mischievium

I work in a level III NICU and our policy is that babies get baths every other day, temp must be at least 36.5, newborns get bathed the first time shortly after admission (as stability allows). While I totally get the wisdom of having baths done on certain days (like everyone gets baths Tues and Sat), I like that our kids fall on different days so that most of the time if you're assignment is a three-way, at most only 2 out of the 3 will require baths in a single night (and actually, if all three are due, it isn't a big deal not to bathe one and leave them for the next night-- it's not like we let them mud wrestle). Baths, along with daily weights, are usually done on the night shift, unless the patient is getting ready to go home (then we do it on days so the family can participate) or if the patient is a chronic bigger baby and generally sleeps through most of the night. Chronic big kids that tend to be sweaty/ smelly often get daily baths, per the nurse's/ parent's discretion (for those on tub baths, it is often a soothing part of their routine). Linens are changed every night regardless of bath status. We use Johnson's head to toe body wash, very sparingly with the micropreemies. That said, if the patient is not stable enough to be bathed, they don't get bathed until they are-- this includes PPHN, CDH babies, Mec Aspirates and any other very sick/ labile baby. Linens for these babies are changed as needed/ tolerated.

All the way on the other side of the country in CA.

Hi Steve, I went to nursing school in NYC and have seen both the NICUs at Morgan Stanley (the new Children's Hospital up on the 168th St. campus) and Mount Sinai. Since I really only *saw* them, I can only speak in terms of facilities-- Morgan Stanley has a *beautiful* new NICU-- really, georgous. Mount Sinai (where I did my preceptorship, but on the L&D floor) from my understanding has had some serious financial issues in the past few years. That said, where I work now (not in NY) is, in terms of sparkly-new stuff, not the top unit in my area, but certainly is in terms of real teamwork (including respect from the medical team for the nurses), morale, and in terms of treating the most critical infants in my region. Sorry I can't be more help and Good Luck!

I just completed my first year in a level III/IV NICU and I am still scared sometimes-- but that's a normal and appropriate response to caring for critically ill patients. But the key, I think, is finding a hospital/unit that offers a good new grad training program-- mine started with 6 weeks of classes 2 days a week and 2 days a week on the floor with a preceptor (we shared the same patients) and then for the next six months we were on Buddying-- we had our own patients, but we had a buddy (a more senior nurse) that was assigned patients in the same room. The buddy was there to answer questions, look over paperwork, give tips/advice, help with procedures, etc. During this time, the charge nurses would try and balance our assignments between: 1. Lower-acuity assignments in the Special Care nursery where we usually have 3 patients (very occasionally 4). These kind of assignements help to work on time management and managing older, often more wakeful/developmentally needy patients. 2. 2-way patient assignments (usually one intubated one extubated/NCPAP) in the Intensive Care Nursery) to get exposure to more acute patients and experience managing relatively stable ventilated patients And: 3. The occasional 1-way patient to get some exposure to managing a more critically ill patient while you still have the support of having a buddy around to help you. That said, at least on my floor, there was no real difference between being on buddying and being "on my own"-- There is still another nurse in the same bay with me to ask questions or get a second opinion on something. There is a really nice atmosphere of cooperation on my unit where it is just kind of expected that when you are done with everything, you ask your baymate if they would like help with anything so when you need help you get help and when you have time you help out. That isn't to say that there aren't days when you both have busy assignments and are running around all day, but it isn't eveyday. We can also always ask our charge nurse or admit nurse (if they aren't busy admitting a patient) for help, as well. AND, they generally give new RNs "skill-appropriate" assignments with occasional "challanges" to keep building our skills. NOW, with THAT all said, it has been a stressful year. There is a lot to learn and there have definitely been times when I've wondered whether I could do it. But, almost all new nurses feel that way and I figure if I am going to be stressed out it might as well be over an area of medicine (babies!!) that I enjoy. And... it gets easier, it just takes some time. Good luck with whatever you decide! mischievium

"HAL", is short for hyperalimentation, also known as "TPN" (total parenteral nutrition). It's an IV fluid made specifically to order for each baby based on their nutritional needs and contains electrolytes, dextrose, vitimins, and protein. Babies who are not taking breastmilk/ formula for whatever reason, are generally on HAL.

