NICURN29

I know I am often in the minority on this one, but I am friends with former patients' family members on FB and often follow them on Instagram. I do not ever initiate the social media relationship, and I won't be friends with them on social media until after their babies are discharged, but I do love seeing updates and such. I also let that sort of inform what I am willing to share on social media. Knowing that patient families are seeing my posts and also because I am very serious about conducting myself appropriately as a member of the nursing profession and an employee of my network limits what I am willing to put online about myself.

This has some good information on Sudden Unexpected Postnatal Collapse and how hospitals are dealing with the risk for it. http://hospital.nuroobaby.com/wp-content/uploads/2016/04/Infant-Assessment-and-Reduction-of-Postnatal-Collapse-Risk_-The-Skin-to-Skin.pdf

I was not talking about any particular physician. I was talking about the medical model vs. the nursing model. There are plenty of fine physicians out there, but their education is very different from nursing education, and that makes a difference to me.

I became a nurse because I wanted to be a nurse, not because I was not smart enough to go to medical school. And I am becoming an APRN (I am in a PMHNP post-Masters) because I am passionate about mental health care and believe that our education in treating the entire patient and not just the illness is one of the most important things we can bring into an AP roll.

We use 1/2 NS with 1/2 unit heparin per mL to flush our second lumen. However, we put a bifuse at the top of the line with the heparinized flush on one port and a NSS flush on the other. We have to break into the line to piggyback a med, but if we are just flushing, the connection between the port and the heparinized flush is always intact, so we break into the line a lot less often.

We also use Cannulaide. Cannulaide - Infant Nasal by Mercury Medical | Medline Industries, Inc.

My opinion differs from most here (and I don't need you to convince me I am wrong...I am perfectly fine with my use of social media where patient families are concerned), but I work in the NICU, and I accept friend requests from my patients' families after their babies are discharged. Our families sometimes become very close to their nurses while we are caring for them and their babies, and it's a great way to see the babies grow and change. I don't put anything on Facebook that I would not want them to read, and if they try to overstep by asking for medical advice, I put a stop to it. My organization does have a social media policy, but it does not forbid Facebook friendship, as long as we are representing ourselves, our profession, and our organization in a positive and professional manner. Seeing babies who I have taken care of grow up is such a highlight of my Facebook experience, and I am so glad to have the opportunity. Of course, if I worked for a network that forbid it, I would follow those rules.

We currently use a McKesson product that is called Care Manager, but we are moving over to Epic in three months. There are several other L3 NICUs in our area that also use Epic.

Hello! We are currently looking at our evidence regarding the wearing of rings in the NICU by nurses and medical providers. Currently, we are allowed "nothing below the elbows" (so no rings, bracelets, watched, Fitbits, etc.). However, in trying to align our guidelines with those in other units of the hospital, we are reconsidering this and thinking of going back to allowing the wearing of one ring. I was wondering if anyone would be willing to tell me what kind of rules you have regarding this in your NICU. If you don't allow rings and have some evidence for that practice, I would love to hear it. And if you do allow a ring and have some evidence for that practice, I would love that as well. Thanks so much!

We use Neobars. I think they are fantastic. They have cut down on our self-extubations and have allowed us to stop nasally intubating babies...which is what we used to go for our teeny-tinies.

We also use the little Posey bands.

Ideally, if I have two patients, one is on each schedule. And the goal is for the feeding to start at the care time, so the assessments and cares are done with that goal in mind. If I have two babies on the same schedule, I just always care for them in the same order all day.

I am not sure why you are documenting in the medical record information about parents' interactions with other parents. It sounds like maybe it would be a CYA strategy, but I would think that, should a case go into litigation, that would be information that you might not want to be discoverable. I think that is instead something that should be discussed with your nurse manager and medical director so that they can approach the parents and encourage them not to share medical advice. We do often have frustrating families, and I try to put myself in their place and remind myself that this is perhaps the most stressful experience they have ever had. I also have a nurse manager and a medical director who I can count on to intervene if there is something like this happening in our unit, and this is hugely helpful for me.

