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Elvish, you are my hero for this one. I thrive on adrenaline and really love taking care of critical NICU patients. But I can't think of a greater joy than bathing one of my little feeder/growers, putting her in fresh jammies, and giving her a nice warm bottle.

Us too. First sign I saw on admission was very mild unilateral clonus. I suspected he was a neuro baby from that moment on... This was followed by blood sugars persistently in the teens despite bolus after bolus; he ended up requiring D20 and diazoxide. Then came the problems with thermoregulation (hyper and hypo), respiratory distress that landed him on bubble, and projectile vomiting once he finally started eating. Ended up with posthemmorhagic hydrocephalus and got sent for a shunt.

"We currently have research in progress looking at the age of donor blood at time of transfusion in relation to NEC development." Steve--yes, this has been a recently emerging concern with us, too. Anything you can share would be appreciated. It's been tossed around as an idea but no direction as of yet.

We also use Medela. Trialed the Penguin but ended up switching back after a one month trial period.

Thank you everyone for your thoughts. I appreciate the insight! NicuGal and nicuguy -- As for the Hcts, two of the transfusions were routine per our unit protocol. I don't have exact values, but as far as I know they weren't drastically low (definitely not thatsthekeyRN -- that's what our old policy was, except with scheduled accuchecks.

What is your unit's policy with regards to making babies NPO for blood transfusions? I recently transferred to a level III NICU. For the two years prior to my arrival, our unit would make babies NPO (starting or increasing IV fluid) for two hours prior to blood, transfuse, and keep NPO two hours after completion. Our neos compared the unit's data from this period to years prior and saw no change in NEC incidence but an increase in hypoglycemic episodes. Because of this, they decided to go back to the old way of continuing feeds throughout the transfusion. This was right when I began working in the unit. Within a couple months we've had three babies die from NEC -- all PRBC transfused within the past 24 hours, all previously fed breast milk exclusively, all ex-24 weekers. I thought keeping kids NPO was standard practice. From what I can tell, evidence points pretty strongly to the existence of TANEC, as well as its high(er) rate of mortality than NEC that's not transfusion associated. I am frankly surprised that two years worth of data from our little 40 bed unit is being valued over many years of research in academic settings and some of the meta analyses that come up at the top of every search. Is there something I'm overlooking? It's not like I want my babies to experience hypoglycemia, but a bolus or some tweaking of IVF seems a whole lot less dire than NEC. Looking for input. Like I said, I'm pretty new to this.

We get paid double time for Thanksgiving, Christmas, and New Year's Day only. However our health system "recognizes" a number of other holidays -- including Easter as well as 7/4, Memorial Day, Christmas Eve, and some others. We're scheduled to work every other holiday and penalized by calling out, but don't get the benefit of extra pay. You call out on one of your scheduled holidays and you're automatically assigned another.

In my old unit, we were limited to RTs to intubate and versed push for sedation prior. No MDs in the unit on night shift. Anesthesia would get called stat if RT couldn't get it; hopefully the patient wouldn't code before they got there. I'm glad to no longer be working there.

Little Bit Sweet Pea Muffin

Our policy says no skin-to-skin with umbilical lines. The rationale is not clearly stated, so I'm not sure if it's due to patient instability or infection risk. PICCs and Broviacs are not contraindications to hold.

In our adult ICUs we assess GCS q4hr for all patients. Neuro patients are q1 or q2hr or more often for evolving status, TPA administration, and so on.

Looks like toomuchbaloney beat me to it! Thanks for the link

Yes, exactly. Constitutional bans against gay marriage are being overturned at the state level very quickly these days, but no new anti-discrimination legislation has been passed. Hence, no legal protection. ENDA, the federal Employee Non Discrimination Act has been stalled for a very long time.

I joined for the first year just to put it on my resume and have let my membership lapse. I see no benefit to continuing to be a member, especially at that price! Now my resume says "Sigma Theta Tau inductee" or something along those lines.

