nurses or social work creating problems- it doesn't happen often on my unit, thankfully, but even happening once is too much. Anyway- sometimes, it takes families a couple days or even weeks, with a micro, to get over the initial shock of having their baby be born premature and/or critically ill. I like to give the family the benefit of the doubt. If they are truly neglectful or innapropriate, it's usually clear as glass.

I don't know what the job situation is in your area. In some places, staright day shift positions are available in all units- in others, they're not. If it comes down to it, you may have to take a position on a floor or in a hospital that's not your first choice, to protect your health. That's a decision you will have to make. As far as disclosing your medical situation, what you discole in your pre-employment exam SHOULD be kept confidential. I have epilepsy, and ideally I should be working straight day shifts. I'm rotating right now and am planning on going to straight nights for the winter. There are nurses who have been on my unit for over 20 years who still have to rotate- straight days are basically impossible to get on, on my floor. If I need to go to straight days for my medical condition, I will either have to go to another unit or another hospital, and that's all there is to it.

When it's a case of "maybe I have a cold, maybe it's allergies, my nose is a little stuffy but not runny if I take Dayquil" kind of thing, most people on my unit will just work through it. Mask on at all times in the unit, gloves & gown for patient contact. Anything worse, I call out. It's not worth it. I actually had strep throat last month- what 30 year old without kids, gets strep in the summer? It was really weird, no idea how I got that (I was probably 5 the last time I had it!), but I did, so I stayed home until I'd been on antibiotics for 48 hours.

:yeahthat: We expect parents to call or visit daily. If there are extenuating circumstances- parents live far away or don't have a phone- special arrangements are made. But we see or hear from the majority of our parents more than once a day. If they can't visit, most parents call several times a day. It's much easier on our unit for parents to call when it's convenient for them.

the entrance to our NICU isn't anything special. Only decorations I'm aware of are the green, pink and blue baby footprints (painted with some kind of stamp) that lead to NICU, L&D and postpartum/newborn. I don't even know which color leads to the NICU. Blue? There's a bulletin board with some NICU grads, and there are also portraits of the neonatalogists and NNPs too. We're moving to a brand new unit in a brand new building in a year!

I'm not the OP but we have LNAs in NH. They have license numbers, continuing education and active practice requirements.

Maybe, just maybe, if I stick it out another 25 years, I might get to permanent day shift. There are nurses in my NICU who have been there 20+ years and still have to pick up occasional night shifts. The few who are actually permanent days have been there longer! The bulk of the nurses rotate 30-40%.

I was under the impression after my last communication with my DON that I will at least have a designated resource nurse for awhile, and they specifically want me to start back on days (I'm a rotator) to get back into the groove. I don't think anyone is expecting me to be able to hit the ground running, except me :)

Subutex was just starting to be used instead of methadone in the area my NICU serves when I had to go out on medical leave, so I'm not super familiar. Despite what the doctors seemed to be promising the moms-to-be, the NAS babies I cared for (or was anywhere near, NAS babies can be so cranky!) who were exposed to Subutex went through pretty much exactly what the babies exposed to methadone went through. It actually made me quite angry. In that area, people on methadone maintainence therapry had to go to a methdone clinic, but Subutex could be prescribed by almost any doctor. I think they needed a certain amount of training and were limited in how many Subutex mainainence patients they could have at any one time? Anyway, it seemed some of the moms were being told by their prescribing docs that their babies would not suffer any ill effects, undergo any kind of withdrawal symptoms, would never need to even see the NICU and in fact go home with mom in 2-3 days. It was very, very frustrating for everyone when the babies were admitted to NICU or Peds when their NAS scores hit the roof. It's been almost 6 months since I've been able to work, so I'm hoping the situation will be a little better when I return.