I just started as a new grad in a NICU in the fall, so I can give you an account of my duties. At the place where I work, new grads spend the first several weeks in class part-time and working one-on-one with a nurse on the floor part time, then we spend the remainder of the first 6 months working with a partner-- which means that you have your own patients and they have their own patients, but they are in the same room with you and they are there to be a resource for you and to check over your documentation. So.. I come on at 7 am or pm depending on the month as my shift rotates each month (more on that later). I'll describe a typical day shift first. 1. Come on at 7am, get report on my babies and get organized. Report includes double-checking IV rates/ vent settings/ and any orders given on the previous shift. My unit consists of an intensive care nursery (icn) and a special care nursery (scn)-- the special care nursery being where the kids go when they are less acute and closer to going home. If I am in the scn, I generally have three patients (rarely, four) who are usually on a Q3 schedule-- which usually means you need to take their vitals, change their diapers, and feed them every three hours and give medications as ordered (we try to time the meds, especially PO meds to fall in line with the rest of their care, but that's not always possible). With three kids, their schedules are usually staggered by 30 minutes or so. In the icn, I usually have 2 patients who are on either Q1, Q2, or Q3 schedules, or 1 patient that is on a Q1 (possibly Q2) schedule-- a patient has to be pretty darn acute to get their own nurse and usually new grads don't get assigned these patients. I figure out which baby is due first and start there. 2. Safety first-- the first thing I do when I get to each bedside is the safety checks-- what are the alarms settings on the monitors (are they what they are supposed to be?)? is there an ambu bag/ anasthesia bag at the bedside and is it working? is the suction canister and tubing hooked up and working and is the pressure set at the right level? 3. Vitals and Assessment-- write down HR/BP/respirations/O2 sat/CO2 levels and continue with assessment-- take temp, auscultate HR (check to make sure it's correlating with the monitor), breath sounds, and bowl sounds, palpate pulses/ abdomen, change diaper and while you're there measure abdominal girth, palpate head (special attention to sagittal suture and fontanelles), while you're doing all that, you look at the baby's skin and assess any IV sites/ wounds and monitor their tolerance to handling. 4. Feeds-- via NG/ OG/ bottle (nipple) or assisting moms with breastfeeding or nippling their baby-- or often a combination of different techniques. Feeding often includes defrosting and fortifying breastmilk-- and making sure there is enough ready to go for the next shift's first feed. 5. Hanging IV fluid-- where I work the day shift mixes and hangs new IV fluids and changes IV tubing if needed. HAL comes up at around 6pm-- as a courtesy, the day shift usually checks and hangs the HAL, though it is technically a night shift responsibility so if you don't get it don't have time to get it done, it should be no big deal. 6. Medication administration- IV/ IM/ SQ/ PO/ PR .... and so it goes. In our unit, all meds are checked with another nurse before administration to assure that the right pt. is getting the right dose at the right time, etc. 7. Blood work/ IV placement- in my unit IV placement and arterial sticks are considered "advanced skills" and not taught until after the first 6 months, if I have a baby who needs an IV or an arterial stick done to draw labs, I get the admit, charge, or my preceptor to do it while I assist. I can do bloodwork via heel stick or an arterial line if that is already in place. 8. Assessment and suctioning of ventilated patients, at least 2X per shift (often times more) with the help of an RT or another RN. 9. Off-unit procedures-- you need to prep your patient and get together the appropriate equipment and paperwork if you need to take your patient off-unit for an MRI/ surgery/etc. You also need to make sure that someone else is assigned to cover your other patients while you're gone. 10. Admissions/ Discharges-- as needed, both involve a lot of paperwork. Admissions involve getting all the equipment set up, getting IV fluids ready, getting IV access if needed, sending off bloodwork, giving meds, etc. Discharges involve a lot of patient teaching. 10. Communicate with the rest of the medical team about the patient-- ie notifying doctors re: abnormal findings, concerns, suggestions, etc. 11. Psychosocial stuff-- do parent/ patient teaching, talk with parents, offer family support and refer them to appropriate resources (social work/ lactation consultants/ etc) when needed. 12. And let us not forget DOCUMENTATION. Night shift includes most of the above, but also: Hanging HAL (though, as I said before, day shift often does this) Weighing and bathing Measuring head circumference, length once a week Doing AM labs Stocking drawers I think that's most of it, though I'm sure I forgot some things. What I was going to say about rotating shifts is that yeah, it kind of sucks, but there are really plusses and minuses to both the day and night shifts-- days are busier and there's more going on so you get exposed to more things (procedures/tests/etc), but nights are quieter and you have more time to look stuff up and more time to get stuff done. As far as the "transition" goes, it really helps if the unit has a really good and structured orientation program. That said, it is A LOT to learn in a realtively short time and can be *very* stressful. Starting pay depends on where you work-- you're more likely to make more $ in a large metropolitan area, public hospitals generally pay less, etc. Any other questions :-) ?

