shermrn

In the absence of any related issues one does not need to check a residual. You only need to check placement if you're going to put something in the tube. Think of the effect on an infant to have the bulk of their stomach contents removed then shoved back in. Reasonably speaking, whatever amount is aspirated should be given back at the same rate the original feed was given. If you gavage an infant with 30 mls over a half hour and then aspirate 15 mls before the next feed, your going to have to give that 15 mls back over 15 minutes. Doing this without any supporting reason to do so is more likely to cause harm.

Generally speaking, your cell phone does not belong on the unit. Besides being an infection control issue, it's just plain silly. Use some common sense.

adpiRn, BSN, RN. Apparently I did misunderstand the point you were trying to make. Regardless, I offered encouragement and support as you start work in the NICU. Your only response of "Yep exactly !" shows exactly what kind of person you are. Good luck.

Congratulations on getting hired in the NICU, it's a great place to work. I do have to take issue with the above comment though. I can imagine how scary and stressful that delivery was, my wife worked labor and delivery for a long time and I've heard of some really scary stuff. Consider though that the 25 wk infant survived to make it to the NICU, during the time he/she was there the NICU team is fighting to keep that baby alive. That's 8-12 hours of "scary" for whoever has that assignment. Not to mention the family will likely be there the entire time needing almost constant teaching and emotional support as they struggle to figure why this is happening to their baby, what are we doing to their baby, is he/she in pain, will the baby survive and if so will he/she have any long term problems. My point is that with most of the deliveries such as you described the scary part doesn't end when the baby leaves the delivery room/OR, it's only just starting. But a great part about working in the NICU is that you will see many of those scary situations resolve. The situation will go from coming to work and wondering if that baby will survive your shift to coming in and wondering how well he/she will breast feed or bottle, or if he'll still get fussy when you put him in the tub and wash his hair. The NICU is an incredible place to work and with your L&D experience you'd make a great addition to the delivery team. I wish you the best of luck.

My first year as an RN I worked at a Long Term Care facility. One day the new administrator passed me in the hall and asked how my day was going, I said, "Oh, it's pretty busy today". The administrator replied with, "Well we all make mistakes." He obviously had no interest in how my day was going, but the encounter stills makes me laugh almost 20 years later.

If the tattoos are "offensive" or you're just self-conscious about them go ahead and put gloves on when you enter patient rooms. In general, I get the feeling gloves are dirty unless I see the person put them on or know they just put them on (if that makes sense). The long sleeve shirt with thumb hole, or any long sleeve shirt really is an infection control issue. Those long sleeves are likely going to touch whatever your hands touch and there's no way to wash them between patients. So wear gloves when it makes sense but otherwise people will have to get used to the tattoos until you're able to remove them.

I started my healthcare career as a CNA in long term care when I was 17 and continued with it for nearly 10 years until I became an RN. The facility where I worked at the time stuck a piece of tape that said "RN" over the "CNA" on my name tag and I continued to work in LTC for another 8 years. I didn't always love the work but stuck with it because I knew how very important it was. Over time I switched to a different facility, for better pay and some different experience. The facility I moved to was opening a TCU and gave me the chance to work with people who had more acute issues than what I was used to, but still involved LTC. I loved what I was doing and saw I was making a difference in peoples lives, I couldn't be happier. Eventually the usual things such as lack of staff, lack of funding for the facility, endless charting, etc. began to weigh on me. To top it off I had a baby on the way and saw that nurses who graduated with me were making more money at the hospital. I had become completely disillusioned with long term care, something very important to me, and was even looking at getting out of nursing all together. I quit long term care and gave the hospital a try, if it wasn't what I wanted to do at least the money was good. I went on to work in med surg then ICU and eventually the NICU (after having a child there). As difficult as the jobs I've taken since have been, I'm always reminded that working in long term care was the most difficult and challenging job I've ever done. Over the summer my grandmother became a resident, and eventually died, at the same facility where I first worked as a CNA back in highschool. Being there to visit her reinforced for me how important those of you who work in long term care are and of how challenging your job is. To all of you who work with our geriatric population, I offer you my unending gratitude and admiration. You are an amazing group of people! Thank you.

I'm on the fence with this issue. Having had a child in the NICU I can see why this appeals to parents. I'm pretty sure management/administration love it as a selling point. I would love to see it installed in all daycares and schools through grade 12. When I leave my dog with a kennel or doggie day care I can go online to watch a live video feed of whats going on, shouldn't I be able to do this with my kids? As a NICU nurse I haven't been too bothered by it, we've done it in special situations in which the mom is hospitalized and unable to visit, or the parents are not from the area and need to go back home to care for their other children or work. What does bother me is that our hospital is installing ipads at each cribside solely for purpose of video monitoring, this seems to be a very expensive approach. Another thing that bothers me is the ipads include audio which could cause some trouble. Every nurse I know, self included, speak differently in the absence of parents/visitors etc. at times. Given the sense of humor some nurses have, parents listening in could get an earful, they may also overhear protected information about other infants. There is the option of turning the volume off but that may be the least important thing you think of during a busy shift. Nice to be able to turn on the sound for parents to say hello and all, but then off it goes. There is also the problem of parents misinterpreting what they see. In this case one would expect a parent to call and ask what's going on, but many of the parents I've met are far more likely to take a less reasonable approach. So there's good and bad to the whole deal. If video monitoring becomes the norm, I certainly hope administration has the appropriate policies in place to deal with every possible outcome and will 100% support which ever party (nurse or parent) is in the right. I suppose this gets into the need for continuously recording the video feed from each cribside. I can see where this could also be abused/manipulated to use against someone for whatever purpose. Will there be a need for some kind of legislation to specifically address any and all issues that could come up as a result of this monitoring? I'm not sure if any of the unions are on this or not. In the interest of full disclosure I'm not 100% a union guy for various reasons. However; I have and still do acknowledge the need for unions and am a union member. The whole video monitoring situation seems like a perfect thing for my union to be involved in.

