dawnebeth

We had a baby who had e coli meningitis--she went home okay, but after months of antibiotics. Amazingly, despite hydrocephalus, she seems very normal (for a 2 month old). However, I know of a different case where a baby got bacterial meningitis on a trip to Asia, was hospitalized there and then came back to the US. She was very damaged by the time I saw her, and I don't know how long she had antibiotics, care, etc, because she was a friend of my daughter's. But at the age of two, she was like an infant--she did eventually learn to walk, etc but will always be delayed.

I have a two year degree and had never seen a premature baby when I started at our level 3 ICN--but we have a great 12 week training course (for all nurses, not just new grads) who are hired. I felt like I had never been in nursing school before, but I knew I belonged with the babies. It was scary and intense and I learned a lot very quickly. I'm still here 24 years later!

When we get a baby on Methadone withdrawal because mom was in a program, the withdrawal sometimes seems to me worse than from Heroin. As another poster mentioned, it can take 2-3 months. The babies are put on morphine and phenobarb. We have a opiate weaning scoring sheet that has to be filled out every four hours with symptoms--if the baby scores high, the doctors are not supposed to decrease the morphine dose--but they often do and then the babies have such a terrible time. Screaming, frantic eating, sneezing, vomiting, etc... I almost wish moms didn't go on methadone during pregnancy.

Nearly all our micro-preemies and babies with gut damage are on Breast milk or banked Breast milk. When only a tiny portion is needed, we do a partial thaw. Let the bottle thaw just enough that the milk closest to the glass thaws and the core in the middle is still frozen. Pour that thawed milk off, write partial thaw, the time and date on the frozen bottle and put it back in the freezer. Then label the small thawed milk in a similar way with the baby's name, etc and put it in the fridge for use in that shift or 24 hours.

I just asked this recently of our nurse practitioner--she said water on a cotton tipped applicator or gauze 2x2 is good.

As others have said, babies don't shiver due to brown fat. Preemies, in particular, are often jittery or tremble simply because they are preemies and their movements are not smooth.

We had our line infections drop dramatically when we started doing sterile line set ups (sterile gloves, hats and using a sterile field to lay out the IV tubing), as well wiping the hubs 15 seconds with alcohol with every new med and flush and--as the poster said above--lots of re-education to make sure all were doing the IV set ups the same way.

Remember that you are at the bedside with the patient your entire shift while the doctor is there a minimum of a few minutes a day. As others have said, you do so much more than be the doctor's assistant and pass bedpans. You are the patient's advocate and first line of defense. I cannot tell you how many times I have told the doctor--this patient is not right, and listed my reasons why. A good doctor will listen to you, especially at a teaching hospital. If you have valid concerns and maybe even suggest getting a blood gas or a CBC to check out the reasons for your concerns, you may have just saved that patient's life. The doctor isn't standing there watching the patient improve or get worse, you are. Where I work, we have new doctors fresh out of medical school. Many times, they don't even know the right orders to write or what tests to try. A gentle suggestion or a smile and a "maybe the patient needs this...?" goes a long way to helping the patient and teaching the doctor the value of listening to the patient And the nurse. lol

24 years ago I took a job in an ICN barely two months out of nursing school (I didn't even take the boards for two more months) and I felt completely at sea. I'd had NO exposure to preemies, very sick babies, etc and was very nervous. But I think all new nurses are, no matter what unit you start on. I had wonderful preceptors who taught me so much and prepared me for my work with babies. It still took a year before I felt totally proficient in the nursery, but I am still there these many years later. Just get in there and be prepared to learn while you are on the job with your preceptors. I don't think enough can be said for on the job training with a good senior nurse at your elbow. The fact that you want to work in the ICN and are interested to prepare will get you far. Good luck

If the baby is stable enough to be held, by all means, regardless of humidity. We use humidity for a month on all babies under 30 weeks and definitely allow moms to hold the babies as soon as possible.

I've been blessed to work in a great ICN for many years with supportive, good nurses who enjoy what they are doing. That's the key--giving love and support to your fellow nurses. No one can work alone or take all the burden of the job. But if you can help out, give a friendly word, smile when it's a difficult patient and hug the nurse next to you when she's down--this goes a long way to making a good unit, be it neonatal or anywhere else. Good luck!

I don't live in Houston, but most hospitals who have volunteers not only have a waiting list, but generally, there is a training period where you have to volunteer in other parts of the hospital first before going to the ICN. In our hospital, you have to volunteer for over six months and then get special training for the ICN.