mitchsmom-- did you mean to say there is a DECREASE in certain cancers?

Neonatal Intensive Care-- I just started and, so far, I love it. I am in training program for new grads-- I agree with whomever said not to let anyone convince you that you *have* to do med/surg first (unless you want to!). There are lots of hospitals out there that have specialty training programs for new grads.

*OR* you could become a Nurse-Midwife (who does well-woman gynecological care and lady partsl deliveries-- cesarian sections are handled by obstetricians) or a Women's Health Nurse-Practitioner (who does everything a Nurse-Midwife does, except deliveries). To become a Nurse-Midwife or Women's Health Nurse Practitioner, you need to get a master's degree and to do that you first need to become a nurse (RN). What it takes to become an RN, depends on if you already have a degree or not. For example, in my case, when I decided I wanted to become a Nurse-Midwife, I already had a bachelor's degree-- just not in nursing. So I looked for accelerated RN-to-MSN programs. These programs were 3 year programs, where the first year was an accelerated RN program (some of the programs actually award a second bachelor's degree after the first year), and the next 1.5-2 years were spent learning the master's specialty (ie: nurse-midwifery, women's health). If you are not an RN and don't have a bachelor's degree, there are a lot of options-- but all involve getting a bachelor's degree before the master's degree. I'm not sure I'm the best person to explain all this, as I am new to nursing myself, but I'll take a stab at it (and maybe the more experienced nurses on the board can add their corrections/ comments?). To become a nurse, you can either begin with becoming an LPN/LVN, an ADN, or BSN. Licensed Practical Nurse/ Licensed Vocational Nurse (LPN/LVN) Education: 1 year full-time (depends on the program) Duties: Does everything that an RN does-- EXCEPT (technically) anything that involves assessment of the patient or patient education. I say technically because I don't think that's what actually happens in practice-- I would guess LPNs end up doing some assessment and teaching. LPNs, to my understanding, work under the direction of RNs and are generally assigned to the most stable, least-complicated patients. Pros: Less time spent in school before working. Can become an LPN and get a job and then go to school part time to get your RN (ADN-see below) while you're working (most hospitals have some sort of tuition reimbursement program). Cons: You work under an RN (this may or may not be a con, depending on how much autonomy you want). The pay-- LPNs are paid considerably less than RNs (up to half as much) for almost the same job. More limited in what unit in the hospital you can work in-- this seems to vary by hospital and state. I know that on the Labor and Delivery floor I worked on, they only had RNs, no LPNs-- I don't know off the top of my head whether or not LPNs can work in the well-baby nursery or not (though my instinct is that they can)-- BUT if you are thinking about becoming an LPN then you should really look into what the case is for LPNs in the state and city/cities you think you want to work. Associate's Degree in Nursing (ADN- RN) Education: 2-3 yrs full-time. Makes you eligible to take the NCLEX-RN and become a Registered Nurse (RN). Pros: Less time/money to become an ADN than to become a BSN. Can work as an RN and enroll in a RN-to-BSN program (and, again, many hospitals have a tuition reimbursement program meaning that they'll pay for part/all of your RN-to-BSN classes). Cons: Still may make less than a BSN, may be limited as far as chances for advancement. Bachelor's of Science in Nursing (BSN- RN) Education: 4 year degree. Makes you eligible to take the NCLEX-RN and become a Registered Nurse (RN). Pros: Receive a bachelor's degree. Greater chances for advancement, should you eventually decide you want to become an administrator or want to go to become an advanced practice nurse/ nurse-practitioner (which requires a master's degree). Highest paid. Cons: Most time and money. Once you have a bachelor's degree in nursing, you can apply for master's programs-- and, again, there are a lot of part-time programs where you can work full-time as an RN and go to school part-time and the hospital will help pay your tuition (how much depends on the hospital) for you to get your master's degree. That all said, to become an OB/GYN, you have to go to medical school-- which first requires that you get a bachelor's degree and take all of the pre-med courses (inorganic chemistry, organic chemistry, biology, physics, calculus, etc.). In total, your bachelor's degree plus medical school is 8 years, then (and this is where I get fuzzy), you have to do a residency and a fellowship in your specialty (OB/GYN) to become a full-fledged doctor.

