FlutterbyNurse

Hi all! I'm a recent MSN NNP grad and am gearing up for my exam. I was wondering if any of you have recommendations for study materials that were helpful for you? Thanks in advance for your help!

As with anything in the nursing world I think it's important to look at the literature. Magnet Status came out of research. In the 1980's, when the nursing shortage was at an all time high and hospitals were doing crazy sign-on bonuses to attract nurses, there were a few hospitals that were having no problem retaining their experienced, seasoned nurses without having to offer incentives or bonuses. A researcher decided to take a look at these hospitals and see what they were doing right to inspire nurses to want to stay. Through this research they found what came to be the 14 forces of magnetism that not only makes working conditions desirable for nurses but also produced better outcomes for patients. Magnet is completely driven by the desire to see positive patient outcomes and to help with nursing recruitment and retention. All of those goals help drive down the cost of healthcare so even though the process of becoming Magnet certified can be expensive, the benefit is that the organization decreases costs. Also, the public is becoming more and more educated about their hospital choices are they are choosing hospitals who go above and beyond in proving their excellence. For our hospital, we were already behaving as a magnet hospital should, we just had to put it down on paper to receive the recognition we so rightly deserved. To me it was like accepting my college diploma, I had already done all of the work, the diploma just proved it! The current research also supports magnet hospitals as having better patient outcomes.

Thanks for the inquiry. Our NICU recently adopted a back to sleep policy as well. However, we chose to do it closer to discharge. Our policy is to allow elevated sleep positions until they are in an open crib and stable. Then we start the back to sleep protocol which sounds similar to yours, however, we still do allow elevation during gavage feeds and for 20 minutes after a feeding (gavage or nipple). Our patients do not even meet criteria to come out of an isolette until they are at least 1600 grams though. We try to model what we expect parents to do at home which is always put baby back to sleep and hold them for at least 20 minutes after a feeding to help prevent reflux. Hope this helps!!

I'm just curious how your units handle volume parameters for feedings? Is there a policy your neos follow or do they all "make their own rules"? I recently had a term baby (39 weeks) who came to us for rule-out sepsis due to lethargy and hypothermia. He had normal temperatures for us in an open crib and wasn't the most active baby in the world, but would wake for feedings and cry vigorously until he was tended to. His blood cultures were negative after 48 hours and antibiotics were d/c'd. He was ad lib feeding from the beginning taking around 30 mL per feed every 2-3 hours, occasionally up to 40 and 50 mLs (mostly formula, mom was supplying minimal amounts of breastmilk). At four days of life he was still eating the same. He also had adequate urine output and was stooling regularly 2-3x/day. In my experience this is an appropriate feeding amount and schedule for a term neonate who is only a few days old. The neo who saw him for discharge seemed to think he should be eating 60 mL every feeding and lasting 3-4 hours between feeds. What's the difference between eating 60 mL q4h and 30 mL q2h? I worked in a labor and delivery/postpartum unit previously and we only expected 1-2 day old term neonates to eat 15-45 mL every 2-3 hours. Sometimes I feel like the NICU world doesn't remember how to treat term babies when it comes to feeding!! Thanks for your input.

I'm not familiar with the hospitals in Tampa, but there are some great ones in Orlando. Florida Hospital has a smaller NICU and Winnie Palmer is the 4th largest NICU in the nation. There are a lot of good opportunities here in Florida and the unit I work in seems to always be hiring. Good luck!

We had a similar issue with methadone. I can only speak from what was discussed regarding methadone, and I am aware that cocaine is quite a different drug. We had a mother who was abusing methadone and subsequently gained a newborn in the NICU that was addicted. We had him on methadone to wean him. When the mother wanted to start providing breastmilk after birth the MD wrote to allow breastmilk. When I asked for her rationale on this order she said that very little methadone crosses to the breastmilk and that some studies have shown the minimal amounts of methadone can actually help the baby to detoxify slowly from the drug. Like I said, I know cocaine is different-but I imagine the same argument could be made for it as well. We see very few cocaine users in our NICU population-thankfully!

