tallynurse

I recently started working at a new hospital. When I was orientated to the IV pump, we were told to be extra cautious because the Alaris pumps they use had been over infusing patients (basically free flowing the fluids sometime within the first 30-60 min of setting the pump). A month later and there's just been a death because of this. The hospital I came from used Hospira plum pumps and I never heard of any issues like this with those. The hospital/state's fix for this is to use volutrol IV sets and only place 2 hrs worth into the volutrol. I'm curious if anyone else is having issues like this with Alaris.

Where did you end up? I'm moving to Sacramento in the Fall (fiancé has a post doctorate at UC Davis) and curious how UC Davis NICU is. What was your interview like?

If you can, express your breast milk for your baby for when he's able to eat. Take care of yourself, try to eat and drink plenty of water and get some rest. When you're with him, talk to him in a soft voice. He knows your voice and that will be comforting for him. As he gets better, hopefully you'll be allowed to do more care for him.

Have you tried getting a post partum or labor and delivery job? In my NICU we hire from post partum a lot, with the idea being that they know well babies and can easily transition to taking care of sick babies. Or just try getting into a hospital with a bigger NICU, no matter what area and ask to shadow in the NICU and talk to the manager about what you can do to get hired.

This is definitely normal. I've been working in NICU 3 years and there are still sometimes I second guess myself. And in that case it's always better to check with someone else. As for seeing the new nurses who started after me, it's the ones who were too confident and acted like they already knew everything from the get go who either didn't make it or are struggling. It's ok to ask for help, we all need it. Don't every think that you've learned everything, even the nurses who have been working in NICU 20-30 years are still learning.

If you want to stay in the area, I would suggest trying to meet with the managers at NICUs in the are to ask what they prefer to see. When I was in nursing school I got the opportunity to meet the manager at the only local NICU through a school event and she said she prefers that if you don't get hired into NICU as a new grad, that you work post partum to get used to well babies. But every unit is a bit different. Use your contacts at your current job to help you too. I was a nurse extern (basically a CNA position offered to nursing students) in the PACU while getting my ASN and my manager as a large part of why I got hired in the NICU as a new grad. I made a good impression in the PACU so my manager bugged the NICU manager to hire me.

I did. It actually seems like it's not as big of a deal as I originally thought. I went to University of Central Florida for my RN-BSN online, no issues with getting my ASN from a non accredited school. I know a lot of my classmates did the University of West Florida's online RN-BSN program.

nicuguy-do you do any special positioning with bubble CPAP? I'm a travel NICU nurse about to work at my first hospital using bubble CPAP and was told to research positioning with it but I'm not really finding anything about positioning differently. Also any tips for bubble CPAP in general would be great!

You did good. Don't beat yourself up over it. NEC (which I'm assuming is what your baby has) can seem to pop up extremely quickly and make a baby sick quickly. So while you may think you should have noticed it sooner, there might not have been much more to notice sooner. I think most nurses I've worked with would have done the same thing, watch it for a little while first unless it was a large jump in girth or there were other symptoms. As for feeling like you shouldn't be asking for help, get rid of that idea. Everyone needs help sometimes and especially as a new grad and when one of your patients gets sick suddenly. I'm sorry the nurses weren't nice about it. Hopefully it was just an off night for them. But never be afraid to ask for help.

I got hired as a new grad in a NICU. In school I didn't get any chance to do clinicals or my preceptorship in the NICU. But I did work as a nurse extern in the PACU and my manager there knew the NICU. She was great and called the NICU manager multiple times telling her to hire me. That's what got me in the door. So impress your preceptor and manager during your internship and ask if they would put in a good word for you in the NICU. It seems managers usually know other managers at the same hospital. Also, call up the NICU manager and ask if there are any certifications or anything you can do to help you get hired. If they don't hire new grads, ask what floor you should work on first. Good luck!

I had an interesting case where a code was called at delivery, when we got there the baby had pinked up on his own but as soon as we walked in the room all nurses kept saying "we didn't know." "it wasn't on the ultrasound" He had club feet, only 4 digits on each hand, micrognathia, small ears, and an oddly shaped head, like indented looking at the temples. I guess they had no clue he had anything wrong. He ended up having trouble keeping his sats above the 70s and needed to be intubated yet no one could get him intubated. They tried for over an hour with no luck. Placed an oral airway to keep his airway open (seemed to mainly be a structural issue) and he had a trach placed. Originally everyone thought exposure to pestisides had caused it since the parents were hispanic, spoke little english, and there's a lot of migrant farmers in the area. But neither of the parents worked in the industry. The geneticist ended up testing for lots of different things but said her guess was Nager's syndrome. He did fit the description well and looked like many of the pictures of people who have Nager's. I never found out if it was that for sure because the testing was going to take 3 months. Once he had the trach placed he did pretty well and after getting a g-tube went home within a month I think. Might not be as interesting as the others, I might just find it interesting because even with the deformities he was adorable and his parents were so sweet and thankful to us.

I started as a new grad in a NICU in FL too. It can be really overwhelming and I was not good with my time management so that was difficult at first. But like others have stated, being a new grad anywhere is such a huge learning curve. I feel like that's especially true in NICU since most nursing schools really don't spend anytime on the specialty. I would think that if they are extending your orientation they probably see potential but realize you just need a little more time. That's ok. If you work in a NICU that has a seperate NICU III and NICU II ask to be started in NICU II once you get off orientation. That's where I was started and even though at the time I was disappointed to not be in NICU III, I realize that having stable feeder/growers gave me time to work on my skills and learn in a less crazy environment. When you make a mistake ask what you could have done to avoid it, learn from it and move on. Dwelling on it and beating yourself up over it won't help. Everyone makes mistakes. Ask lots of questions. Never be afraid to ask questions. It's always better to ask what you think is a stupid question when it comes to patients. Give it some time and if you still don't think it's right for you then you can change to another unit. But you're probably just being hard on yourself, everyone is harder on themselves.

NICU can be really hard to get into sometimes but if you think that's where you're meant to be don't give up. I would say call or email the manager you interviewed with, thank them for taking the time to interview and consider you and then ask if there's anything you can do to help better your chances for next time. Some suggest getting a post-partum job so you get to know well babies, some say Peds. Maybe she can suggest some certifications they like their nurses to have. But don't give up. I interviewed in my first NICU in June, thought I was going to get it and then was told they only had 2 positions instead of 3 and I was the 3rd. Spent the next 3 months applying to every NICU in the state of FL and southern GA and was about to give up and look for post partum when the manager I had interviewed with called saying they had another position come open if I was still interested. And while you're waiting, continue to be the best in you're current unit. I was hired as a new grad and I really think the only reason I was was because I made sure to impress my manager and coworkers in the PACU as a nurse extern. Which lead to my manager bugging the NICU manager to hire me. It'll happen, don't throw in the towel yet.

I work NICU so there aren't as many float options. This hospital only floats to nursery and that's very rarely needed. I have also worked at teaching hospitals but they didn't not have NICU residents so I don't know how that would affect staffing. Thanks for the suggestions. Does anyone have any experience with any per diem agencies to give recommendations?

Hi, I'm on an assignment in California and our census is very low. I got called off all last week except for 6 hours. While I do have some guaranteed pay, I really can't afford for this to keep happening. I'm also worried they might cancel my contract if census doesn't pick up soon. My question is, a traveler who traveled in Cali a few years ago told me about something where she would be called in to work other hospitals when they were short staffed last minute and unable to keep the nurse patient ratios where they are required to be. But I don't know what this is called. I'm in the San Diego area. Can anyone point me to some companies that do this? Also anyone have experience with their contract being cancelled because of low census?