Finallyat40

PARKLAND! in Dallas, wonderful supportive teaching facility....and if you don't see "it" there...it probably doesn't exist! They have extensive orientation programs for new grads and their pay scale is very much in line with the "for-profit" hospitals, in fact I think a bit higher. here is their website http://www.pmh.org Jamie

We usually have 12-14 a month, but then we'll go a couple of weeks and have none....we are a county delivery hospital with upwards of 16,000 deliveries a year and an average census of about 75. These numbers only include babies born over 23 weeks with a heart rate. The others are counted in L&D. Jamie

Having been precepted and now being a preceptor here are a few things that I try to do: 1) Remember that they have graduated from nursing school and passed the boards, therefore, they are not clueless, they just need to be led to the water. 2) Positive feedback is necessary all the time, especially when pointing out something they need to improve on. 3) I teach by the "watch one, do one, teach one" theory, and it's worked quite well thus far.... 4) Try to allow them some space and not hover (this doesn't mean don't be there.....) 5) Hospital paperwork is often so overwhelming....we do this together for a while, with me telling them what to write, then as that becomes ingrained, they just start to pick it up. 6) MOST IMPORTANTLY: Precepting is hard work....don't let anyone tell you differently! There may be times when you need to blow off steam...do it in a "safe" place, so your student doesn't hear you....nothing will knock them to their knees faster than this! Congratulations on becoming a teacher to our next generation. Enjoy! Jamie

Can't wait to see you in January....glad you decided to come with us! Jamie

I would definitely cover the following: Braxton Hicks contraction vs. real contractions, how to tell, when to call, etc. My hands and feet are swelling, what does this mean? What is a mucous plug, when does it pass, etc. Breast changes in the last trimester, leakiness, preparing breasts for breastfeeding, What should I include in my hospital bag? Basic supplies needed in a nursery (be sure and include and emergency kit), What do I need to have at home when I come home from the hospital (i.e., pads, tylenol, etc) Suggestions on how to "survive" the initial post-partum period, i.e. setting limits with visitors/grandparents,etc. be sure and have a few easy to fix meals in the fridge and freezer, These are just off the top of my head...I'm sure there are many more...I'm not sure I'd show the video simply because by the second/third trimester, they are pretty much past that and if they've done any reading on their own have already gathered the info....I would think that a class such as this would/could pretty much run itself, especially if you could get some interaction going. Good luck to you, this sounds really interesting. Jamie

Happens to everyone, some more than others! Just keep your ABC's in mind, get the tube out and off the face, make a good seal and bag the baby up, while at the same time letting someone know you need a provider and an RT. Maintain your airway and you'll be fine. It's scary as all get out the first time, then you learn to just roll with the punches. I am currently orienting a new RN and I keep telling her to remember that these guys didn't read the book so we can't expect them to go by it! Just an aside....we used to have a guy who did our head sono's that we nicknamed "the extubator"....He had the worst luck, and I honestly don't think it was ever his fault...he now works for the company that makes the sono machines and every once in a while we'll see him come through, but he's always called the same thing! Good Luck to you! Jamie

Well, I might sound a bit jaded....but it's because I am! I graduated from nursing school in '04 and have to admit that my entire time in school, my absolute intention was to work at big Baylor in the NICU....no questions asked! As I readied to graduate, I interviewed at all the big hospitals, the only hospital that I felt totally welcomed into during the interview process was Parkland. So when it came down to making a final decision, and there was literally 2 cents an hour difference...I chose Parkland! And I absolutely believe, this is where I am supposed to be! The Parkland family is special. The vast majority of nurses who work at Parkland are not there because this is the only job they could find, they are there because Parkland is in their blood....there are learning opportunities every single day! I have had multiple opportunities (most of them financially impressive) to leave here, and have turned them all down....I live to learn and teach and care for those who feel uncared for in life. I work at Parkland and I'm thrilled to be here....come on over...we'd love to have you! Jamie

One thing that keeps getting missed about Group One is that they aren't only there for the hiring of nurses....most of the hospital systems run EVERYONE through Group One...from environmental services to nurse practitioner to CRNA. I had a Group One file long before I went to nursing school, due to working in healthcare for 20 years. I've only known of one person who was denied employment due to Group One and she finally admitted that she lied on her application concerning a criminal charge that resulted in probation years ago...she answered NO to have you ever been convicted. Jamie

We give our vanc with lipids all the time, unless you have a double lumen and then we put it through there. Amp is definitely not compatible with TPN, it causes a precipitate that can actually clot off a line, even if it's pushed. We had a kiddo recently who was really sick, on hifi and ino, terrible stick, had finally gotten a picc, but only a single lumen....amp was given through the line and it clotted off within 10 minutes! Thankfully the NNP's were able to overthread it and we still had a line. Jamie

