neominder

i have been a nicu nurse for five years, and the overwhelming majority of our patients go home and do well. we have even been suprised by a few we thought would be so badly brain damaged that they would never walk, talk, or so much a sit by them selves were doing all of the above. there have been a few times when i feel we have done a family a disservice, but in that moment you have to decide life or death and if a parent wants you to "save" thier baby at all cost, you have no choice. i can say it makes my job a little more difficult, and i have asked not to care for a baby because i didn't feel we were doing the right thing by that baby, he did eventually die. it is sad, but for every sad story there are so many good and happy endings.

we co-bed in our unit everything from twins to quints. the just have to be infection free, no iv's and in ra or canula. they can co-bed in isolettes or large peds cribs depending on the size of the babies. this works well with fairly healthy babes, and is a big pain if you have chronic bpders who will fuss and wake each other up all night.

we used to do only prn changes when the dressing became non-occlusive. now they are q monday and prn. this was as an attempt to lower infection rate. it hasn't helped thus far, and we are having more problems with the lines being pulled back and becoming peripheral. when the changes were prn they were done by the pcvc(picc) team...now we are all trained to do the dressing changes ourselves.

we have primary nursing in our unit. it is completely voluntary. i love it, and almost always have a primary pt. we also have associates who care for the baby if the primary isn't there. either a nurse can sign up for a primary, or parents can ask to have a nurse assigned to thier baby, but it has to be acceptable to both nurse and family. a primary follows a pt through the nicu stay, when the pt moves to level ii they will then pick up a new primary nurse form the level ii staff. those of us who primary love it, and those who really like all the adrenaline don't they just take care of the super sick kids w/o primaries and do admissions...

In az if the infant is >24 weeks and makes any attempt to breathe we have to resusitate. which then leaves the parents the terrible decision of withdrawing support if the damage we have done is great. I wouldn't want to go to the hospital under 26 weeks. but I luckily will not have to make that decision, I had 3 healthy full term kids! and I don't plan on anymore.

we haven't had lemon swabs in our unit for much longer then i have been there. suctioning, sterile h2o and gauze are the norm. i like to dip a sterile cotton tipped swab in breastmilk for small vented babies. it gives them a positive oral stimulation, they love it, they suck on it like it was the best thing on earth...and if they were eating, that would be what lubes the mucous membranes of the mouth...plus the moms love it. even if the baby isn't eating yet, she still is providing something pleasent for her baby that only she can.:)

we now have an actual written policy in our unit for micro-premies, 28weeks and under. they are q6hr if at all possible, that includes coordinating respiratory and xrays. we have always done the same for pphn kids.

i absolutely agree. i went into nursing school knowing exactly what i wanted to do. i made it through because i knew i wouldn't have to take care of adults ever again!! i couldn't imagine doing anything else. i have been doing this for 5 years, and can see working here for many more.

i believe whole heartedly in primary care in the nicu. the way our unit is set up we have 3 levels icn-intesive care level iii, ccn- level ii continuing care for feeding & growing babies nicu grads, and imc- intermediate care (pt usually ther

as with all things...it depends on the baby. i wish the docs would all see it that way. in my unit some tend to focus too much on numbers and not enough on clinical findings:angryfire. so a good blood gas means extubate, even if the patient is working or tachypnic while on vent...we are asking for failure...sorry, venting a little. on our micro preemies the one thing that has help to keep them extubated was long canula and using conventional vent settings, this as helped with apnea.