barbnicu

you are actually fortunate to have had a preview of some of the care that nurses give. As for political issues: there are, and always will be those managers who make things difficult (who have no clue); administration that dictates pt. care issues, and generally some "bad eggs". You are going to have to learn to distance yourself from staff with issues, and try to not pay them much attention. As for my own experiences: I have worked for not for profit hospitals, and for profit hospitals. I much prefer the not for profit. Why? I have had much better experiences in these hospitals- the focus is not so much on how much money the facility can make, but on the quality of care given.Keeping in mind that although the hosp. doesn't make a profit; supplies, salaries and other stuff costs money and if materials (and time) are wasted, that can impact on the bottom line also. In my own experience, my current (and I hope the last) hospital where I work, has nurtured me, and the other staff. We are encouraged to grow professionally. In the last 5 years at this hosp. many of the staff have achieved certification in their field, I have been allowed to get education certs, and now, I teach childbirth, infant care, and sibling clases. I have been enc. by my manager and the admin. to grow as much as I can, and I am SO grateful for the support I, and the rest of the staff, are given. Mind you, I know that not every hosp., or managers are like mine, but, change is always a given, and what does not work well now, can be changed by the staff nurses. It takes commitment, and perseverance, and the will to follow your instincts.

if you think that holding a dying person's hand, or teaching a new mother how to feed her baby, or helping and supporting a child during a scary procedure are cons; then rethink. However, if those are things that you would want done for you, then they are pros. In all that a nurse does, patient advocacy is utmost. I always put everything I do during my shifts in the perspective of: is this what, or how I would want this done for my mother, brother, sibling or child? Or spouse? Or myself? I think that this is kind of like applying the "Golden Rule". If you want to be part of this special world that is: caring people who care for people, then it is FOR you. If not............

Same here, upper 20's, exchange transfusion; you know the drill. Did have an infant who just could not get the bili down, it stayed in the teens. Went home on Actigal. Another one who had that deep bronze color, found out she had CMV. But it was too late when we got all the tests back. Sad day.

We will give trophic feeds, starting with small amts: 1 or 2 mls, through the OG, then leave it open to vent air. How did change your "high flow nasal cannula" set up? Nasal "rinsing" is so irritating to the babies. I am very interested in finding out anything that can make them more comfortable.

I went to LPN school when I was in my late 20's, had a child in Kindergarden at the time. 14 years later, I graduated from nursing school again, with an ADS in nursing. I aced my boards, and stayed at the same place where I worked as an LPN. I just got an upgrade in pay, and more responsibility. But, I LOVE it! My husband and I moved to AZ in 2002, and now my pay is DOUBLE what it was in Pa. after 20 years at the same hospital. So, my friend and future colleague, GO FOR IT!!!! You will be in demand, and find new challenges every day. You know that you have done a good job, when you can say "I made a difference in someone's life today" when you go to bed at night. Good Luck. Keep posting, and I am sure that you will get tons of support from everyone else on the web site.

Thanks to everyone who got back to me. It is our standard of care to place an OG to vent for infants with resp. diffulculty, no matter what the gestational age. Especially if they are on Vapotherm, or Nasal cannula. I agree with that, they are going to inflate their little stomachs quickly, and that can just create more resp. distress. The question was: is there evidence to support this practice? Esp. with the weight parameters: OG to low inter. sx 1501 grams. If I can't come up with written evidence, the neo. will just have to make it a standing order, and it won't be written into the System Policy (I am on the policy committee)

Back to the Vapotherm: does anyone have evidence that the neonates stomach has to be decompressed? Our current practice is: #8OG to low intermittant suction for neonate 1501 grams. Anyone come across any of this? We have been using Vapotherm since our unit opened in 2005 (with time off when they were recalled), and all of the staff, including Doc, and NNP's love it! We are a small unit, but almost all the staff has Level 3 experience. I am going to share the input about keeping the tubing warm to keep down the incidence of "showers" for the baby. That is one of the things that cause challenges for us. We also find that if the flow goes below 2.5 lpm, there is more "rainout". What is everyone else doing about that?

The decompression horse is not dead yet. I need to find EVIDENCE for placing a tube to decompress the stomach of a neonate on Vapotherm. My Neo doc. wants a #8F OG to low intermittant suction for infant 1501 grams. Has anyone come across any literature to support these recomendations?