Congrats on your move into the NICU world....it's a wonderful place to be! One thing that I've noticed about NICU nurses is that they tend to be very protective....both about their babies and their selves in terms of newcomers. You do tend to have to prove yourself to a point, which is why orientation is so important to increase your comfort level. I also see this on our unit when nurses change shifts...even though they are known to the unit, there is a transition time. When I first started working in NICU, I overheard someone say that NICU nurses mark their territory, and has been described as "peeing around their beds". I laughed and thought that was ridiculous, now, after 4 years, i realize that I'm guilty of that...not so much from other nurses, but from every one else! Give yourself some time to adjust and I hope you learn to love the itty bitties as much as I do! jamie

Boy, can I say, been there, done that! I was all set to start nursing school in August, fell down some stairs and ended up having total rotator cuff repair on August 21st! The doctor told me not to reapply for Spring because I wouldn't be ready, I told him, he hadn't ever had a patient like me....he said he had never released a patient with this type of surgery in less than six months...I said we'll see. Long story short, honestly, this surgery is VERY painful, and frustrating...you can't d anything for yourself...the therapy is very time consuming and painful...BUT, if you're determined, you can do it....I was released from the doctor on December 8th, after a full 12 weeks of therapy. I can tell you that I was very careful with my shoulder, the patients I would have normally moved on my own, I requested assistance with, but I made it and my shoulder is so much better and I have full movement. good Luck to you...Don't give up! jamie

That says everything about why we do what we do! Thanks for sharing! Jamie

I live in forney and work at parkland...day shift, the commute is about 35 minutes....it's not really bad....not much traffic, most of it is highway driving....I think it's the best of both worlds...I get to live in almost a country setting and work in the city at one of the best hospitals in town. I love Forney, it's growing very fast, the schools are great and it has a great sense of community. Jamie

Paula, I'm truly sorry for your family's loss. Please take the opportunity to allow yourself to grieve. Just a thought, go pick up a Christmas ornament that would be special for Shirley and give it to your daughter and son in law for their tree. I have five of these on my tree and they will never be forgotten...each year we talk about those ornaments (and the first one would be 22 this year) and who they stand for. All my babies, the two that are here with me, and the five who aren't, are precious in my sight. Take good care of yourself....and a major High Five for finding a doctor to meet your needs....even though you were in the system! Jamie

Hi Sunny, First off, as someone who's experienced both sides of this firsthand, I applaud you for wanting to be therapeutic in your response. Believe it or not, medical personnel are the worst about turning a baby into a fetus, in my experience. It's a way of being able to cover up emotions and continue to do their jobs. After all, we, as nurses, doctors, etc, should be strong and never feel these emotions....right? When I've been involved in caring for the family during these times, I make sure that I write something specific about their baby....i.e., he has the most beautiful hands, his lips are te prettiest I've ever seen, etc. I am now a NICU nurse and just the other day I received a thank you note from a mom whose baby died at 20 hours, full term with a diaphragmatic hernia. She thanked me for the love that I showed her baby and her family and all the things that we did to provide her with keepsakes of her precious babies short life. We even made this mom a scrapbook with pictures....the baby looked so peaceful and her pictures came out wonderfully, and we took pics with all the family members holding her, bathing her, dressing her, etc. The extra time that you spend writing a personal note is definitely appreciated. Kudos to you, keep up the great work. Jamie

I currently work in the NICU at Parkland (which is the county hospital). We have a Level III, and the only things we don't do are ECMO and cardiac (those kiddos go to Childrens). I honestly don't know how many beds we're licensed for, but right now we're running a census of 80. As for your interest in running to deliveries, we have what is called a resus team, which is comprised of separate staffing, and their responsibility is to go to the deliveries, admit the new ones and get them settled (usually caring for them during the first four hours), then the baby goes into regular staffing. I've been here three years and love it....no two days are the same....we'll go two or three days with minimal admissions, then BAM, you're working six admits in 20 minutes! If you'd like more specific info, feel free to PM me. Jamie

I am an active member of our units bereavement committee and in an effort to more therapeutically help our families, we are wondering how other units deal with this: The baby at your bedside is decompensating, the writing is on the wall, the parents need to be notified and urged to come to the hospital quickly. Typically this phone call on our unit is handled by a physician, resident, chaplain, NNP, etc, but sometimes the bedside nurse. One of our physicians has suggested that we put together a "script" of sorts to assist the callers when making these calls, especially in the form of therapeutic communication. It seems that since these calls are made in the "heat of the moment", they tend to be more of a "hurry up and get here" rather than more of a realistic overview of the situation. Any suggestions you have would be most welcomed. I'll be compiling any responses to take to our committee meeting to utilize in the making of this script recommendation. Thanks. Jamie