You will eventually get over the nervousness. Also do not hesitate to consult with another nurse or doctor, in the long run they appreciate it. I think coworkers are more worried about the nurse who doesn't ask questions or seek assistance.

I work within the same health system that provides care to myself, wife and children. We are allowed to view our own medical records as well as those of children under a certain age. Whenever I have a clinic visit I will check my chart a few days later, just out of curiosity. I've noticed some false and inaccurate information but nothing I'd raise a fuss over. I had been in with influenze symptoms, a full assessment was documeted, it was also documented that I was strongly encouraged to quit smoking. Much of the assessment that was charted was not really completed (pedal pulses weren't checked, abdomen not palpated or auscultated, pupils, reflexs, etc. not assessed.) I also do not smoke and never have. I think much of the charting includes smart text which the MD/NNP/PA has to go through to delete what doesn't apply, sometimes they miss a couple of lines. I wouldn't say that my provider gave false documentation, just made made an error omission or mistaken entry. Some providers cut and paste parts of their documentation, file it, then return later (sometimes much later) to make corrections or updates. If you see the documentation before they do this, yes it can look like false documentation but it's really just incomplete. I think that makes sense. I would only consider reporting false documentation if it resulted in harm to the patient or violated legal and ethical standads.

I admit the abortion thing is off topic, however I brought it up to further illustrate how silly the Joy Behar uproar is when there are much larger issues to deal with. A last thought on your abortion comment. Simply because something is LEGAL does not make it right. Some nurses use the term "legal medical treatment" to defend their position on abortion. The fact that it's legal doesn't cover the fact that the "medical procedure" is no more than the intentional killing of a human being. Ok that's all I have to say. Let's return to the Joy Behar discussion.

I would like to see #nursesunite write a petition requesting legislation to remove abortion from services provided by planned parenthood. Granted I'm not on this site often, but I haven't noticed much of an uproar from nurses over the whole planned parenthood issue and the videos that have been released. It's sad that comments from Joy Behar, or the killing of a lion, draw more attention than the deaths of untold numbers of infants.

This is going to sound crazy, however I'm posting this in all seriousness. We have all had those infants who are going through withdrawal or for some other reason get so worked up to the point where they are inconsolable. I have found that when I sing the song Found a Peanut to them they at least calm down enough to take the pacifier or a bottle. Perhaps I am crazy, some coworkers would agree, but my observation has been that this works for me in the majority of situations. It calms the infant down enough until some other more long lasting intervention can be started, whether it be to give meds, get a bottle ready, etc. Now I don't know if it's that they are terrified by the sound of my voice or what, but that is the only song I have found works. Maybe it's the tone of my voice the song brings out, perhaps a different song for someone else. Thought this was an interesting observation to post and wondered if any of you have had similar observations. If not maybe you'll at least get a chuckle out of the idea.

I'm just happy to hear a parent say "Thank you".

As a NICU nurse and the parent of a 27 weeker who was in the NICU for 4.5 months I think the advice you've been given is appropriate. If you are unable to be present for rounds daily then ask to have the MD/Resident/NNP (which ever one is running the care of your infant) give you a call each day. Otherwise try to be there as often as you can and show a willingnees to do as much as they'll let you do with your baby. As a nurse I like it when parents are fairly independent in handling their baby, however I prefer they check in with me before doing anything hands on to the baby. While he/she is their kid, I'm still responsible. If the staff know you're a nurse they may find it easier to explain certain things knowing that you have a similar knowledge base or speak the same language. But don't let them just assume you know everything, make sure to ask questions, most of them will understand that you are a parent first and foremost and may even forget you're a nurse. Also if you are not comfortable handling your baby let them know so they can show you some ways to safely handle and interact with your baby. One last thing that will make things between you and the staff go smoothly is to let them know when you plan to visit and how long you plan to stay, when you leave make sure they know it and give a time when you plan to come back. If you want to be present for baby's bath, let them know and they will work it out with you. Also if you plan to come for a feeding, try to be there a half hour to twenty minutes before the scheduled feeding time. Some of us get a bit put off if the baby is to eat at 3:00, and we know mom is coming to breast feed but doesn't show up until right at 3:00 or later, it takes a while to get vital signs and diaper change done before feeding and we usually have at least one other baby who may be waiting to get fed at the same time or shortly after. So my advice is a bit disorganized but I hope it helps. Be present, participate, and communicate. I hope everything goes well with your new baby. Congratulations!