Also, if you haven't already you should check out the Ob-gyn nursing/ Midwifery nursing forum: https://allnurses.com/forums/forumdisplay.php?f=35 They talk a lot more about the Labor and Delivery side of Maternal-Child Health, but there may be some nurses in that forum that have more experience in working with well-babies and mother-baby couplets. -m.

:rotfl: Well, I think it's obvious from my replies what *I* think you should do:rotfl:. If you don't want to get a BSN right out of high school, then I REALLY think you should get an ADN and become an RN. Reasons? 1. I think it gives you the best chance of being able to work with moms and babies, regardless of how the unit at the hospital you wan to work at is structured (with well-baby nurseries or, as PRMENRS mentioned with no well-baby nursery and the babies rooming-in with their mom, or even on floors that combine Labor and Delivery and Postpartum). 2. You get paid better. That all said, I don't know you personally, so I can't say for sure what is really in your best interest.:) -m.

Wether you go into an LPN program or an ADN program, you will learn general nursing, as a previous poster mentioned. You have to in order to get your license. And, as PRMENRS mentioned, you really want to have broad experience because things *do* change. Hospitals change how they structure their units and what their nurses are expected to do and *you* may change your mind about what you want to do. Or you may not change your mind, but it's good to have options. The "350 hours of Practical Nursing Medical-Surgical I and II"-- remember when I mentioned that school would include clinical rotations? That's what (I think) this is. In nursing school, you have your regular (also called "didactic") classes-- just like the classes you take in school right now where you go to class, listen to a lecture, have a textbook that you read out of, and take written tests. Your clinical classes/ rotations are where you are actually *in* the hospital, on the floor working and learning the necessary skills-- how to give a shot, how to place an IV or urinary catheter, even simple stuff like how to make a bed or move patients. "Medical-Surgical" means that you will probably be on an Adult "Medical-Surgical" floor (check with your community college to be sure that's what they mean). Medical/ Surgical floors can be general-- meaning that they have a combination of patients who are recovering from surgery (hence the "Surgical" part) or who are being treated for serious Medical problems (for example: Kidney disease/ failure or infections like pneumonia) OR, they can be specialized medical/ surgical floors-- like during my medical/surgical rotation I worked on a gastrointestinal (GI) floor, so we had a lot of patients that had some sort of surgery on their stomach, intestines, or bowels. It was not an area of nursing *I* liked, but I did learn skills that help me care for patients on other floors and I got through it in order to do what I want to do now. I know you're thinking about getting your LPN, then working on your RN while you work-- which is a FINE idea and totally up to you-- you're the one who knows your financial situation and it is your life, but here are some things to find out before you decide between the LPN and ADN programs: 1. Are there well-baby nurseries in the hospitals in the areas (city/ town) that you want to work? 2. If so, do they hire LPNs to work in the well- baby nursery? 3. Do the LPNs ONLY work in the nursery or do they rotate between the well-baby nursery and the postpartum floor? You can get answers to these questions by calling the Human Resources departments of hospitals you are interested in. The Human Resources departments are the department of the hospital that handles recruiting nurses and hiring nurses (and all other employees). If you can't find their number on the website for the hospital or in the phone book, you can call the general information number for the hospital and ask for the number for the human resources department. If you just called them and said "Hi, my name is ------------, and I am considering going into nursing. I would like to speak to someone about opportunities at your hospital for LPNs and RNs." Either the person you are talking to can answer your questions or they should be able to transfer your call to someone else in the department who can. Also, you may want to go talk to the people who run the LPN and ADN programs at the community college near you. They may able to help you figure out what program would work best for you if you want to work with moms and babies. If the hospitals in your area DO have well-baby nurseries and they DO hire LPNs to work in the well-baby nursery-- then GREAT! You can do an LPN program, then get a job as an LPN in the well-baby nursery, and work while you get your ADN to become an RN. *BUT* If they don't have well-baby nurseries, or the if they do but don't hire LPNs to work in the nursery or the postpartum floor, then you may want to go directly for the ADN. ALSO: Working with mothers and babies-- whether in Labor & Delivery, on a Postpartum floor, or in the well-baby nursery (if there is one), is very popular with nurses, which means there is more competition for the jobs in this area. I'm not saying you can't get a job doing it, but you should keep in mind that it may be harder to get a job with moms and babies, than in other units like general medical/ surgical units or psychiatriac units. I'm not saying any of this to discourage you from pursuing an LPN, you just need to be sure that you can be an LPN and get a job working where you want to work. Otherwise, you could end up getting your LPN and have to work for a year or two in an area of the hospital you don't particularly like while you get your ADN so you can get into working with moms and babies. I know I said a lot-- did any of that make any sense? :)

