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L/D 4 yrs & Level 3 NICU 15 yrs
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karnicurnc has 19 years experience and specializes in L/D 4 yrs & Level 3 NICU 15 yrs.

karnicurnc's Latest Activity

  1. karnicurnc

    NICU ratios

    I work in a 60 bed Level III unit. Admissions, CPAP, vents and stable HFJV/HFOV are 2 patients per RN. Other intensive care status patients are 1 of 3 patients cared for by 1 RN. Intermediate care (stepdown/PCU) patients are 1 of 4 infants in an assignment. This allows the bare minimum care to be given with no time for extra stuff. Pretty ridiculous. These decisions are dictated by state regulations and we have been fighting for better ratios for years, using NANN guidelines, to no avail. Family satisfaction scores (which sadly have become the benchmark by which quality care is given even though the two are often mutually exclusive) would improve if parents perceived that nurses had time to give that extra care.
  2. karnicurnc

    Phasing out CNS

    I am a neonatal CNS who graduated in May of last year. My hospital paid for me to go to school as the state requires a CNS in a Level III or higher NICU. I am 1 of 11 CNS's in my hospital (a large teaching/tertiary regional facility) and we are well-utilized in the system. I have received offers from other centers looking for a neonatal CNS, so maybe it depends on what your focus is on. I am lucky to have quite a bit of autonomy in my role, and for that I am grateful. When I went to school I was 1 of 2 neonatal CNS students and our plan of study was a hybrid - taking classes with NNP students and adult CNS students. This year that school opened up a dedicated neonatal CNS track.
  3. karnicurnc

    Length Boards

    Do you use a length board in your unit and if so, what brand/model? Thank you!
  4. karnicurnc

    NG/OG placement

    X-ray verification is the gold standard for tube placement, but is not a feasible option to irradiate an infant before every feeding or when the tube becomes dislodged. Best practice also dictates 2 methods be used. We have recently stopped checking aspirate (as there is no real predictive value in that from a GI standpoint) and the 2 methods we use are an xray at initial placement and weekly, and checking the tube cm marking before each feeding. We do still aspirate air to remove it from the belly but it is not a placement check.
  5. karnicurnc

    NAS, How do you score?

    Inter-rater reliability training can improve the accuracy of scoring and boost the confidence the providers have in the nursing staff related to scoring. I have read several research articles that use this training. Neo Advances
  6. karnicurnc


    We use EPIC also, but don't let them sell you the adult ICU version and tell you they can modify it for NICU. Buy the NICU module to begin with.
  7. karnicurnc

    8 weeks of orientation

    I agree that is not enough time for orientation. Request more time, if you can. Talk with other newbies to see how they handled it. Ask for a buddy when off orientation - a person you can go to for advice, help.
  8. karnicurnc

    New job!

    The NICU is an intimidating place. The patients are often very sick, and families are extremely stressed. So it is good to heave a little bit of healthy fear. It will keep you on your toes. Make sure you have a good relationship with your preceptor, as she/he will be your guide to caring for the tiniest patients. I also recommend the STABLE and Merenstein and Gardner books as resources. Don't try to read M&G from cover to cover, but rather use it as a resource to further your understanding of a patient, such as a baby with PPHN, or NEC, or RDS. Think about your patient as you read the text and integrate what you did with how and why. Good luck!
  9. karnicurnc

    Nicu in need

    I am quite concerned about how your unit is handling this escalation in level of care. The "blind leading the blind" puts everyone's license in jeopardy. You can't just start running a Level III NICU. I agree with the other posts about having APNs train and support as you transition to caring for patients with higher acuity.
  10. karnicurnc

    Nicu/peds float - becoming competent

    Agree with the above comments. Our float pool receives about 3-4 days of training and take the feeder/growers. The most experienced floats can take slightly more complicated kids, but that takes time. Once you get the hang of taking the feeder/growers, try to observe and ask questions of the nurses taking care of the sicker infants. That shows curiosity and motivation to learn new things. Try to be patient.
  11. karnicurnc

    Parent Support Groups

    A support group made up of former parents who mentor current NICU parents? Or a support group where you as a nurse offer support to current NICU families?
  12. Several things I want to comment on: Rotating shifts within the same week is a problem. Can you ask to be on days or night totally, and not rotate around? Your nurse to patient ratios (5-8 patients) are unreasonable and dangerous. What level NICU do you work in? Do you have government-mandated guidelines as far as staffing ratios? Do I understand you correctly that you are in the UK? How do other NICUs manage their staffing? Making multiple errors (a sign of fatigue and stress) is quite concerning. You are jeopardizing the health of the patients, as well as your license and therefore the ability to practice elsewhere. Have you spoken to your manager? Can they get some travelers in for relief? Do you have any way to file a complaint with an overseeing organization (such as JCAHO, here in the US)? Patient safety is a big deal, and people tend to listen when bad things happen, unfortunately.
  13. karnicurnc

    Looking for some hand hygeine policy input...

    Same as babybums, above, no rings with stones and no artificial nails. Plain wedding band is allowed.
  14. karnicurnc

    CNA in the NICU

    Hi, Just curious if your NICU employs nursing or patient care assistants and what some of their responsibilities might be, such as PO feeding stable infants, taking vitals, NG/OG feedings after placement is checked by the RN, etc. Thanks!
  15. karnicurnc

    Penguin refrigerators

    We are considering purchasing the mini Penguin refrigerators for each bedspace (60 beds) in the NICU. They would be used for breast milk and formula storage and take the place of the "apartment" fridge that serves 12 infants/pod. I would appreciate any feedback on this product, or any pros/cons of having individual refrigerators for each patient. Thank you!
  16. karnicurnc

    neonatal CNS exam

    Hi everyone, I am studying for the neonatal CNS exam offered by AACN. It is a new test, and according to their website, 5 people took it in 2014, and all 5 passed, but there isn't really a lot of study material out there like there is with other (adult) exams. Any study tips, advice, suggestions would be greatly appreciated, especially from the 5 who passed last year!