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!

Nurse, Registered Nurse, or RN are all correct terms. Also don't get too caught up in political correctness, people need to call things as they see them. Political correctness is a joke.

The "open-mindedly" part is a nice reminder, thanks.

Ok I admit it, my skepticism regarding the data that shows our healthcare system is worse than other countries was unfounded. I'm not sure where I was going with my questioning of that information.

Well, yes I walked right into that one. I am familiar with that data and I don't dispute the cost of our healthcare. I'm just skeptical of how accurate the data, for example, on life expectancy and preventable deaths is when you look at the differences in the populations and lifestyles of the compared countries.

What do you mean by "better outcomes", can you define these outcomes and compare them apples to apples with the same stats for U.S. healthcare? I always hear how the countries with socialized type healthcare have "better outcomes" but I've never seen an unbiased comparison. Also I would think an accurate comparison would account for the differences in the populations served by the compared health systems. It's really not an accurate statement to make that other countries pay less and have better outcomes. I'm not denying the expense of healthcare in the U.S, I just want to see the hard evidence that, regardless of cost, our outcomes are inferior. Do not bring up statistics that state Americans are more obese and have higher rates of heart disease or whatever, these exist in part due to lifestyle choices not quality of healthcare. I can have the best doctor in the country provide free services and still be the sickest in the bunch simply by not following that dotor's advice. Ok I'm rambling, but I just want to see a true comparison between different systems.

I was going to try to post something constructive, but it didn't come out right and I can't delete this post. So everybody just have a good day or something.

Well I see my post generated a lot of discussion and interesting comments. I want to touch on the whole greed issue. Many of us look at the CEO types who make millions a year, we may think "they can get by with less" and we label them greedy and selfish. How many people who make minimum wage, those who work beside the RN's in housekeeping or dietary, how many of them look at us and say "those nurses make good money, they could get by with less" and then label us as being greedy. It's all relative to your perspective and situation. Who am I to say that someone doesn't deserve to be paid a certain amount or that they don't need that much money, when looking at those who make more or less than me? It's clear that capitalism has it's downfalls, there are winners and losers as with all aspects of life. What is the alternative? As I posted earlier, we have the power to change the way things are. There is a lot of blame being tossed around these days, but no one wants to pull themselves away from their TV or video games long enough to actually make change happen. We're too caught up in our selfish lifestyles and content to be armchair politicians screeming what should be done rather than doing what needs to be done. While we still have some freedom left, American citizens need to get off their butts and get involved before we lose the opportunity all together. Onless someone has anything helpful to add, or suggestions for how the average person can get involved and participate in government, I think this thread is pretty much dead.

liberated847 I agree our politicians are bought and sold, however I think the blame for this falls squarely on the American people. We let this happen by failing to hold our elected officials accountable. The American people are also guilty of becoming slaves to consumerism. Corporations and politicians only have the power we give them. The corporations make their profits because we buy their stuff, they ship jobs to other countries because we demand lower prices. The politicians do whatever they want because we let them. Then we complain about all these things as if none of us are to blame, using corporate executives and politicians as scapegoats. In the end they are human and do what most any of us would do given unlimited wealth and power. In America it's not the system that has failed, it's the citizen who has failed. Too many people are completely oblivious to how this country runs. I like to think the founding fathers envisioned the voters being informed citizens with some skin in the game, rather than a mass of zombies voting for whoever had the biggest advertising budget.

I think it's great you have a goal, stick with it. At your age you could start on the path to becoming an expert in human anatomy and physiology. If you are able to master these subjects, most everything else should make sense and come pretty easily to you, It's also basic science in which the information is not likely to change between now and the time you are in nursing school, it's also something you can begin to learn now on your own time. Also train yourself to be good at observing the tiniest details, like ones skin color, breathing pattern, etc. It will be helpful of course to be comfortable talking with people who are going through a difficult time in their lives, become a good listener, get comfortable knowing what to say and when to say it, learn when it's best to say nothing and just listen. A second or third language would also come in handy, whatever you are most likely to run into in your neck of the woods. I hope this helps. Good luck with everything.

In our NICU the baby's head is almost always at the RN's left hand, unless there is some reason this won't work out.