PreemieNurse

I have been a NICU nurse my entire nursing career...since the 70s. It's a wonderful place to work, and many nurses who work there do not leave. We have seen many ICU nurses transfer down to the NICU because they are tired of moving heavy patients around and their backs are getting bad.... I am also reading posts of how hospitals are not offering intensive care courses and merely throwing nurses into the departments and expecting them to learn fast and take a big assignment within the first week or so of going to that unit. It's very important that hospitals continue education past nursing school. The hospital where I worked had a 6 week ICU course that was mandatory...the nurse (no matter how experienced in med-surg or if new grad) took that course and then was precepted by an experienced nurse for no less than 6 weeks following the course. By the time those 12 weeks were over, that nurse should be able to take on a full assignment on her/his own. Same for NICU. There needs to be a neonatal course in place (or maybe one offered at another hospital where the new hires into the NICU can attend). My first job in the NICU in a PA hospital offered that 6 week NICU course and then I worked the same schedule as my preceptor for another 6 weeks. The second hospital where I got a NICU job did not offer the course, but the nearby hospital who had a level 4 NICU did. Our new nurses into the NICU went there 2 days/week for 6 weeks to take their course. The hospitals need to set up these type of courses in order for their new nurses (to intensive care units) to be successful and confident in their skills. I don't understand how hospitals can just "throw" inexperienced nurses into these intensive care units without any specialized training. That is just dangerous, and sets the nurse (and the hospital) up for potential lawsuits.

thank you rkitty! I appreciate your info! Yes I am looking for research-based procedures ideally!

Carol we return residuals because of the electrolytes and gastric enzymes found in residuals. Usually the residual is just undigested feeding. Yes I know it seems gross but I believe it's a necessity to keep F & E balance. And yes, always a sterile syringe even though it's a clean procedure. I mean, why not? KXC yes that's exactly what we do in a NICU and you've heard "once a NICU nurse always a NICU nurse" and I guess that's why I want to get another syringe when I've filled the first one! I just couldn't see squirting residual into anything and then giving it back from whatever container I used. Thanks for all your input!! Much appreciated!

thank you! That's what I wanted to know...so those of you who said you would put it in a clean cup...one more question...you said you would return it...so how? Do you attach the syringe barrel and let it run in by gravity? Funny how student texts tell you to return the residual but there is no step by step instruction for that...

Congratulations on your years as a cancer survivor!! That's wonderful!! And kudos for following your dream of becoming a nurse...we need nurses with your dedication~ as for your question...employers are not permitted to ask you about your health issues...just like they can't ask your age or if you plan on having a family (for the younger applicants!)...but as a nurse you will be asked to do a certain amount of lifting, standing, walking etc...and that is part of your job description...that you must be able to do a certain % of all that. I had a severe leg injury in 79 and it took me a long time to recuperate...I couldn't stoop anymore but I could walk and stand and lift over 10 lbs..so I continued to work as a nurse. So you should not have a bit of trouble!! Again, congratulations and best of luck on your nursing journey!!!

Carol I don't understand the idea of flushing and not having to check for residual.. can you explain the correlation? The texts still advise to check for residual. This is in a procedure associated for giving NG meds (again, remember this is a skills lab)... the text gives them the information to check for residual before administering meds... But my question is, what happens when your syringe is full of residual and you need to check for additional residual? Squirt it into a clean glass? Or just get another syringe (which I would do, but people don't agree with me, they think it's ok to use a clean glass). Thanks!

And like anything else in nursing practice, it must be backed up by the research...best practices!

Check for residual to assess for tolerance and digestion of tube feedings. Keep in mind that I am in a skills lab and we do not teach specific to any facility...we are merely teaching skills and we follow the descriptions found in their texts. Each facility will have their own policy. We stress to the students that they must follow the policy and procedure where they are doing their clinicals.

