rainbows4me

Congratulations on passing the boards! It takes a long time to become comfortable in NICU. Some people are more natural with organization and time management than others, and as a new grad, you're likely to have a few kinks to work out. Don't let that get you discouraged, as it doesn't indicate how well you will eventually be as a NICU nurse. Time management, while obviously important, will come with time and experience. Keep up the hard work, and I'm sure you'll find yourself improving in speed and organization. As I'm sure you've read on these boards, it usually takes a couple of years to feel truly comfortable as a NICU nurse. I've been at it for over two years, and there are certainly days where I feel overwhelmed and wonder if it'll ever feel completely comfortable... And of course I know that when you're taking care of sick, sick babies, it is not 'comfortable'. That's the crazy love/hate realtionship of mine with NICU. Adrenaline rush and all...

Looking for some help here... Our unit uses bubble cpap. We have been struggling with ideas for chin straps on our babies who continually have their mouths gaping open, and thus stop bubbling and lose their pressure. We used to tie stockinette (the very stretchy white kind) around their chin and over their head ... you know, the old 'bunny ears' approach, but we had a couple of events in the past with misuse (tied way too tight) leading to molding and now our management is trying to come up with a better solution. The current idea is to fold a piece of non-stretchy cotton and tape it under the chin and onto the hat. We have had HORRIBLE luck with this - since the hats are stretchy and the tape sticky on the baby but never for long on the hat. I go into the bed with the baby desating to 60s, not bubbling, to find baby with wide open mouth, tape stuck to hands and face... Or to find that when crying, the baby has pulled on the chinstrap and thus pulled down the hat which pulls the cpap prongs out of the nose... ug!!). I keep thinking that we should be able to come up with a separate chin strap product/idea that would not interfere with our cpap hats (which are tough enough to keep stable without adding chin straps holding strong jaws)... What are you all doing?? Very specific information please - including manufacturers if you use manufactured products. Thanks in advance!!! Rainbows

Great book! I have read this book, along with many other midwife/doula/homebirth books. And yes, I am a NICU nurse, and yes, I've had a midwife birth with a free standing birthing center, and yes, I totally support homebirth with low risk mothers and well trained professionals. Not all NICU nurses are opposed to homebirth (although in my experience the majority are).

Now let's be fair. You honestly think that bad things don't happen in hospitals? That a bad birth at home would have been a great birth in the hospital?? I hate it when people assume that a failed/bad homebirth would have been a better outcome in the hospital:angryfire Four of the worst outcomes I have seen in the last six months were hospital births. Two were from our very own level three teaching hospital and resulted in taking 30 & 39 weekers off the vents due to flat EEGs. We have had a couple of failed/bad homebirths during this time as well, but both of those kids were home in a week. It also amazes me that we, as NICU nurses, tend to diss those homebirth or even birthplan parents who have such a difficult time seeing their baby in the NICU. Doesn't it bother you more to see the parents who don't care? I see (or usually don't see much of) so many drug-addicted, no prenatal care, DSS involved parents, that even though they may demand more of my time and attention I'm glad when I have parents who care enough to be angry!

To be honest - I'm glad I'm done having babies! As a NICU nurse, the blissful ignorance is gone - I have seen the bad outcomes of birth. Bad outcomes of hospital births and bad outcomes of home births. And if you look at the research, you have a higher percentage of having a bad outcome in a hospital than you do with a well managed well screened home birth. (Obviously some of this is because high risk deliveries aren't home births!) I've read this thread with great interest. I was a momma before I was a NICU nurse - had 2 babes in the hospital and my last in a free-standing birthing center with a CNM and RN in attendance. My birthing center birth (5 miles from a hospital) was amazing and beautiful and something I wouldn't trade for anything. I would have had a homebirth but my partner was not comfortable with the idea. It is often difficult for me to witness the bad outcomes that we see in the NICU and reconcile them with my supportive views of homebirth and birth in general as a normal life experience rather than a medical procedure. It is only because of my NICU experience that I personally could not be comfortable giving birth at home or in a freestanding birthing center again. This is a very personal statement, because it's not based on research or my support of the homebirth experience, but because having seen bad outcomes, I would be (irrationally) terrified that something would go wrong. I'm glad that I finished having babies before I became a NICU nurse for this very reason. I feel sorry for my coworkers who have to wrestle with these fears (regardless of where they give birth) and realize that it is certainly one of the downsides of the job... Thanks for starting this thread! Good food for thought!!

Which is an easier moral to follow if you aren't risking losing your job for calling out. Not as simple as worrying about your paycheck, it's worrying about your career, your evaluations, not to mention being able to care for your own family (don't know about you, but my paycheck doesn't go for bon-bons and vacations!) The issue at hand here is not 'that sick nurse', it's the SYSTEM that promotes 'that sick nurse' going to work when she is not well. If that changed, I doubt you'd have many problems.

We do "5 channel studies" which along with the regular HR/RR/sat also monitor esophageal pH. Never saw so many kids diagnosed with reflux as those on our unit... wonder how many kids off the street would test positive for reflux if you gave them all a 5 channel... It's become a big joke around here now.

Seems like it's usually a 2-3 or a 8-10... Not usually in middle! And our whole unit seems to be that way as well - either we go a whole shift with no admission or we're getting 3 admissions, crashing kids, and calls for immediate transport! I actually like the 8-10 nights... they just fly by.

A year and a half. Love the work I do, don't always love the politics of such a seasoned unit. Like yours, ours has many 25+ year veterans, many of whom started in our unit as new grads!