I've been out on medical LOA due to my seizure disorder since late January. I had only been working in my NICU for about 10 months when I had to take this almost 6-month-long LOA. I've probably posted 2 or 3 times in the past few months that I was going back "any day now", but I really think it's going to happen now- I've been free of absence seizures for over a month now, and my last generalized seizure was in March. It seems like we finally hit the right combination & doses of drugs to get my brain back in gear. When I last spoke to my neuro doc, he said he wanted me free of absence seizures/losses of consciousness and free of drug side effects for 4 weeks. I'm there. I see him Friday. I hope to be back at work and complaining about the hours next week I never realized until this year that I'd been having partial seizures & absence seizures my entire adult life, and now that they are under control, I am having a much easier time learning & understanding things. I've been studying some of the things I could never fully wrap my mind around before- cardiac issues, mostly- over the past month or two but a few days ago it hit me. I've forgotten a lot of the "little" things! Things like appropriate blood sugar ranges and blood gas results. And now I'm afraid that I when I go back, I may not realize what I've forgotten and it's scaring the you-know-what out of me! I've never been afraid of asking questions- patient safety is far more important than my ego. But if anyone can point out some of the little, everyday things- you know, those kind of things that are second nature when we're working and therefore hard to list when we're thinking of important things we do/need to know!- so I don't HAVE to take time away from patient care to remember them when I realize I've forgotten them (make sense?) I would really appreciate it. I guess it takes more time to put my "broken" brain back together than I realized! TIA, Sarah B

eek. The X-ray techs MAKE us wear the apron if we're assisting, and either set up a shield or place themselves between the machine and the next incubator. They also make sure everyone else- parents, other nurses- are out of the danger zone. I really appreciate their efforts! If I'm not assisting, I generally run away with my hands over my ovaries muttering that I probably don't need them but *just in case* I better protect them...

I didn't call out once and I should have. The story: I work 50/50 days & nights. We self-schedule and I was scheduling myself all over the place, to get long stretches of days off. I had worked 4 nights in a row, 1 or 2 days off, worked 2 days, then had 5 off. I never got my sleep right and had 3 day shifts in a row coming up. The night before the first of the 3, I couldn't sleep. Around 2am I called to see if there was a need for me to work the night instead of the day shift (often there is). Nope, needed me on days. Tried to sleep. Tried really hard. Got about 2 hours. Went to work. I have a 1 hour commute and work 12s. It took a lot of caffeine to get through the day. I asked & called everyone I could to see if anyone could take my next 2 day shifts for nights, usually there's always someone wanting to work a day shift instead of nights! But not that day. At lunch my coworker noticed my left eye was twitching, which was weird. I got through the day on nerves & caffeine, considered staying at a hotel instead of driving home but was so overtired that I was fully awake. Drove home without incident. Tried to sleep. It never came. I was so overtired that I was wired and just couldn't fall asleep. Took an Ambien, couldn't sleep. Took 2 Benadryl. Still couldn't sleep. Around 11/11:30, when I had basically been awake for 34 hours with just that 2 hour "nap" the night before, I apparently told my husband that I "felt funny". I don't remember that, because minutes later I had 2 grand mal seizures within a minute of each other. All I remember of that, is my husband being incredibly mean to me by making me get dressed in the middle of the night before he drove me to the ER. I haven't been able to go to work since. That was the end of January. I had 3 seizures when I was a teenager, and had been stable for 13 years on medication. It's believed that the 2 seizures I had that night were triggered by lack of sleep, low medication levels (when my schedule gets screwy I don't take it as consistently as I should; I've changed that habit) and the benadryl (which can lower the seizure threshhold). My doctors don't know why, but something triggered that night in my brain and for 2 months, I had numerous partial seizures every day, and a total of 2 more generalized convulsions. It's taken this long to find the right combination of medications to control them. And I can't help but wonder- if I had just called out and gotten some sleep that first day, would any of this have happened? I have no way of knowing. But I could have seized when I was holding a baby (I work in the NICU!) or on my long drive home. Luckily it happened int he comfort of my own bed. And hopefully, I'll be cleared to return to work at the end of the month. But I am VERY protective of my sleep now. I'll still be working rotating shifts but will be doing it in 2 or 3 month blocks.

If moving is not an option, what about commuting? Not sure where in Maine she lives but if commuting to NH or Mass is an option, she should check it out.

I live in NH/work in Maine and have heard from several of my coworkers who graduated in the past few years, how tight the job market is for new grad RNs in Maine. Too many new grads and not enough new grad positions. I had no idea, I went to school in NH and there were plenty of new grad positions in hospitals when I graduated. One of my coworkers moved to Chicago for a year as a new grad, moved back and got a job as an experienced RN without a problem.