Originally Posted by awsmfun This is why every nursing student needs to work as a CNA before they apply to nursing school. Then they would really know what being an RN really involves! What ever happened to this requirement? No wonder so many bimbos are going into nursing! As a nurse educator I have thought this way as well...our college admits based on GPA and you can admit all the book smart people you want but they need to have a lot of common sense and the ability to be a critical thinker. As for the student who isn't in nursing to clean up after patients...she will get a big dose of reality upon graduation and tries to find a job without that description. One poster was correct, she won't be very popular on her unit if she tries to find someone else to do the "dirty" work...I question her reason for being in nursing to begin with...because she'll "always have a job?"...I have known a few nurses in my past who got into nursing to meet a doctor..(that's a joke!). Someone who comes to nursing school because they have a strong desire to care for people who need their care...that's the kind of student I want to teach... as many posters said..."she will find out soon enough." Many non-bedside jobs don't come without clinical experience first...just read the want ads.

Hello...I would like your feedback on the way you deal with gastric residual at your facility. I am an educator and recently I overheard one of the other educators telling her students that when checking gastric residual from a feeding and the residual completely filled the syringe you were using, you may empty the syringe into the emesis basis, and reconnect the now-empty syringe to check for additional residual. This was shocking to me as I had never done this before and do not like the idea of having to "suck the residual back up" in order to return it to the patient. Yet I cannot find in any of the student's text as to the correct step when you have more than what the syringe holds...only what the maximum residual is for calling the doctor, shutting off the pump, etc. Can you tell me what you do in your facility? My feeling would be to get another syringe to continue, but another faculty member said she used to just use a clean glass to empty the syringe into. Not sure this is good practice either? I know it's not a sterile procedure, but I am thinking of the messiness of returning to stomach. Thanks in advance!!

That is what is being practiced in this area. The 3cc syringes exert too much PSI on the tip of the catheter and can actually tear the tip off, causing it to end up in the circulation. Not a good thing. 10cc much lower PSI, which is why they are being used and why we continue to teach that practice.

Hi folks, need your input. I am an instructor in a nursing program and there seems to be some confusion concerning size of syringe when giving a med through a central/PICC line. 10 cc we know if you are using capped line...but what if you are administering through the Y site farther back from the cap (continuous IV infusing)..what size syringe..still a 10? I thought I read a couple of years back that you could use a 3 cc syringe of med only at the Y site....but of course, don't know where I read that.

Thank you!! Poor students are so confused because we teach them a certain way in the lab...they get to clinicals and each instructor is different...because they want their students to function the way that THEY practice. This ends up with potentially incorrect information being relayed to student at clinical...and they are really frustrated...and we can understand why.... wish I had the literature...I'll keep looking but many thanks for your input!

I teach nursing education and some questions have come up regarding what the students are learning regarding IV med administration. I am looking for any journal articles or Best Practice information... IV push...on a continuous IV.... kink tubing while pushing or no? Is there a guideline for kink or no kink related to the rate of the primary IV? Should we kink if rate less than 100 for example..? No kink if rate higher than 100? IV piggyback...hanging flush bag and run at same rate as primary rate to infuse remaining med in tubing? For example..my primary IV rate was 125/hr.... but due to incompatibility I hung a NSS bag...do I run that at 125/hr as well? So....if my primary IV was 75/hr...do I set my rate for my NSS flush at 75/hr? Where can I find the literature backing these ideas? thanks!!!!!

Just the regular UOP...you can type that in the facebook search and it will pull it up. I also am part of the alumnae group, but the basic UOP seems to have a lot of current students... that might be the most helpful to you...

Team projects are pretty good... I have to be honest, you get good people and you get lazy people...but I had better success with teams at the MSN level. At the BSN level I think there was a lot of catfighting and I think people were just not cut out for the online environment. Going through the MSN program, I found people to be more cooperative and had less problems with groups. At the end of each class, the group is always swapped around anyway...you are never in the same class of people...because there are multiple classes of the same course starting at the same time. The facilitators (as the profs call themselves) say that they take into consideration (and grade accordingly) people in the learning teams who don't pull their weight. I really only had a problem with 1 lady over the course of 13 classes so that was very good. I teach LPN students in the lab through the year and in the summer teach them OB at clinicals. My state (PA) board is cracking down on nursing programs...even adjunct clinical faculty MUST be an MSN or be actively working on their MSN. So going back to school is a must for those adjuncts who want to continue teaching.

