karnicurnc MSN, APRN, CNS

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 a...

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 wel...

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 checkin...

Agree with post above about oxygen and it's detrimental effect. Pumping 100% FiO2 into a preemie's closed incubator can contribute to ROP (think Stevie Wonder). Also oxygen is a drug and I would think it is out of an RN's scope of practice to admin...

I wanted to share our newly developed feeding protocol related to gastric residuals. This is a section taken from our staff education presentation and explains the evidence behind our decision to no longer check residuals. Gastric residuals are a s...

I agree, good idea to apply. All they can do is decline to interview, but you will never know if you don't try. Good luck!

We do weekly surveillance swabs. If positive then infants are isolated until d/c. We recently had a large group (about 20%) of MRSA-colonized infants. We had to isolate, cohort, treat with bactroban, bathe with CHG (those that qualified) and then ...

We do not check abd girths as they are useless as stated previously. Here are two articles that helped to provide evidence to change our practice from checking residuals to NOT checking them unless there are other signs of feeding intolerance (abd di...

We have used the Medela warmer for years, but only had 1 per pod of 12 infants, so it was not very useful except for the one person who got to it first for that round of feedings. We have also used warm tap water in Styrofoam cups for years (a horri...

From Medela's waterless warmer user guide: "Medela Disposable Inserts are a limited use item. Medela recommends changing the inserts every 12 hours. Inserts should be changed if human milk comes in contact with the inserts. Inserts should also be cha...

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

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.

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.

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 precept...

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...

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!

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/gro...

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?

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 ...

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

4 per bedspace, so that means 8 swarming visitors for twins and 12 for triplets. It's a zoo.

I agree, standard ordersets and submitting incident reports will help. Be thorough, objective, and polite.

I agree with the above posts: the transport nurse put the lines in - he/she should know exactly where they are. Nothing in your care contributed to the IVH. Being born early, in an outlying facility, and being transported in on a vent is all it tak...

Hi! Yes, sometimes the babies cry nonstop, some are sedated, the families can be challenging, and we do titrate drips. Spending a day shadowing a NICU nurse will provide invaluable insight into the daily workflow. Try to spend some time with the ve...

We encourage consistent breastfeeding if the mother can produce a UDS that is negative for street drugs. Most of these mothers are not able to maintain a supply because they do not visit and therefore breastfeed often enough, so in a few days it bec...