JaredRN

You have a right to talk about working conditions, as long as you're not slamming other people which you could be sued for slander. A union will back you up on that. If you don't have a union, you do still have rights, unles you work in a right to work state, at which point your comments probably will get you fired. But if it was union you have just cause on your side. But in the future, becareful, unless you work in a facility that has strong union support and solidarity, people generally do tend to back stab you.

The 66 yearold woman had a enteral feed hooked up to an iv line. I believe we have to stand together on patient safety, because Sutter believes they can replace you with anybody. And that's what they did...

I think you can argue safety both ways on 8-hour vs 12-hour shifts. There can definitely be more mandatory overtime if shift scheduling is not filled in correctly. I think that continuity of care is sacraficed a little because if one shift can stay with a patient for 5 days a week, thats a lot better then assignments changing every day or other day with 12 hour shifts, where a nurse may not return for 4 days or more. There could be less fatigue, possibly fewer errors. Ultimately everyone I work with prefer's 12 hour shifts. I think that working too many in a row can burn you out where a reprieve of 3 or 4 days after doesn't feel like enough. People still work 16 hour shifts which can be dangerous too, but often times nurses will do it for the double time. Give or take, nursing is demanding work that takes a lot of skill, and concentration which is hard to keep up for 12 hours. You should probably look in to how often people actually get a break. Some nurses don't get a break at all. Some might get a break short, and don't clock the missed meal or break because they're afraid of getting in trouble. Some places let you put all your breaks into 1 hour, or 2 30 minutes. Those can be just as dangerous sometimes too.

You know, every nurse has a bad day, just like every mom can. Sometimes you just get tired of the insanity of it all. And if that feels arrogant or uncaring, just remember there are no perfect nurses out there. The ones you got to watch out for, are the ones who think they are.

Hahahaha... I love how my assinine comment created the best discussion on neonatal ethics I have seen yet. All I did was bleep a cussword at an ex president, and the context just spewed out. I'm really fortunate to be part of a community of such smart nurses and also laughing my ass off.

****** Ronald Regan

Hi n315,lpn, I am a pediatric ICU nurse, and I know exactly the kind of baby you're dealing with. Best advice I can tell you, don't worry about the sounds. I'm not telling you not to worry about anything, you sound like you just lack a little experience and maybe some confidence. Let me tell you what exactly a baby like this has gone through. To give you an idea, because premature babies are born with underdeveloped lungs, and the variety of things that go wrong, like respiratory failure. They mec aspirate, or born to early, or develop an infection. They have acute respiratory failure, their lungs fill up with fluid get edematous and no longer have adequate gas exchange. Maybe a little pulmonary hypertension on top of that to give a little multisystem organ failure and you should of seen this kid when he was 2 or 3 days old on a ventilator, probably either jet ventilator or high frequency occillator, maybe a little nitric therapy and all these lines and tubes in side of him. A UA catheter here, an L cath there. These kids unfortunately sometimes get better but not completely healthy or even normal, and they almost always develop chronic lung disease. So you're probably looking at a very delayed child, probably with multiple medical problems, maybe a little syndromy (PICU nurses make up their own words sometimes). You know chromosomal deletion, maybe a really low one. Probably very delayed or mentally retarded, maybe spastic cerebral palsy. Just an all around train wreck. CLD can be irreversible, sometimes the babies will grow back viable lung tissue but this isn't the case most of the time because of the repeated exposure to therapies to keep the buggers alive, namely chronic ventilator support and the resulting barotrauma, also the effects that free radicals have destroying lung tissue being on oxygen so long. So these kids end up with having jacked up lungs in general. The kid sounds like he breathes really hard, thats because he doesnt have as much (if any) viable lung tissue a healthy infant does for gas exchange, and why he needs to be on a ventilator. I once took care of an infant who made it to 13 months of age with only a little bit of his right lower lung left. Well what happened to him was he got pneumonia in that little bit of lung and died within a few hours, just to tell you how fragile these kids are. Can't live without lungs, and putting this kid on ecmo is just crazy stupid. If he sounds coorifice all the time, his lungs are also producing a lot of mucous which you probably suction all time from this kids trach. If he sounds wheezy his airways are constricted, from mucous or bronchospasming, so he needs bronchodilators constantly. Don't focus on the lung sounds too much, pay attention to how the kids looks like his overall work of breathing. You should also have a pulse oximeter. Also keep in mind these kids should be on palliative care and dont live for much longer, which is why you're there as skilled nursing care. Because the parent's are idiots and didn't want to withdraw care, and probably wanted everything done, and now you have a train wreck in front of you. Document what you see, what people say, what you do, and you'll be just fine. Just pay attention, make sure he gets the therapies he needs, and when he gets a pneumonia watch out, hes probably on his last leg. But don't worry too much about it, cause the outcomes for these kids aren't very good anyway (I don't see too many make it to 2 years). I tend to focus my interventions on the parent's if they're even around, thing's like supportive care and dying and not prolonging suffering. In these cases I bet they look at you as the only respite they have, leave you babysitting while probably getting drunk somewhere to escape their troubles.