I'd get up and give my seat to anyone who needed it more than me, whether that's a fellow nurse, a tech, an NP or an MD. If I need to be sitting wherever I'm sitting though, I'm not going to give up my seat JUST because there's a doctor looking for one. But I don't work with doctors who expect that, either.

Why don't you get involved with this committee? You obviously have a lot to offer them. It IS in the best interest of both mom & baby (and the hospital!) for the babies to room in. You could help ensure that your hospital policy reflects that.

I'm in a pickle. A big, frustrating pickle. I've had a seizure disorder since I was a teenager and have been stable on medication for over a decade, although when I had a horrible spell of migraines a couple years ago the changes on my EEG that were present when I was initally diagnosed had returned. Still, I wasn't having any grand mal (or whatever they call them now) seizures, and was still on my medication, so it didn't seem concerning. Fast forward to January. After working a crazy day/night rotation stretch that screwed up my sleep, I went to work after getting only 2 hours sleep. Worked my 12, drove home, was so OVER-tired that I couldn't fall asleep but was in bed trying to sleep. Apparently I told my husband that I "felt funny" and then had 2 generalized convulsions within minutes of each other. My medication levels in the ER were low, they medicated me & DC'd me and I spoke to my neuro doc on the phone the next morning- he raised my dosage and scheduled an EEG for a few days later. I didn't feel safe working until I got some answers so I spoke to my boss about it. My EEG showed the same changes, nothing new, and my doctor felt it was just an isolated incident due to sleep deprivation and low meds levels and OK'd me to return to work but not on crazy rotating schedule. Employee Health however decided I needed to be stable on my higher med dose for 2 weeks before letting me come back. Which was good, because I had another seizure, when I was home alone. I realized that first week I was home that I was having partial seizures where I didn't loose consciousness that really didn't affect me or my performance at all- had probably been having them for years and just wasn't aware. That day I was feeling pretty wonky (is that a word?) for about 4 hours, then felt this horrible sense of "impending doom" and HAD to lie down. I lost consciousness for 20 minutes, woke up with my dogs on top of me, and my right had clenched around a piece of dog kibble, feeling very "post-ictal". Back to the Dr's, added a second med, switched to a neuro within walking distance because the neuro doc I'd been seeing since childhood was over an hour away and getting a ride there this often was getting impossible. New neuro agreed with old neuro's plan, ordered an MRI, but kept me out of work. The night before my scheduled MRI, had another generalized convulsion and hit my head. So, that's 4 in about 6 weeks. MRI was fine but neuro doc upped my meds and wanted me out of work for a few more weeks. I was finally starting to feel "normal" again, free of the partial seizures, and then some of the side effects of the med I've been on forever became intolerable (hand tremors, vision changes, 24/7 nausea). So now while we readjust (starting a third med, increased my second, tapering off my first over a period of about 6 weeks total) I am out of work. I've been home for 2 months and will be out for another 2. My boss has been completely supportive of my situation, but I'm afraid what the outcome of this latest news will be- I've only been in the NICU since last April! This neuro doc is very cautious about releasing me back to work in the NICU because of the nature of our work. Understandable, I feel the same way, but this is so frustrating. Each addition or increase in my meds makes me so tired and they're all giving me horrid GI side effects. I can't drive so I'm bottled up in the house- I was so tired for the first month that I couldn't even watch a movie start to finish. Since then I've re-taught myself how to knit. But I am desparate to return to work when I'm feeling better, because I feel so useless and am afraid of losing my skills. And now I'm worried that they won't be able to hold my job for me- FMLA only covers 12 weeks. I'm hoping that once the inital side effects wear off they can find part-time work away from the bedside for me but that's no guarantee. I'm just so upset and frustrated, I guess this was more of a "vent" than looking for advice. But if anyone has been in similar shoes or does have some advice, I'm open. And thanks for reading my vent...

Nope, we don't do them either. None of our RNs do PICCs either. I'd like to learn both. Actually, I'll be happy when I can just go back to work- I've been on medical LOA for nearly 2 months now and am finally feeling well enough to be bored!