bmsrn

I give it together frequently in the PACU. Are you thinking of Phenergan with Dilaudid?

Level 3. 70 beds. We had someone celebrate their 1st birthday in our unit. Our docs will NOT transfer them out. When we are full we are continually transferring babies to nursery.

I work in a level III NICU. The only thing we don't do is ECMO. I'm guessing that the only thing that makes somewhere a level 4. I don't think your transition is going to be hard, since you have already had critical babies. You should pretty much know everything already. If you can take care of a critical intubated 1:1 patient, then you should be able to take care of a cooling baby or a post op baby.

Our policy is that you HAVE to scan the patient. Every bedside has a computer and scanner. We have to scan the baby, then the med. Our ID bands are these little labels that look laminated. We usually get 2, so we wrap one around the ankle, then somehow loop the other one through it- we get creative. We do this because the barcode on the first band is so curved(around the ankle), it's usually doesn't scan. I personally like to make the 2nd one pretty long, so I can easily scan the barcode without disturbing a baby in an isolette. If it's a crib baby- almost always, their meds are timed around their feeding so they are already awake. If they aren't, I usually have pharmacy re-time them. The barcode on the ID band matches the barcode on every piece of paper in the chart so technically you can scan that, but if caught, it's probably a write up. If a baby has a HUGS tag, we just loop a ID band through the HUGS strap. Not every baby has a HUGS tag though.

We will tape our feedings like others have mentioned if it's under 10ml. We use 4fr, 6fr, and 8fr feeding tubes. We don't use the 8fr that much. I don't think it's unsafe like mentioned above. It goes pretty slow. I personally think it's a waste of time and supplied to put a feeding that's 10ml or less on a pump. We usually don't have tape residue all over our beds.

I only pop the top when necessary. It depends on what I'm doing and the babies size. If they are a micro-preemie I'd only open for an intubation or re-taping the ETT. I see a lot of newer nurses that open it all the time. We don't really have a policy.

Get your bachelors degree.

We also never help lock a line. Any kind of central line will have KVO fluids running, it's usually D5w with 1:1 hep, going at 0.3 or 0.5 ml/hr. Our PIVs are saline locked.

First congrats on your pregnancy. Where I work its very hard to hide it. You may tell one person but what if you don't work the same schedule as them?Besides, the minute I see another nurse always doing someone's X-rays we all know what that means. I agree with the other posters. Your charge nurses need to know- you don't want to be assigned a cmv baby. We've had a lot if new hires recently and a lot of them got pregnant soon after being hired. I've never seen anyone fired for being pregnant in our nicu.

I have both of the main ones. They each have their pros and cons. The big difference for me is that one is outline format and the other is like a textbook with paragraphs.

How about a family nurse practitioner. That way you can do adults or children. You can work in a pediatricians office or even a Walgreens 1 minute clinic- that would have nice hours. I agree with previous posters- get a degree in something you can actually find a job in. I've never even heard of a CNL.

That's how I always thought it was too, and that's how our unit has always been. Since people have complained about having their assignment being switched(especially when they work 3 in a row) when I primary nurse works, our unit manager decided the other nurse keeps that assignment and the primary nurse does not get their primary. Any ideas on how to approach her or what to say to maybe get her to change it back?

How does your unit handle assigning nurses their primary? Will a nurse have their primary every day they work- regardless if the nurse who worked yesterday( and had that baby) is back today- but the primary nurse is working too?

Surgeons and docs assess our babies when they can. I won't really say it's at their convenience. Our docs are extremely busy. They are gentle with our kids. After they assess, I just re-wrap them and they go to sleep. Our level 2 kids are usually on a q3h schedule which starts at either 8, 8:30, 9, or 9:30. Our level 2 kids are on a Q2 vitals and hand on Q4 schedule, that starts at either 8, 8:30 or 9. With almost 60 patients and nurses always changing the babies schedules around, it seems like it'd be very hard for this to be coordinated. If I have an extremely cranky baby, I will ask them not to wake the baby up and usually they'll just tell me to call them when the baby is awake.