Hi Gigi... I did UOP for both BSN and MSN... once I got going I went all the way... I would not have done school any other way... I LOVED the online format... are you on Facebook? There is a UOP application there too that people are "fans" so you can chat with other students there too. Books...well I am the type who doesn't like to read online books...one of the ladies I teach with went to UOP had a lot of the books I needed...but you can get books through Amazon...used copies are well priced...and then you can sell them back through Amazon... it is a fast-paced program (but I loved that classes didn't take an entire traditional semester like ground programs)... so you do have to be dedicated to the program. Support from your family is a must! There will be times you can't "go out" because you have to log into class or get a paper/group project worked on. But it's 2 years!! That's it! I took the Nursing education track and now teach in a nursing program at the local community college. I finished last Nov (08) but am headed to Phoenix in a couple weeks to officially "walk" at graduation... very excited about that. I agree with JoMom, a lot of the research you will do is found in the UOP library... some of the books for classes I barely even opened... which is why I sold them back on Amazon. I hope that helps. I am so happy I went back to school at UOP! If you get onto Facebook, check out the UOP group!

Not contaminated, but old. Why are we teaching backpriming to our students when it doesn't seem all that important if we're not doing it when hanging PB on a primary line. This just goes against my beliefs (it takes 20 ml to flush a primary line and if the patient never gets this, he is missing his entire dose. I am hearing that even though the hospital is having this as policy, a lot of nurses are not following it. I say you have to go with what you know as best practice.

Bec, are you talking about a gravity flow or an IV on pump? If you are hanging a brand new PB to an existing line on a pump (or gravity, doesn't matter) attach secondary tubing to PB bag. Using needleless port closest to IV bag on primary line (above pump), attach secondary tubing. You do not need to forward prime if using new tubing, simply "backprime" the air into the PB bag. On a pump, you can leave your primary IV running while doing this. If you are using a PLUM pump, you have to stop A to backprime. Once done backpriming, restart A. Program B, then start B. A will be paused until B is done. If gravity, adjust your drop rate by clamp on primary line. I am a skills instructor so please let me know if I can be of further assistance. Hope my written explanation helps.

Thank you. This is what I am trying to understand...but excuse my ignorance and tell me what a reseal is... so you are saying the old med remains in the line and is used when the new bag is spiked? Even though it may be an every 8 or 12 hour med...it's ok in the tubing. What was the thought behind this practice? To decrease the amount of fluid given?..because we're only talking about 30 mls or so of the flush...I can understand your fluid sensitive example but on the general med-surg floors you don't find this so much... thanks for your help!

Hi everyone, I have a question for you all. I teach in an ADN program in the skills lab. We teach IVPB via the flush bag and the backpriming into the old bag thing...if pt has a hepwell... We just heard that an area hospital is not permitting the use of flush bags when giving PBs through a well... just manual flush before and after... but hanging the PB with a primary line and connecting to pt. So, my question is..does anyone else have this practice at your facility? Is this a safe practice? We are amazed because we have never seen this before. Are there studies that back this practice up? A primary line holds 20mls..so there is old med in that line... you can't backprime to get the old med out of the line.. so the patient gets the old med too? Can someone explain this to me? Thanks!

Good luck to you! It does get burdensome after a bit (as ALL schools do!) but I wouldn't have done my BSN and MSN any other way. Overall I am very pleased with UOP. I am teaching in an ADN program and very happy I made the switch from bedside. I love meeting all the students and helping them to learn! My advice for you would be to take a 2 week break in between classes. One just wasn't enough...one just got you caught up on the housework but not enough time for yourself to breathe! I also took a month off in the summer so I could go on a vacation without taking my laptop and worrying about assignments. I have two colleagues who attend ground classes in a traditional semester format. They have just as much work as we do at Phoenix, plus they have to travel an hour to class. With the cost of gas, online courses are a perfect solution! Let us know if you have any concerns or questions! We are happy to help!

So Bryan, how did you do in the Financial class? I hated most every minute of it...although I did learn a few things (like I won't be going on for my MBA anytime soon~) I got an A and happy for that! I am taking a 3 week break and then on to the community health class or whatever the title of that one is!

It sounds like your class is slightly different regarding assignments. My team did a ppt on EBP (there was a group of topics to choose from) and I chose teen pregnancy for my paper. I have heard of classes being slightly different from each other as far as required work.

Nurse 79, my reply was for you~