I think you should put this on your resume. First of all, you do not need to include why you left as a part of your actual resume and when the employer questions you about the job I would say something like, "I gained a lot of valuable experience from that position, however, it wasn't a good fit for me as I felt I wanted to do something more challenging (or more specialized, etc-insert into here whatever difference the new job has that you're applying for over the last unit)". Experience is something that will make you more valuable over other job candidates and honesty is always the best policy. If you lie by omitting it, it will look like you're trying to hide something you did wrong. If the potential employer pries beyond your initial answer I would mention that they only gave a 5 week orientation and that you weren't prepared to safely perform your duties alone after such a short time period. 5 weeks is not that long for orientation of a new grad!!! Hope this helps!

Sorry-just realized you asked another question of me. Our unit visitation policy allows for two visitors per baby at the bedside at a time. One person must be banded and all visitors have to be over the age of 18, except that we do allow siblings over the age of 2 to visit with proper vaccine documentation.

D'Lycia (Is it just me, or would this be pronounced dee-li-shia, making it sound a lot like delicious??) Kennique A'Laysia

I don't know where you are in FL, but I'm in the Orlando area. If you need any of the suggested items-bp cuffs and diapers-I could get them to you if you're close by. Let me know! :)

I am a level II NICU nurse with a background similar to yours. My original job was in a L/D mother baby unit that had nursery and peds on the floor as well. There was some debate over here as to whether I should try to study and get my NICU certification or just do the low risk neonate cert. It seemed that people were trying to make me feel like it would be less valuable to have the low risk neonate cert-but this didn't make sense to me as a certification is a certification in my mind. So I don't think you should feel like one is better than another. Get the certification that you'd like to have. Do you want to work in mother/baby areas in the future? Do you think having the maternal component will be useful to you in the future? I think the poor pass rate for the low risk neonate might have more to do with mother/baby unit level I nursery nurses taking it thinking that "low risk" neonate means normal newborn. As you know, level II babies are anything but "normal". We just did our review course for the RNC exams and I feel like the low risk neonate exam is doable. It sounds like you are self-motivated and will study for whichever you choose to take. Good luck!

The way our monitors work the respiration piece is not terribly accurate. It takes the baby's respirations and averages them-so they are not true to the second. So we don't use apnea alarms-only spO2 alarms and heartrate alarms. The way to tell if you are having a 'true' bradycardic episode is to look at the monitor and see if the heartbeats are widespaced on the screen. When that happens I go to look at my patient to see if they are apneic and/or have any color change. Sometiems-after the event-you can look back and see a break in breathing on the monitor prior to a brady, but not always. Hope this helps!

We are only allowed to have drinks in breakrooms or restrooms. We were all given the OSHA printout that mandates this-no drinks are allowed in patient care areas or anywhere that blood or body fluids might be found-so our nurses' station in the pod is out too because people put specimens on the counters when they are labeling them. Our hospital is very strict about this and I think my kidneys are suffering for it.

We have been using z-flow positioners in our unit for a year with good result. We don't see skin breakdown at all now and we are seeing much better head shapes as well. No more toaster heads!! :chuckle

I work in the one of the top ten largest NICUs in the nation. We have 120 beds and have operated with up to 137 kids on the unit at our highest number. It is a great place to work and we have the advantage of being a teaching hospital as well. It is interesting though because we don't yet implement some simple things such as utilizing donor milk-we use Prolacta as a fortifier, but no direct donor milk. :doh:

Our unit uses milk techs. We have two to three techs a day dedicated to making and mixing all of the breastmilk in our unit. They have their own room and are required to wear surgical hats while in the room. They only work on one patient's milk at a time. The milk fortifiers we currently use are HMF 1:25 or 1:50, Prolacta in several different concentrations-the mixing instructions vary according to the guidelines given to us from Prolacta, and powdered Similac Neosure 1 tsp to 90 mL of breastmilk for 24 cals and 1/2 tsp to 90 mL for 22 cals. We clean the measuring spoons with Super Sani-Cloths between each patient's milk. We do not use Enfacare to fortify with as we were instructed by our Diaticien that they do not want their product to be used in this manner.