I am a gay woman working in a state and hospital where I could be fired just for being gay. Many states still do not have non-discrimination laws when it comes to homosexuality. I am lucky to have never had a problem at work (despite being the only openly gay person on a unit composed of mainly older, conservative, highly religious women). I do know multiple people, including a nurse, who have lost their jobs shortly after coming out in the workplace. I doubt that is coincidental! I think it's important to remember that people stay closeted not just for social reasons at work but out of fear of losing their job and the benefits that go along with it. I often say how lucky I feel to still be employed, and look forward to a day when I don't have to feel lucky just to be treated the same as my peers. I also look forward to being able to add my wife to my insurance policy (our marriage is legally recognized here as of two months ago, but my employer still does not offer benefits). And to second parent adoption becoming legal so our future kiddos can have the same protections as their peers. And the list goes on... We've come a long way but there is still more to come!

Our fire department in town does car seat safety checks. We recommend that to parents if they have questions or need help with installation. On discharge, the RN carries the infant to the car in his/her car seat, hands the seat to the parent to put in the car, and writes a note documenting this in the chart on return to the unit. It's absolutely a liability/CYA thing.

We secure to the cheek with tegaderm. Apparently there was an accidental extubation caused by a patient pulling out their OGT and the ETT coming with.

I echo the previous poster who said nipride. There's something oh-so-satisfying about watching the art line pressures drop. Now that I'm in NICU... I'm a fan of surfactant of course, indomethacin, anything vasoactive still... But I'd have to say that my favorite med of all time is a basic multivitamin and high kcal formula. To watch those little buggers grow, get strong, and go home is one of the greatest blessings in the world!

Is there a particular type of patient you've enjoyed working with or diagnosis that interests you? Perhaps there is a specialty that suits you well. Hospital work is stressful by definition it seems, perhaps you would want to try clinic nursing, case management, or work in a doctor's office. (Not that those positions are stress-free, but it's a different beast.) When I was in nursing school I used to read through all the specialty boards on this site. The possibilities are endless. Hope you find something that suits you more.

Years ago I had to miss my pathophysiology final -- basically the last thing standing between me and nursing school -- because we had an incident in my neighborhood and there was a SWAT team guarding my house. I was panicked, not because of the intruders on our block but because I wasn't going to get into nursing school! The cops wouldn't let me take a picture of them as proof for my professor, but I did get a handwritten note with a badge number from the one who was standing watch over my front door. Been a nurse for two years now and haven't called out yet...

We can run levophed 4/250 through a PIV and 16/250 and 32/250 through central lines only. We don't have anyone to put in CVCs at night, though, so we're often without any options. I ran levophed through a #22 in a patient's thumb a while back because we had no other access. Sometimes it's a fight to get a central line even on day shift. I had a little lady with ischemic limb from a pressor running through a PIV in her forearm for 48 hours because no one would drop a central line. Arterial lines are only ordered once a second pressor is started, and sometimes not even then.

There's an entire board under the "career" tab devoted to nursing resume help, and many of the posts are geared towards new grads. Nursing Resume Help FWIW, I included my senior preceptorship on my resume because it was 220 hours in the same type of specialized unit to which I was applying. I called it "clinical experience," not "professional experience" because, no matter how autonomously you work as a nursing student, nothing can compare to being out there on your own! Good luck with the job hunt!

For a patient with E. coli bacteremia AND bilateral PEs: Levophed, neosynephrine, epinephrine, vasopressin, versed, nimbex, heparin, insulin, sodium bicarb, 4 PRBCs, 2 FFP, and a few KVO/piggy back lines for abx. I will never forget that night!

Most of our LIPs use it as their first line choice. I can't say that I've seen it cause significant bradycardia (nothing like Precedex). A mild drop in heart rate isn't uncommon, though, but I see that as a sign of achieving adequate sedation. Hypotension is usually my main concern, and we see vent/propofol/levophed/dilaudid IVP as a common combination. For patients having profound hypotension we'll use midazolam and fentanyl instead. Our sedation order set is to titrate to achieve a RASS of -3 with a daily sedation vacation at 0700 (unless otherwise ordered). Max is 80 mcg/kg/min but occasionally we'll go up to 100 with an LIP order. Our dietary folks always take propofol use into account and reevaluate these patients daily. One of our docs checks trigs daily, most do q72 hours.

I would dress my best. I think that any contact with a potential employer should be treated as an interview. You're a professional, an enthusiastic candidate, and can present yourself as such!