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We do this in the NICU

We always change diapers with every set of cares. Cares are either q 3, 4 or 6 hours for a sick baby we don't want to touch too often.

We allow 4 at bedside. Either parents can bring whoever they like with them, or appoint 4 people who are allowed to visit without parents.

Oh, and to answer someone's question: he did receive the vitamin K shot before transport.

Thank you for the kind words everyone! I am feeling much better about the situation. It's still terribly sad of course, but I'm not questioning whether I caused this outcome anymore and that's a big relief. I realize I did the best I could under the circumstances, and have learned a lesson to carry on through the rest of my NICU career. I do still feel upset that this nurse didn't talk to me about her concerns, but went to the charge nurse instead. This is actually the same nurse I had a safety concern about one day a few months ago. It appeared she had flushed a med line through, which we don't do at my hospital, so I thought she may have given a baby too much gent. I did alert the doctors to this, and we drew levels. Baby was fine. I asked her about it when she was back that night, and we straightened it out. I tried to be nice about it and told her it would be an easy mistake to make. Maybe she holds some hostility towards me for this? I don't know. I'd like to talk to her about this and tell her I'd appreciate she talk to me in the future about any concerns she has. I'd kind of like to find out why she lied/misunderstood some things she told the charge nurse that weren't true. (Like I didn't know what fluids were running. I didn't do the MRSA swab because I didn't know how.) As far as the baby, I know the doctors talked to parents that day and they said they didn't want to remove support yet. Baby extubated himself while parents were holding that afternoon, and they said they didn't want him reintubated. So if he doesn't make it on CPAP, I guess that will be it for him

The other day I got an admission late in the afternoon. It was a transfer in from another hospital. Unprepped 27 weeker and Mom walked in complete. This hospital doesn't keep babies less than 30 weeks, so they let her deliver there since there was little time and transferred baby to us. The baby arrived stable but with a lot to sort out. I had actually never admitted a baby from another hospital before, so it was pretty hectic. Baby came intubated, with UVC and UAC; fluids, meds, and drips already running, on the transport team's pumps. It was a confusing mess trying to sort out their equipment and hook it up to our pumps. Syringes without labels, unfamiliar concentrations of meds, and unfamiliar tubing. It took 3 of us to sort it out while dealing with being in isolation and constantly needing to run and grab more equipment and extra pump channels, etc. It took us quite a long time to switch over all the fluids to our pumps, then change everything as we got meds and fluids sent up from pharmacy. During all the chaos I checked to make sure lines were secure, and we got an xray straight off to check placement of lines and ETT. Doctors gave the ok that we were in good position, so we carried on working. Thankfully the baby remained stable during all this. I had finished hanging the new fluids and meds, weaned down his oxygen quite a bit, and fully examined the baby, but had not sat down to chart a thing when 7:00 rolls around and the night nurse arrived. I introduced her to the family, then stepped outside to chart and give her report. It was not my best report. I was a bit frazzled, but did the best I could. During report I realized I had never counted back to get a centimeter marking on the UV and UA lines. (I didn't get this in report from the other hospital because the nurse didn't know them) I told her they were secure, and xray verified placement, but I didn't have the measurement written down. I know this is a mistake, and it's something I should have checked right off the bat. I felt really bad not knowing that piece of information. I should have also suggested we go in together and look at the markings, but I didn't. A few days later I worked another shift, but wasn't assigned this baby. I checked in to see how he was doing in the morning. The nurse who had him that day told me he had a massive grade 4 bleed and they were going to talk to parents about removing support later. I felt devastated. So guilty that I could have made a mistake (in addition to not checking the lines properly) and just terrible for the family I had met the other day. I feel like if this baby had had a better nurse on admission, maybe this wouldn't have happened. I never expected that outcome. A few hours later the charge nurse came to talk to me and said that the nurse I gave report to that night was concerned about my care because I didn't know where the UV and UA were. She also complained about me not completing the MRSA swab, and said I didn't know what IV fluids were running. It was true I didn't do the swab, and passed along that it still needed to be collected, but I told her all the IV fluids and rates and meds, so I'm not sure where she got that. So I just feel really terrible about the whole thing. Guilty I didn't do the best job on this baby, and really feel bad that the other nurse was concerned about the care I gave. I've never had anyone question my quality of care, but I've also never made a mistake like that before. I had to go to the bathroom and cry/ get myself together for a good while then, and I'm still feeling pretty shaken up about it. Thank you for listening to the rant. Any advice you can give me would be appreciated.