After the cleaning solution has dried, we rinse our beds with plain water to remove any residue. They are cleaned by our unit clerks/PCAs.

We have two care times...8-11-2-5 and 9-12-3-6. Our level III babies are assessed and have vitals done q3h. Our level II babies are assessed qshift, so 3x/day. Baths are done whenever parents schedule them or on nights if parents are not taking part. We bathe every four days. TPN/IL are hung after 1900, and labs are done with the 0500/0600 cares for babies on IV nutrition and with the 0800/0900 cares for others.

Honestly, it took me a good two years of working in the NICU to not feel anxious coming to work everyday. And I think that was an important part of what made me successful...I had respect for the acuity of the babies and knew that anything could happen at any time, and I could not let my guard down. Now, of course, my "Spidey Sense" is better developed, so I don't have be on high alert quite as much. But I think not feeling that worry means that someone is not getting the whole picture and may not be cut out for being in a critical care environment. I am SO GLAD that I stuck it out and made it from novice to expert because I think being a NICU nurse is the best job in the world. BUT no one will judge you if you decide to do something else...the most important thing is that you get to do work you enjoy that 8is meaningful to you.

Betamethasone is given during the pregnancy, so I would not say that qualifies. There is also Lasix, Aldactone, Diuril, and/or Aldactazide, which are often used to help us wean babies off respiratory support. The nebs we most often use are Xopenex and Pulmicort. We use Survanta and dexamethasone (using the DART protocol) as well.

We definitely do if a baby is on high-frequency ventilation. And otherwise, it depends on the baby. Our nurses are good about advocating for pain control and/or control of agitation if it seems indicated, and our medical providers are pretty responsive to our requests.

You could also check out the Neofax and the Core Curriculum for medication information.

I would not agree that "most" NICUs do daily CXRs for tube placement. In fact, that is contraindicated by the evidence. While your L3 may do that, mine does not. We do sometimes do daily CXRs on intubated babies if we are following the development of their lung disease, but they are not done just to check tube placement.

I had a patient self-extubate when I was on orientation. My preceptor asked me if I was comfortable bagging her, and I said no, so she did it. Once it was obvious the tube was out, we called for the NP, who reintubated. The parents were standing at the bedside through the whole thing. A few years ago, the mom stopped in to visit because she was in the area. She immediately recognized me as the baby's nurse that night and said, "Thank God you were standing right there and got her help right away." Her memory of the incident is that I helped her baby. Until that moment, my memory was that I had made a mistake...but I was able to let that go finally. These things happen. No one expects you to know everything right away...that is why there is a long orientation process. It sounds like you did the right thing calling for help...even more experienced nurses have to do that sometimes!

We use Neobars on all of our ETTs and LOVE them. They are manufactured by Neotech, and we rarely have babies self-extubate when their tubes are secured with one.

I have no other information. Sorry!

There is very minimal risk to a baby getting the breast milk of another mother. Here is some information from the CDC...Breastfeeding: Recommendations: Another Woman's Breastmilk | DNPAO | CDC This is basically the information we give to a mother whose baby got fed another mother's milk, and we follow these recommendations. I have not made a breast milk error, but we have had some in our unit. The people who have made the errors were placed on corrective action but not removed from their position. We put some process changes in place to help provide opportunities to double check our milk at the bedside with another nurse before feeding. And when we transition to Epic next year, we will start scanning our milk.

Hello! I am looking for some product information and/or care information regarding the use of ECG leads on micropreemies. We have recently had several 23-weekers, and even using the limb leads has resulted in burns to their skin. We have been moving the leads every 3 hours with cares, and still there is sometimes skin integrity issues from their use. I am looking for information (A) on what brand leads you use in your NICU, especially on babies with very immature skin, and (B) any "modifications" you may make in your lead use (for example, we place Coban over the sensor on our pulseox probes for micros so that they don't have the light backed right up to their skin) that you may utilize to help protect skin. Thanks for any help you can offer!