I found the descrption below on: http://www.futuresinnursing.org/education/index.shtml "Licensed Practical Nurse (LPN) Program completed in 1 year Offered by vocational-technical schools, community colleges, and some hospital-based nursing education programs LPNs wishing to become Registered Nurses (RN) can usually obtain advanced placement in hospital-based education programs or in Associate Degree in Nursing programs, allowing them to complete the RN requirements in a shorter amount of time. Once students have completed the necessary courses they must pass a licensing exam to practice as a practical nurse and use the title Licensed Practical Nurse (LPN)." So it looks like you should find out if any of the vocational/technical schools, community colleges, or hospitals in your area offer LPN/LVN education programs. That said, I don't think I was clear in my earlier email that the nurses that worked in the well-baby nursery and the nurses that worked on the postpartum part of the floor (with the moms) were the same nurses-- meaning that they rotate. BUT, that is one hospital, other hospitals do it differently. Some hospitals have what they call LDRP (labor delivery recovery postpartum) rooms and the nurses there are expected to assist with the deliveries, work with postpartum moms, and work with babies. The key to all of this is to find out what the hospitals you think you might want to work at in the future do and what kind of nurses they hire to work with mothers and babies. I could be wrong here (please, LPNs/LVNs, speak up if I am!) but you REALLY should consider Associate's Degree courses to get your RN, at least. It may take more time, but it is SO worth it because you will be MUCH better paid than you would as an LPN and you have so many more options in terms of where you can work. From the same website I mentioned above: "Associate Degree in Nursing (ADN) Offered by junior and community colleges and some universities Completed within 2-3 years College credits earned in an associate degree program are generally accepted at many colleges and universities that provide a Bachelor's Degree in Nursing. In some cases all credits received at this level will be transferable depending on arrangements made between two-year and four-year schools." -m.

Really? That's surprising. Maybe it's a regional thing, but the three major hospitals I worked in during school in NYC all had well-baby nurseries. They allowed rooming-in (baby staying in mom's room), but all gave moms the option of having the baby in the nursery at night, or when they wanted to take a shower, or other times that they couldn't supervise the baby for whatever reason. How do hospitals that don't have well-baby nurseries handle supervising the baby when mom can't? Is it mom's responsibility to make sure that someone else (the dad, or a grandparent, or a friend) comes in to the hospital to watch the baby or does the nurse stay in the room? Do they do the newborn assessments, etc. in the mom's room? -m.

Glad I could help!:) One other note about the IV thing-- the "rule" seems to be that one nurse will make 2 attempts to get an IV in and then will get another nurse to try. Even very seasoned nurses have times that they miss the vein. :)