Litlbabynurse

I recently switching to a smaller NICU within the same healthcare company and am a little frustrated by some of the way things are done in this new unit. Admitted a 25 weeker the other night...In my old unit, this infant would have been admitted directly into a giraffe with a snuggle and bendie available immediately for containment. Developmental care would have started from the minute the baby rolled through the door. However, at this unit, the baby *was* admitted to a giraffe (that stayed open for the next two hours when it really didn't need to be), but without any kind of boundary helpers at all. The infant stayed prone and spreadeagle until I finally couldn't take it anymore and at least put rolls around it to try to flex its legs and arms a little back to midline. When I asked about it, I was told that they don't like to put the baby in a snugglie or such until it is stable. They responded that they liked to be able to see the baby better before doing anything like that. Perhaps, but I've never had any trouble monitoring a baby in a snuggle before. *shrugs* Also, my previous unit allowed the nurses a considerable amount of autonomy in caring for infants. This one requires a doctor's order for even things such as weaning an isolette or weaning nasal cannula oxygen. And these are the same doctors in both facilities!! The only difference is that the other unit was a teaching hospital and much of the care was done by residents, where this one is a private hospital that uses only attendings and neonatologists. On one other occasion, my preceptor told me that she doesn't like to wean oxygen because she feels that the babies need the oxygen more when they are small and she'd rather just leave it turned up, regardless of their sats. Maybe I'm just complaining about nothing, but it certainly doesn't feel that way. I'm an LPN and was only allowed to care for feeder/growers basically in my old position. In this unit, I am being vent trained and can care for much sicker babies. So, I'm having this conflict in my own mind about being precepted by nurses with much less NICU experience than my own, but also having to learn how to care for sicker kids from them. Like I said, I'm probably just complaining, but its one of those nights, lol.

My routine is probably a whole lot different than the ones you've read so far. I work nights in an NICU. 1. Stand at the desk and wait while everyone else argues over what patients they want to take for the night. 2. Take the leftover assignment and get report. I have a patient load of anywhere from one to four patients, depending on acuity, so report doesn't usually take long. 3. Go to each patient and eyeball them, measure ET tubes, check IV fluids and rates, check IV sites and lines, glance at the monitors to make sure that we are all currently ticking along at a nice base rate, make sure there are no surprise messes in the beds that need to be cleaned up quickly, and greet/talk to family members that may be at the bedside. 4. Check my charts for any orders that may have been missed on the previous shift and any labwork that will be needed during my shift. 5. Find out what doctor is on call and make sure I have that pager number written down somewhere in plain sight. 6. Find the RT and remind her/him of any blood gases that I will be drawing during the night since they have to be at the bedside to run the labwork. 7. Spend the next 11 hours doing assessments, vitals, feedings, and labs. My patients usually have to be assessed and vital signed every 1-4 hours, again depending on acuity. 8. Spend a lot of time praying that none of them decides to crump or self extubate during my shift. Of course, if that happens, that adds a little more chaos to the night. 9. If I get an admission, the RN will do the admission assessment, then pass the baby off to me for the rest of the work. 10. Keep a close eye on lab results and call the doctor to notify them of all blood gas results. Take orders as needed, implement those orders and notify RT if I need a vent change, etc. 11. At some point during the night, I try to take a lunch break and a smoke break. 12. If parents are present, I often do teaching and facilitate bonding between the baby and parents. 13. At the end of the shift, I make sure that everyone is straightened up, clean, positioned well (of course, I do this throughout the night too) and then give report to the next victim. 14. Go home and collapse.

Ok, this one brought tears to my eyes. I think I know this little girl. I think I took care of her. The picture links aren't working anymore though. I would love to have seen them. This makes me soo proud.

I just recently (this week) transferred from a major children's hospital to a smaller unit in the same healthcare network. While the unit I'm in now does not use ECMO (we transfer), the unit that I just left uses ECMO quite a bit. It seems to run in waves. We could go for weeks without an ECMO patient, and then have three kids or more on circuits at the same time. The last night that I worked there, four babies were on it. As far as the criteria, I'm not really sure about gestational age, but I've only seen one child under 2kg on it during the four years that I was there. We used it mostly for mec aspirations, diaphramatic hernia, hypoplastic left, and PPHN.