HyperSaurus, RN

I passed! I checked a week after taking the exam on the NCC website and found out there.

My last facility changed them every three days. My current facility considers them good for 30 days, however, they never last that long.

My unit uses them frequently on term PPHN, MAS, ECMO, coolers, post-op, or just freaking septic. We use Mepitel (or some clear thingy) to attach to the probe itself, which minimizes the contact with the baby's skin. Unlike our facility's CICU, we do move our NIRs probe q4hr. I don't see them on preemies very often, if at all.

I just sat my exam and forgot that they don't give results right away. smh

ET tape with cuts from the outside towards the middle (not all the way). Top strip goes on the upper lip like a mustache and the bottom strip you take both ends and wrap around the OG in a barber-pole pattern.

Ack! That's good to know...I'm planning on sitting my exam next month.

Not all NICUs are run that way (where new grads/new to specialty nurses are pigeon-holed into level 2 babies until they've proven themselves). Even then, you'll find that NICU is an odd mix of super-stable feeder growers (even in a level 4 unit), super critical babes, and stably sick kiddos. It's pretty rare for me to have 12 bottles in a shift. Give it time and don't be afraid to try a different NICU.

Oh, that’s absolutely fair. The two kiddos I’m thinking of are two and four years old. The two year old is mobile, interactive, and no trach. The four year old, I’m not sure about other than that there is a video of the kiddo singing and “helping” mom do dishes. I do also follow a former 23 weeker (the parents were recommended many times to let the baby go, as the baby was severely septic and had huge grade IV bleeds). That kid is trached, g-tubed, completely wheelchair bound, and uninteractive. It’s so sad. I know that they are very much exceptionalities. The two year old had minimal IVH and mild CLD. I still think that 22week parents should be given the choice (between resusc and comfort care, which comfort care being highly encouraged) and include an explain in real world terms what their kid would be likely facing down the road. For every one miracle 22 weeker we have, there’s 10 (at least) that either don’t make it or have catastrophic defects down the road.

I know this is old, but I'd like to update: It's rare, but we have sent a handful of 22 weekers home on room air and nippling. Two of them periodically update us, the kiddos seem to be developmentally on track. Now, I don't know what's going on behind the scenes, but it does change my perspective regarding resuscitating 22 weekers.

Daily. We don't have a consistent time like we did at my old facility. Where I used to work, it was done with the weights at the first hands on after midnight. Here, It's whenever, but must be charted and done every day. It's part of our CLABSI prevention bundle.

We do the bulk of our report outside the patient room against the patient chart, and then go in to do and chart a double check of lines/fluids/milk.

Level IV's actually don't have to be ECMO capable. Tacoma General and Swedish First Hill in Seattle are both Level IV, but can't do ECMO. They do have to be able to do surgical procedures, transports, and outreach education.

Lol, my version seems to be, "Wow, this is so much better than the way I used to do it!"

So, what's second unit syndrome? lol

I've recently gotten a new position in a larger (70 ish beds) level IV NICU after three + years experience in a small (20 ish beds) level III NICU. After a week of orientation, I have to say, I feel like I've got some culture shock going on. New charting system, more complex patients, a huge unit, private rooms (previously from an open bay unit), and while they're getting me some orientation time working with issues I haven't dealt with before (namely, surgical patients), I'm only going to end up with 4 weeks orientation. I'm not sure if there's a point to this, other than to ask if anyone else has made this transition, and if so, what advice do you have.

McKesson Paragon. We had click boxes. One for Apnea v periodic breathing v shallow, brady y/n, feeding y/n, stim mild vs moderate v none, a fill in box for HR and for sat. That worked out pretty well, as you could do patient inquiry just for the Apnea/Brady tab and see the trends over whatever time period you wanted.

I work in a small level 3a NICU. Our PICC nurses insert PICCs and do dressing changes (but they often have their own assignment as well). RT does vent adjustments (we can titrate FiO2, and depending on the ordering physician, we're the ones telling RT what adjustments we want). We do our own milk mixing, our own labs, often no physician/NNP on the floor overnight (but usually 5-10 minutes away)

Hmm. It can be very territorial between nurses, and especially when you're new, you are constantly being watched. However, the flip side to that is that when things go wrong, all hands are on deck very quickly. It's frustrating sending home kidlets to a home life that you know is not good, but due to red tape, ect, the parents get custody (even worse if the child dies at home). I work in a Level III facility that is capable of taking care of some pretty sick kidlets (micropreemies, vents, oscillators, iNO, drips, ect), but we can't do surgery and we can't do ECMO. When we send kids out, we don't often find out how they do or even if the kid survives. I am significantly more sensitive to noise stimulation and alarm fatigue than I ever was on a medical with tele floor, due to frequent crying, ventilator or CPAP alarms, IV pumps, and monitor alarms for bradys or desats. This may be unique to my unit, but we do a significant amount of overtime d/t transports and unexpected admissions. With all of that said, I couldn't imagine going anywhere else now. I love what I do.

Lol, no, I would not feel remotely comfortable. We keep 3 RNs on at all times, even if there are only 2 babies. If something bad walks into our L&D unit, that automatically takes two of our nurses out of our unit.

I'm from a rather small unit, with 8 hour shifts and 3 shifts total. We don't practice primary care nursing officially, but we do try to keep the same RNs with the same babies as often as possible. It usually works out that there's a small core staff for each baby.

ACLS is not required for our L&D nurses, although I can understand why it is required at other facilities. Codes on moms are incredibly rare on our LDRP floor. NICU RNs are encouraged to take PALS, but not ACLS

All of our infants are placed head towards wall, feet towards unit. For intubation, the baby is briefly turned with feet towards wall, intubated, and then turned back. We really haven't had any issues. The only exception is when a baby is on HFOV.

Our NICU never allows siblings. Parents and grandparents only with only two visitors at the bedside at that. During flu season, we are usually closed to grandparents as well. There are a couple of reasons for that. One, a child may be asymptomatic but carry in a virus. Two, we're a small open unit, it gets loud quickly with increasing amount of people.

Our floats take strictly feeder/growers only, unless they have spent a significant amount of time with us and feel comfortable with a little bit more. For us, that means room air, PIVs with antibiotics, very stable. They only get 3 days of orientation, which really isn't much at all. Yes, there is a definite separation between floats and core staff, but that's ok. We appreciate that they are helping us out, and they appreciate when we try not to give them tough assignments.

What kind of tape is that? It looks like duoderm