Not a morbid question at all.....I am going to answer this from a NNICU standpoint rather than L&D, but we work very closely in conjunction with each other in these situations. We will clean up, bathe and dress the baby and then give the family the opportunity to spend time with the baby......either in their room, or our family room (much of this depends on mom's situation regarding recovery.....I will give the familiy as much time as they need to spend with the baby.....I think the longest I've had a baby "out" was around 12 hours. Once the family has said their goodbyes, we will then prep the baby to go to the morgue. I will transport the babyto the morgue, where it will be picked up by their funeral home. Every once in a while, the family will request to see the baby again and the hospital chaplain will retrieve the baby for the family after preparing them for how the baby will be very cold and hard. Does this help? Jamie

We don't get paid per se, but we do earn 8 hours of comp time for every 200 hours that we precept....I'm too tired to figure out how much that is, but it's definitely not very much. I love to precept, and although I do appreciate breaks when they're given to me, but I feel that there are some who are good at precepting and some that are not so good.....a new nurse deserves to be oriented by someone who likes what they're doing. It helps get them off to a better more positive start. Jamie

Our first day TPN does not have MVI in it, therefore it is not yellow, but it does contain all the other nutrients, especially proteins, this is not a special order bag from the pharmacy, but rather one that is standard. We don't typically draw nutrition labs until after 24 hours, then the doc writes the TPN order for exactly what the baby needs. We have had a few periods when the pharmacy was out of MVI and our bags would come up clear....it's really weird getting report and looking up at what should be a banana bag, but it's clear! Jamie

I don't know if this will be of much help or not, but on this forum, we are not to give any medical advice. What I'm hearing from you is that you're not asking for that, you're simply asking the best way to communicate with the staff that are caring for your baby and to get them to communicate with you. Here are a few thoughts: 1) When you go to the unit to visit your baby, immediately ask your baby's nurse to page the provider to the bedside. When they arrive, ask them for an update on his status for that day and his plan of care going forward. It also doesn't hurtto ask the nurse the same question, as each of them focus on different areas, so this might help with the completeness of the report. 2) Ask your child's provider (NNP) to schedule a family conference with your attending physician, social worker, NNP, the entire team, so that you can get some answers concerning the future. Don't expect a great deal of specific information out of this because these babies are so resilient and can overcome some major things, so you're most likely to get a range type of answer to your questions. 3) Keep in mind that you'll catch more flies with honey than with vinegar....I'm not saying you shouldn't ask questions, just try to keep them organized and realistic. Congratulations on the birth of your son and always remember....You are his best advocate, so be sure and participate in his care. Jamie

Oh, I can so relate to your feelings. There is a fine line between caring for a patient and doing everything in their best interest and playing God. We do have an ethics committee in our hospital, and have called them in periodically when we have a situation that has become "complicated and confusing", such as the one you mention. We had a case at one time that was awful...much the same situation as yours, except the parents refused to make him DNR or take him off, and the nursing staff was feeling really used....this kiddo was alot of work, even as a one to one. The ethics ommittee interviewed everyone involved....docs, family, and even a couple of nurses, and then handed down the decision that further care was futile, so the baby was made DNR, and the parents were given 10 days to transfer him to another facility or at that time we would remove life support. Within two hours of the decision, the baby coded and went to heaven...I said at the time that he just needed permission to go and since his parents weren't giving it, he was hanging on. After it was over, his parents were so relieved at not being made to make the decision....I think that's what it boiled down to with them. Lots of hugs for you and your coworkers. Jamie

I second the Core Curicullum for Neonatal Nursing....great reference, easy to understand and especially good for someone new to the NICU and/or nursing. Jamie

The first and most important part to this story, which happened in a hospital very close to me, is that the nurses did NOT file safe harbor.....they refused the assignment, based on the acuity and number. Although I agree with these nurses that their assignments seemed unsafe, from the stories I've seen and heard on the news and in the paper, they didn't go about handling this situation in a professional matter....in fact, it was reported that they went into the neighborhood surrounding the hospital to gather folks for a press conference they held and to carry signs when they petitioned the hospital. I work in a NICU in the area, and you know what, I wish I could say that I never had to have an assignment that was too heavy.....the reality is that especially in an ICU environment, numbers and acuities change in seconds...and they aren't always ideal. Jamie

Okay, your community is primarily over 40...how about some of the following: Prostate Cancer Screening cover the importance, how often, what age, incidence of death based on age/culture, etc. Mammography guidelines - how many, when to start, accredited clinics in your area (you could even call around and see who will be offering discounts in October for screenings) Hypertension signs and symptoms, screening devices, when to see a doctor, ways to prevent, etc. Type II Diabetes - Incidence, frequency, lifestyle changes, etc. you've gotten some great ideas from the other posters....the key here is to pick a topic you can be passionate about and get moving with it. Jamie