I always tell people to call or email the unit manager--sometimes monthly, to keep your name fresh in her mind when the unit does start hiring.

We've always worn our own uniforms--usually in bright patterns and color--only the OR has hospital scrubs.

Our tubes have numbers on them. We're supposed to check the number at the lip or nares every shift (who now remembers that I checked the number at the lip last night and never wrote it down on my notes). Pushing air into a small baby isn't always the greatest idea, especially a baby who already may gulp air or be on Nasal CPAP which blows air into the stomach. Drawing back stomach contents is always a good indicator, as well.

I'm the person in our unit who most frequently works with/trains the nursing students doing their preceptorships and while our unit doesn't hire any new nurses very often, nearly every new grad hired in the last five years was a nurse who had worked with me during her preceptorship. Our manager regularly asks what I thought of this nurse when I worked with her and would she be a good fit in our unit. I think ICN preceptorships are invaluable and really wish I'd had one when I first started!

Yeah, just yesterday, I said quite loudly--I hate when the bottom/legs of the IV pole are splattered with formula and IV fluids and cleaned them right in front of the nurse who had that pole. She did say thank you.

Our new 'baby' docs are, for the most part, very respectful to the nurses, and quite frequently ask our opinion and then run to the neo for confirmation on an order. Generally, we nurses say tell the resident the same thing that the neo does! lol I've had the occasional arrogant intern or resident, but not many. They all carry around a binder labled "knowing your ICN"--and on the front page, it says "your nurses are important resources" or something like that, and "listen to the experienced ICN nurses!"

We get 22 weekers from time to time, although not recently. I don't recall one ever surviving. One time, we had a small for gestational age 29 weeker who was doing well despite being barely 14 oz, and right beside was a 22 weeker exactly the same size. It was odd to see them side by side--the 29 week baby was flexed, one tiny fist in her mouth, contentedly sucking. the 22 weeker just lay there like a pithed frog--so very sad. Only lasted a few days.

It's always wonderful to make those connections between the nurse and a baby and his family. I love doing primary nursing because I can get to know the baby very closely and follow her recovery, being aware of all the complexities of her care and what issues affect her. And the wonderfulness of being able to hold her once she is bigger after caring for such a tiny infant on a vent. In my unit, however, we were not allowed to do primary nursing until we had been there for 6 months to a year. I know because I wanted to primary a baby right away and was told that I needed more experience with a wide range of infants.

If Dad is listed on the birth certificate, he can visit. If there is animosity between the parents, the social worker generally gets involved to set up separate times for each to come to the bedside. This has certainly happened before! If there is no dad listed on the birth certificate, or mom isn't sure between two or more guys, we only allow in whomever the mom has listed on her visitors card, regardless of what their alleged involvement with the baby may be. We had one case where the baby was red-headed, Irish looking. Mom was Hispanic and her husband was black. We took one look at paternal Grandma and thought, no way. The presumed dad came in and we thought, no way. Then a red haired, actually off the boat, Irishman showed up and talked to the social worker. After quite a rigamarole, meetings with mom and the social worker, etc, he was allowed to visit. Very, very obviously the baby's dad. Looked just like him. Suddenly, the paternal grandma and all rarely visited again, and the Irish dad visited nearly every day until the baby died. It was a very sad and complicated situation to say the least.

I don't know specifics, but we got rid of the all 6's rule years ago, when we went to the 'smart' syringe pumps which have the drips calculated and use standard drips that the pharmacy makes up. Of course, we always have two nurses double check the dosage and correct baby, etc, because problems do occur, but it does seem more straight forward than the all 6's rule did. imo

Oh, yeah! We complained about a year ago or so, and I thought they seemed easier that previously. It does help to tap the base of the bottle on the palm of your hand pretty firmly before trying to unscrew the top. When I have to put 24 hours worth into a kangaroo pump, I use one of those round rubber gripper things to open all the bottles.

Any experience working as a nurse is a benefit. Our ICN trains all new hires, regardless of what they have done previously--for 12 weeks with a preceptor. As long as you could get hired, I think you would have a good shot since you've already mastered assessments, giving injections, dealing with crying babies, etc!

We never retrograde anything in the ICN, although they do on the floors, which always confuses us nursery nurses when we float. We use syringe pumps exclusively and give gent over half an hour All Gent doses are mixed by the pharmacy, but as far as I know the dosage intervals are decided by the gestational age and weight of the baby. Smaller preemies get 24 hours, larger ones q12. With blood levels done at the fifth dose on q24 and the third dose on q12 dosing.