I have to agree, that while it's not my first choice, i've done it many times. Last night, in fact, I was forced to as well! When your hands are dirty and you see a brady to the 50s, sat in the 60s and flat line in the resp monitor, you do what you need to do. I think you might do yourself some harm by reporting this - I know in my unit it'd come accross as trying to stir up trouble. I'm not saying this should be your standard of care for an ABD episode, but sometimes it is necessary to buy time until you can wash your hands and get into that bed or wait for someone who is clean to get to the bedside.

Our unit uses "technical associates", which are often CNAs. They do heelstick blood draws, Algos, car seat tests, and help with feedings, baths, weights, vitals, stocking, etc. We are a 50+ bed level 3 and utilize 2-4 per shift.

seven days here as well...

We use 23 weeks and 400 grams as a cut off. Our outcomes with 23 weekers (23 and change) have not all been bad, but certainly the majority of them do not survive without major problems along the way, if they survive at all. We did recently have a 23 weeker who was on cpap at 1 week - crazy. The jury is still out on this baby's final outcome, but for now it looks good.

Our dopa/dobuta is mixed together (same syringe) in a dosage based on the kilos of the baby in either single or double strength. I think it's similar to what Gomper's described. We then have a chart that has to be posted at the bedside with the microgram/kilo rate by ml/hr. Our pharmacy (we have our own pharmacy in our NICU) mixes dopa/dobuta during the day, but we still mix our own at night. We also mix all of our iv fluids and other drips (insulin) at night. Interestingly, however, right around our last JACHO visit, they wouldn't allow us to mix our drips and took away all of our cheat sheets and supplies. We had to call down to the main pharmacy - who were CLUELESS! I had a pharmacist asking me what our formulation for certain IV fluids and drips was! Once it took 4 hours to get an insulin drip - we were beside ourselves - within a day or two after JACHO we got all of our cheat sheets and supplies back. Thank God.

We don't use any pre-fab wrap pieces - we just use Coban - and a fresh piece whenever it get's old looking.

We rotate our pulse ox probes Q3 or Q4 and I have never noticed any smell associated with our sites or probes. Perhaps it's the eight hours?? Rainbows

You express my own feelings/thoughts/sadness/upset of this week. I hope you find some peace and comfort. Big hug for you.... Rainbows

But my internal belief says that euthenasia involves "acting on" in order to provide death... Is stopping futile medical care euthenasia? Or is it allowing death to occur? We act on and on and on to lengthen the death process - in many many times to the detriment of our patient (pain and suffering). I'm sure you are right in legal terms - but I just can't believe that what we do sometimes in the name of the law and 'family rights' is the right and just thing to do. Our unit has had two similar cases within a short period of time. One family chose to remove life support (even before our docs had come to that themselves- which created an interesting scenario). The other family continues to want "everything done" - even when many of our consults for specialist treatments have refused to treat this patient because it is futile. Argh! I am sorry to sound so cynical - it's been a rough week - as I've had both of these kiddos... I go back and forth between fury and tears! Peace, Rainbows

Our unit has had a string of sad babes lately who have had huge in-utero assaults with complete neuro hits. I'm curious how other units deal this these kiddos - the ones who have flat eegs, blown pupils, documented extensive PVL/ liquification of brain matter, not response to stimuli, etc. These aren't micros with bleeds, but rather close to term/term babies who have been down for a long, long time prior to resucitation. Do your docs ever just 'decide' to take kids off of vents for parents who can't seem to grasp the reality of this situation (after adequate time for processing/coming to terms with the situation)?? It's been frustrating watching all of the pain, money, unnecessary trauma experienced by everyone from the baby to the parents to the healthcare system at large. I get so frustrated by parents who continue to want 'everything done' even when the bad, bad outcome is SO obvious and proven. I'm told that there used to be a day when docs would just say "I'm sorry, we've done everything we can, but we need to take your baby off of life support and we're going to do so," but it never seems to happen in our unit. Is it a sign of these legal times?? How do you all handle it?? Heavy heart, but mad and frustrated as well...:uhoh21:

We use 1/2NS - and never any heparine - at 1cc/hour unless it's a wee bitty micro and then sometimes 1/2cc/hour. Now any of our UV lines always have heparine, but never the UA. Rainbows

All of our blood products come prefiltered - we use the regular sized (not micro) extension tubing and never use a separate filter. Interesting... Rainbows

We change our NG/OG tubes Q48, but I have heard from some of the other level IV units we transport to (we're a large level III) that they actually insert only for the feed and then remove. They are doing this based on a reported correlation with long-term NG/OG and reflux. Based on the amount of reflux we see, it wouldn't surprise me if this was true. Anyone else heard of this?? Rainbows

I started almost a year ago as a new grad (wow!! can't believe it's coming up on a year!) and I interviewed for the position in January. I had sent my stuff in to the hospital recruiter in the fall of my final year (graduated May 2004), interviewed in January and was hired that day. I chose not to start until mid August - spent the summer hanging with my kids for a change after the craziness of nursing school. My hospital has a really competitive new grad program, so earlier is certainly better around here. Good luck to you!! Carolyn:rolleyes:

but wanted to give you a hug... I hope everything works out without any lasting effects. My first big error was starting a double strength dopamine drip and a single strength rate!!! (oh yeah - that's double the dose!) Luckily for us (baby and myself) we caught it within five minutes before any harm came to the baby. HR was up, but came back down quickly. It is so scary to have an error happen, and yet everyone tells me they happen to everyone... It just feels so awful!! Peace...