It's going to be stressful, especially since this a lot of this is new to you. Honestly, I don't see how someone can expect you to just stroll on in and NOT be stressed. You just need to take it day by day. Maybe you should look at level III NICU's that aren't in the biggest childrens hospital in Texas. Not trying to sound sarcastic at all, but not all level 3 NICU's are created equally. Some can have a way higher acuity then others. Maybe you can talk to your charge nurse, and discuss the kinds of assignments you have been getting. As for a baby dieing- no body likes this part of our job. It happens though. You should see if your hospital offers some kind of course or training. Some nurses in my unit have done Resolve Through Sharing.

I have personally seen quite a few babies have setbacks after those 2 month immunizations, and it's usually the previous micros. It's to the point now to where we separate those 3 vaccines by 24 hours, so they are given over a 3 day period. Previously the doctors would write for all of them, and tell us to give them all at the same time. When we would question it they'd go on about how there was no "proof" of babies having setback from the vaccines. As for the Hep B, we have a weight requirement. I believe it's 2kg.

We still do. I have a relative whose a NICU nurse and her hospital does not- something about evidence based practice. Everyone measures differently though, so I usually compare my measurements. Our policy isn't set in stone, definitely not every 4 hours. Some kids I do it once a shift, others I do it twice a shift.

We used Vapotherm in our unit until they had their recall. We switched to Fisher Pykel and we've been using that since then. I believe they are pretty much the same thing.

Our unit does not use Vapotherm. That was before my time I guess, but now we just use Fisher Pykels. We also use Sipap- a lot.

I have never heard of this. Is this just a plain NC? And it can be used for NCPAP? So no more velcro head pieces and masks? I went on their website and it looks like the cannulas we use, but we do not use our cannulas for CPAP.

We also have a dedicated med line, and our TPN tubing is portless- so there is no such thing as giving it to the closes port. Things like Amp and caffeine I'll push through my medline, then run my flush over a set amount of time. Our med line tubing is 0.7ml so I'll run that much. When we have meds that are not compatible with TPN or lipids and we have limited access, we do "delay" our TPN/lipids for 30 minutes. I understand that it's not a substitute, but at the same time nothing has ever happened. I'd rather do it this way than have an IV just for 1 medication that is not compatible. It seems like an infection risk to me to have more access then needed.

We limit the use of adhesives. How do you secure a PIV or dress a PICC with no adhesives? For heelsticks, we have what we call OB sponges. They are cotton squares that stretch and stick to themselves. For kids that kick a lot, I just tape over the OB sponge. We still have band-aids in our unit. I only use them for immunizations, and by that time the babies are bigger and going home.

As for spending time with your family, it's no different no matter what kind of nurse you are. I find it's actually easier to spend time with my family. I am also a wife and mother. I find that nurses generally work three 12 hour shifts per week. I realize there are other kinds of shifts out there, but the NICU I work in only does 12 hour shifts. That leaves 4 days a week to spend with my family. If you are sure that you want to be a NICU nurse, to me it doesn't matter about limiting your skills because you will be a NICU nurse, and that's all you need to know. When you decide to further your education, you can go for anything. If I further my education I will not go for NNP, because I don't want to work 24 hour shifts, and working on holidays and weekends sucks. With 2 young kids(under 4), a M-F and 9-5 job looks pretty nice.

We do not remove OG/NG tubes during PO feeds on my unit. I have heard of other hospitals doing it though. I guess some doctors feel that the tube can cause reflux or aspiration. Most of our kids who are nippling have NGs in, unless they have a nasal cannula, then they have to have an OG. We have 2 different bottles used for cleft babies. We use the Haberman and the Mead-Johnson Cleft Palate Nurser.

Our unit does not use the ones from L & D at all. We can literally cut it off once the baby comes to the NICU. There is a universal ID band for our hospital. Ours get printed on a "baby" size and they are adjustable. Everyone gets one. Even the micro-preemies are supposed to have one on. The material is very thin, it's like a clear sticker that folds over the barcode and all the information on the tag. We can then wrap it around the babies ankle or wrist and adjust the tightness.