At my facility we have mom label the breastmilk with two of the baby's patient labels. We require double independent verification (both people need to check the milk bottle label against the patient's ID band that they are wearing-which is also a label-verifying name and MRN). We are working on a barcode system to use where we would scan the milk and the baby's band. We have milk techs who prepare all the breastmilk for the unit and they do the same double independent verification process when they are getting ready to prepare the milk. They verify with the nurse what the baby is eating and how much to prepare. They then re-label the bottles/syringes with a patient label and a color coded milk label detailing if the milk was fresh or frozen and whether it has been fortified or not. This label also includes an expiration date and time and whether the bottle can be frozen or not if it is not used. I might be able to scan our milk stickers to send you samples of them if you are interested. Hope this helps!

I work with a nurse who had a 25 weeker 14 years ago. It's amazing, but he is doing great. The one thing that she offers to our parents that I'm unable to is a knowledge of what it feels like to see your tiny baby through plexiglass hooked up to machines and lines. And the guilt that can be associated with it as well. She is great in being supportive and helpful to the families-also, she carries pics of her little boy at birth and currently which gives the families hope that their baby will do well also. She works with me in the level II area, which might be a better choice since our kids are doing well and getting bigger so it's not as intense on this side. Good luck to you!! :redpinkhe

Our NICU has 112 beds-level III and level II combined. We use volunteers as much as possible. I'm in the level II area, but I know they are utilized in level III as well. In level II they can change diapers, bottle feed babies and hold-rock, sing, read to-babies. They are life savers! We have quite a large number of regular volunteers now. They have to apply, go through extensive training, do at least 50 hours outside of the NICU as a volunteer and take a course specific to volunteering in the NICU. Our hospital's website has more information if you'd like to contact the volunteer organizer to see what all we require-http://www.orlandohealth.com/OrlandoRegional/GetInvolved/Volunteer/WinniePalmerHospitalVolunteerServises/WinniePalmerHospitalVolunteerServises.aspx?Pid=1548&Wid=1

We use the Nutrisafe 2 system by VYGON. http://www.vygonusa.com/whats-new.htm It is a purple system that sarted in the UK and is now over here in States as well. It is NG tubes, NG tubing and Enteral feed syringes. They have a special end on all of them that does not allow for any other kind of syringe to be used on them. We recently made the switch for the purpose of meeting JCAHO standards as well. I like the new system. Only real complaint we've had on it is that the numbers on the NG tubes are hard to read when you are placing them. We've talked to the company about this and they are working on changing the font to make it easier to see. Hope this helps!! :redpinkhe

Our policy allows no jewelry from the elbows down for staff or visitors. Staff and visitors must do a 3 minute surgical scrub before any patient contact occurs. Isolette covers are changed bi-weekly when we change the isolette or PRN (if they fall on the floor or are visibly soiled).

I work in Orlando, FL at Winnie Palmer Hospital. We have a new (2 year old) state of the art facility that has level III and we are one of the go-to hospitals in the state for ECMO. Our level III nurses are all trained for the DR with those who want to go on DR calls more often welcome to sign up for the DR team. We sometimes have 3-4 nurses and RTs at different deliveries at one time depending on how busy the day is. On average there are 45-55 deliveries per day here with all of the c-sections attended by the NICU team and any complicated vag deliveries. We are one of the largest NICUs in the nation (last time I heard we were the third largest in the US). We currently have 4 NNPs who work in our NICU. They are involved in the care of all the NICU kids and do a lot of independent work in the level II NICU. As far as NNP programs-there is one person here doing their NNP work through UF online. She only has to go up there to school about once or twice a month. We are only about an hour from the east coast and there are really nice beaches on either coast. I love my job and this hospital. :redbeathe There is a lot of good support from administration and we are actually starting the process of seeking magnet status now as well. If you ever get the chance to come down here I'd be more than happy to give you a tour!

i am on the unit practice council for the level ii nicu that i work in. we are currently looking at some of our current practices to see if we, as a unit, are following current best practice recommendations. one of the areas we feel we need improvement in is in ng/og tube securement. what, specifically, do you use/like in your units? also, is there a product currently made for that use in the neonatal world? we need names and manufacturer information so that we can decide what to use in our unit. thanks for your input!! :heartbeat