ckey01

My NICU is working on expanding our use of developmental care products and we're starting with Freddy Frogs. I used them at my last hospital, but I don't think we had specific guidelines for their use. Our medical director is very hesitant to introduce developmental care products for a variety of reasons, so I'd like some definitive guidelines in place before I present our proposal to her. Would anyone be willing to share their units policy/guidelines or any research you've found? It would be much appreciated (by me and our poor 24-weekers)!

What level is the NICU? Short answer is no, that isn't enough time. My residency was almost 6 months long and a mix of working on the unit with a preceptor and class work. It seemed like pretty much the perfect amount of time to at least get you somewhat ready to practice safely in the nicu on your own.

I'm one of three guys in my NICU and was the first in about 7 years when I started. I started as a new grad, which is the route I would definitely recommend if you intend to stay there for the long haul. NICU is an entirely different world and it's best to start there from the beginning IMO. Definitely look at Children's Hospitals and major teaching hospitals as they are the most likely to have new grad residency programs.

We don't do daily x-rays on our intubated kids, but we do get them at least weekly. I was surprised when OP said it had been 2 full weeks.

If you let the commute stop you, I think you'll regret it. If your heart is really in the NICU then you need to take your shot and get in there.

If NICU is your goal then you should do whatever you can to start in the NICU. It's an entirely different world and while the skills you develop in peds would definitely help, the best option is to learn in the NICU from the very start. While the commute is long, I currently drive about an hour to my NICU job and a few podcasts make the time fly by.

Yep, totally possible. I started in a Level IIIc NICU right after graduating with my ADN. Just need to find the right hospital and start networking hard until you can get recommendations.

Agreed, that is not a safe assignment. I work in an extremely busy level IIIc unit and our oscillator kids are always 1:1.

Congrats on the pleasent first day! What field did you move too?

Cup of coffee w/ fruit snacks and some mini-muffins after my first round of assessments. I'll then eat lunch around 2am with a cherry coke and then have a granola bar real quick near the end of my shift.

Nada. But then, I work weekend nights and management always forget that we exist so I didn't really expect anything.

It entirely depends on the baby and what might be causing them to desat. If it's a bigger baby and reflux causes them problems, then sitting them up or stimulating them is usually enough to get them to stop periodic breathing and bring their sats back on their own. If it's a small baby with an immature respiratory drive that is causing them to go apnic or periodic/shallow breath I'll usually give them an opportunity to fix it on their own. If they don't bring themselves back up I'll then increase their FiO2 and do some tactile stimulation and see if that helps. If not, or the desat worsens, I'll get an RT and start with blowby at 100% and then move to facial CPAP/bagging. If their HR ever drops or if bagging does not help then it's time to hit that 'ole code button and start the party.

Similar to the others, we do not use heparin in our PIVs. PICC, UVC/UAC, and central lines we use 1u/mL in whatever fluid is running. We also flush 2nd ports with 1ml of heparin every 6 hours.

Our charge nurses do not take an assignment. They have a multitude of duties involved with staffing and admissions and help out around the unit. We are a 107-bed Level III NICU so we get a lot of deliveries. Because of that we have a dedicated resus team that goes on all high-risk deliveries (accompanied by an RT, NNP, and sometimes a Fellow or Resident). They handle the entire admission process and the baby's first 4 hours in the NICU. They are then handed off to whichever RN is first-admit.

Same here.