NICURN9

Wow! How unfair for those parents. Nothing like adding to their stress. Our multiples are always in the same room unless one of them get an infectious disease and needs to be isolated or something similar. They are not neccessarily side-by-side but most of the time they are....just depends on acuity and ability to move other patients around (ie...not going to move a 650gm kid on an oscillator just so twins can be next to each other). We do not co-bed. We were co-bedding them a few years ago but now we are not. I am PRN and I don't really remember the reason that we quit. Hope that helps

I am so glad I found this board. It's nice to hear what it is like elsewhere. I have worked in our NICU for 8 years and I LOVE my job. I am only PRN now because I adopted a short-gut child from our unit and he had a small intestine and liver transplant 5 years ago and is a lot of medical work still at times. Anyway.... we used to have a group of only 4 docs all in the same group, all been there a while. About 6 years ago a new group from the medical school started 'invading' our unit. Over time 1 of the old group left, 1 joined the new group and the old group consisted of 2. Old group hired one new guy so they are now 3. New group had now grown to 4docs. Old group and new group hate each other by the way. To the point of fighting over a delivering mother's big belly about who was going to take the baby!!! The old group was respectful of the nurses and valued our opnions. They understood that we spent 8-12 full hours with the patient while they spend 10-12 minutes with them. The new group does not think we have much to offer. We have been told so much as "you aren't paid to think, you are paid to DO". This mentality has REALLY taken a toll on our unit. We often find ourselves doing things that we don't agree with and over charting to protect ourselves. Oh....and we even had a doc tell a babies family recently that is was the nurses fault that their baby died!!!!!!!!!!! (of course he left out the fact that he tried to do an abdominal tap at the bedside from the right side just below the rib cage right before the baby died!). It just makes me sick. I used to feel like we, as a team, were really making a difference in these kids lives, now I feel like I constantly doing things that are hurting these kids because there is an "order" for it! Ugh! So.....how is it between you and the docs in your unit? (and thanks for letting me vent) Kim

Well....thanks for the insight. I guess it isn't all that unusual just not OUR policy. As for tissue necrosis....never really had a problem with it. We watch these IV sites like hawks and babies who are on dop/dob are usually kids who have a nurse standing over their bedside almost constantly so it isn't like we wouldn't notice a bad IV site for 2 hours or something. I guess my biggest fear with doing this was that it isn't our policy and if someone else were to come into the situation to help (ie nurse on break and baby has an antibx due) she may piggy back another med into the PICC line further up and FLUSH. And I don't know about your unit, but we have a few nurses who are a few fries short of a happy meal.... why the heck they are still working there (for YEARS) is beyond me...but this is a totally plausible scenario. Another issue with this is that we have a lot of policies and procedure guidelines and protocols but it seems that whenever someone doesn't like it they just change it. Then why the heck do we even HAVE these. Let's just do it freestyle! We have a hard time getting mgmnt to back us up on these things and it is really frustrating. We never draw blood through our PICC lines but maybe if we are going to be running these drugs through there we need a new protocol that involves aspirating a cc or two before flushing if the need to flush arises. Thanks again! I feel better! Kim

Double time if you work the actual holiday...nothing for the "eve"

Hi. I am just looking for some different perspectives here. What is your hospital policy for using Dopamine and/or Dobutamine as far as piggy-backing, flushing and what sites to use? I have been a NICU nurse for 8 years. I am PRN now and things have changed some as we have a new set of docs,etc... We always had a policy though that Dop/Dob could only be piggy-back with each other and had to use a peripheral site so that in the even that we had to flush that site we could disconnect the tubing from the hub of the catheter and flush it OUT of the tubing before flusing the site itself. We find ourselves using more and more of the triple strength dilution meaning that our rate is 0.16cc/HR to deliver the dose. I had a very sick baby the other afternoon and the doc insisted that I switch the Dopamine over and run it through the picc line and give the antibiotics through the peripheral site. I tried to explain to him how dangerous this would be if we had to flush that PICC line, but he would not hear of it. Insisted it would be fine. Granted our PICCs are pretty small but I am guessing that priming volume is about 0.5cc and that would equal 3 HOURS worth of Dopamine if we had to flush it through. He still insisted this was ok and the charge nurse finally informed him that if he wrote the order that way we would do it that way. I was VERY uncomfortable doing this! Just wondering what your policy is and do you use the triple strength dilution?