I don't think you are missing anything. I think they are just completely lacking common sense! I've moved on from this. I decided that probably isn't even a good place to work if they can't handle something as basic as this!

Yep I definitely have an RN license! My program had us taking many similar classes to the BSN group, but with more emphasis on leadership

Hi Guys, I have kind of an unusual degree. I have a MSN in Nursing. The program was entry level, for people who already had a bachelors in an area other than nursing. (I also have a BS in Psychology.) I recently applied for a new job at a magnet hospital. They are telling me that because of their magnet status, they can only hire nurses with a BSN. I really don't understand this reasoning, when I have a degree higher than a BSN. Has anybody had a similar experience? Maybe some of you out there are ADN to MSN degree holders? It's really frustrating because I was actually recommended for this job, met with the hiring manager who seemed really excited about me, and now it seems we are at a dead end. UGh!

We always use diapers too. Just try to fold the extra cloth down, and plenty of skin is exposed.

I've been a NICU nurse for 3 years now, and it's been my plan all along to get some good level 3 experience and go back to school for my NNP degree. I"m starting to question whether this is what I want to do now, and I was hoping some of you fine people could give me any insight! Let's start at the beginning... I graduated in 2010 from an entry level master's of nursing: CNL program. (unusual, I know) I thought the CNL position seemed like a good fit for me, and I was thinking of taking the certification test after I got some nursing experience. But since I graduated, I have seen zero job postings looking for a CNL. Maybe this position just didn't take off... I've worked in two level 2 NICUs since graduating, and recently got a great job at a level 3 teaching hospital. I'm sure I don't want to be a staff nurse forever. I do enjoy it, but I feel I want to advance myself. I need at least 2 years of level 3 experience to go to NNP school. Now that those 2 years are ticking away, I'm not sure if an NNP position would be right for me. I see our NNPs working 24-48 hour shifts, and I can't imagine wanting to do that once I have children. Plus, I'm feeling overwhelmed by the new information right now and the thought of having more responsibility around these fragile babies scares me. I'm wondering about possibly taking on a CNC roll or an education leader roll instead. Could I do any of these jobs part time once I start a family? Would they all pay about the same? I just don't know! Any other positions you guys can suggest, and what I should do in the meantime to prepare myself for them? Thank you so much for reading this long post!

No, I don't think they are expecting that. But I'm not really sure what the big "No Nos" are. The only one I've ever needed to know for my job in a level 2 is that you need to stop the TPN before hanging ampicillin.

I didn't have access to their hospital guidelines, and I don't know if they use Neofax or not. I was studying with a compatibility chart from my school. http://www.uichildrens.org/uploadedFiles/UIChildrens/Health_Professionals/Iowa_Neonatology_Handbook/Pharmacology/NICU%20Intravenous%20Drug%20Compatibility%20Chart.pdf

Hi All, I'm starting a new job in a level 3 NICU and my job offer is contingent on me passing a NICU pharmacology test. I feel pretty confident about all the topics on the study guide except IV incompatibilities. At work right now (a level 2 NICU), I look up everything in our med book to make sure it's compatible with TPN and lipids before I give it. I just don't trust my memory on this! And we don't give the full range of meds a level 3 NICU would. But for this test, I'm supposed to have the common incompatibilities memorized. So far I have ampicillin, versed, albumin, acyclovir, gancyclovir, amphotericin B, indocin and ibuprofen, and phenobarb down for being incompatible with TPN and lipids. Am I missing any? Are there any other common drugs you might give at the same time if they were compatible (like 2 antibiotics that can't mix?) Anything else you can think I should have memorized? Thank you so much!

Hello all! Quick question for all you NICU peeps :) On my unit we have a lot of CVC's...especially Broviacs and PICC lines. It is standard protocol that every baby with a CVC is on prophylactic nystatin (a swab to their mouths) My question is....why? Do CVC's cause thrush? Or are they worried about fungus from the mouth somehow infecting the bloodstream? I've worked here a year and my old hospital never did this. Nobody was able to explain this during orientation and now I just feel silly asking after giving it for so long :) Anybody else work on a unit that does this? Thanks a bunch!