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elizabells BSN, RN

NICU

Content by elizabells

  1. elizabells

    Isolette covers

    I keep seeing references in threads to Isolette covers, like they're a specific thing. We use... blankets. Often it's the same hospital-issue blankets we use to swaddle, make beds/rolls, etc. You know, the white ones with teal and pink stripes. Once in a while the volunteer group will send up a big load of crocheted blankets and we throw one of those on, or a parent will bring something in. Do y'all have some special thing you use? I could sort of picture a shaped, maybe quilted kind of thing. I'd be shocked, SHOCKED to discover that this is some EBP developmental care thing that the entire rest of the universe has caught onto and that my unit stubbornly refuses to acknowledge. [/sarcasm]
  2. elizabells

    Univ of Mich ECMO training

    Has anyone been? I'm talking about the ECMO specialist training course. My unit keeps making noises about training RNs to run the pump bc we don't have enough perfusionists, so I asked if I could do the course. My boss now, of course, wants to know a) how much it costs and b) whether it would be worth it. So has anyone been to it? How long was it? Cost? Did you really feel prepared to run a pump afterwards? I emailed the sign-up person to ask all of this, of course, but I'd love to have the perspective of someone who has done it or knows someone who has.
  3. elizabells

    NCLEX urban legends

    Okay. Here's my thinking - those of us who have taken the NCLEX should post myths we heard and their falsity. Please, please only post things you KNOW to be false. Then folks who are flippin out (as we all did) can come look and ask questions we didn't think of. Okay? 1) No math questions = failed: FALSE. I passed in 75 with no math. 2) If you get a survey at the end that's about the test, you passed, whereas if you get a survey about the test CENTER you failed: FALSE. I got the test center survey and passed. 3) If you get an "easy" question at the end, you failed: FALSE. We all know more about different things. What is an easy question to me (something about NICU) might be hard to you, and an easy question for you (something about geri, for example) would be impossible for me. 4) I got 75/265 questions, so I must have passed/failed: FALSE. See the excellent number of questions thread. 5) A certain number of people are randomly selected to receive all 265 questions, regardless of performance: FALSE. Okay, I don't actually work for the NCLEX people, but all available information indicates that this is a load of bunk. mods? sticky?
  4. elizabells

    preparing for your first night shift

    So. I finally got the email on my senior practicum clinical placement: I'm in one of the best NICUs in the country (WOOOOOOOO!!!!) on nights (also WOOOOOO!!!) Now, while I'm definitely excited for nights because I hatehatehate getting up early in the morning, my thoughts have turned to that first shift. How did you all prepare for that? Should I stay up all night the night prior and sleep the day of? Should I start doing this a couple of days before? Luckily I only have one class, one day a week, for two hours 5-7 (not sure if that's a day I'll be working yet). I'm sure I'll adjust fine and dandy, but I really want a job in this unit after graduation and I don't want to make a crappy impression on my first day by being zonked out. Can ya tell I'm a little anxious and excited? Can ya can ya can ya?
  5. elizabells

    IR Drain???

    Hellooooo my friends. I'm doing a careplan on a patient with an IR drain. I have NO idea what this is, and neither does google or any of my texts. Neither did my preceptor (!). By the time I realized all this, I had of course come home and couldn't ask the pts nurse. Anyone? Bueller? It was draining an abdominal abcess, if that helps...there was sanguinous dark green fluid coming out.
  6. So my unit is way over census and understaffed. I've had an utterly ridiculous assignment the last few nights; you know, the kind of shift where when 0700 rolls around the fact that you and all your patients are still alive seems like a victory? Yesterday morning I arrived home just beat. My legs felt like the bones might shatter any minute, my lips were puffy (a weird thing that happens when I'm overtired), my hands were shaking and I just felt like hell. I went to brush my teeth, as you do, and after a few seconds I realized that something didn't taste right and my mouth felt really sticky. I looked down at my sink and discovered that I was not, in fact, brushing with toothpaste. Turns out that Crest Vivid White and Eucerin Plus Intensive Repair Hand Ointment are packaged in tubes of almost the exact same size and shape. That'll learn me to keep them next to each other on the counter. :trout: So dish: What's the silliest thing you've ever done after a wretched night at work?
  7. elizabells

    My two least favorite words

    "Nurse's discretion" Translation: we have no intention of giving you any guidance, so you're on your own, but if a family member doesn't like something you said or did, we're totally going to yell at you.
  8. elizabells

    Who runs your ECMO pumps?

    Hey, all. In the time I've worked in the NICU, I've gotten hopelessly, irredeemably addicted to ECMO. At my hospital Clinical Perfusionists set up and run the pumps and we look after the babies. I know there are hospitals out there that have RNs on pump after it's set up. Anyone work at one? I'm prepared to go to perfusion school if I must, but the prospect of going back to college for yet a third time is a little daunting.
  9. elizabells

    Humiliating IV questions

    Hey, y'all. I have an embarassing confession to make. I've been in the NICU, student and RN, since March of 06. In that time, I have successfully started ONE IV. One. Now, I'm really good at venipuncture. Good enough that I help out other nurses when they can't get their labs. But I have some kind of psychomotor disconnect when it comes to advancing the catheter and flushing. It's truly pathetic. I know that it's hard to say what I'm doing wrong when you haven't seen me do it, but does anyone have tips? I just can't advance that d(&* catheter properly! It bends, it kinks, and if by some miracle I get it in all the way, it's gone straight through the vein and it blows, or it just won't flush. thanks
  10. elizabells

    LPCH-New grads?

    My inside informant tells me that at least one of LPCH's units has such low census that other units had to absorb nurses who were at risk of being laid off. So basically no outside hiring was done this year.
  11. elizabells

    Problems with blood bank

    Okay, I know I'm terrible, and I'm sorry you're having frustrations with this (and I would be BOILING mad if I were you) but I'm giggling like a fiend right now. It's late, I guess. Nothing about this yet in NYC. But our blood bank suuuuuuuuhhhhuuuuuucks at all times, so I'm not sure I would notice if they got any worse.
  12. elizabells

    One of those weeks

    The tally from the last M&M was 18 in a month. Which more than doubled our previous high, which was 8. We took the other NEC twin off the other day 2/2 a bad bleed. On the bright side, I had the most rock-star cardiac the other day. Extubated less than 24h post op, eating shortly thereafter. Woot!
  13. elizabells

    One of those weeks

    So in the past week, we've had: A former 36wk TGA who was grown for a while, full feeds, used to take him off the monitor and walk him around. Then we did his arterial switch. Died suddenly just after the OR. A harlequin ichthyosis. Died. Conjoined twins who shared a liver and one three-chambered heart. Died. A growing preemie who went from full feeds to his intestines in a silo, they're all dead and the surgeons couldn't fit them back in. Peeing bright red blood, K+ of 9 with rhythm changes. Gonna die. A 6mo old with MAPCAS who was initially deemed unrepairable, then decided to take him to the OR but with a 40% chance he'd make it off the table, made it through, been two months since then, got a Nissen a week ago, was sitting in his stroller today on room air, shrieked once, asystole, coded, shocked, lido, epi. Died. Whiskey. Tango. Foxtrot.
  14. BWAH! I will be stealing "alcasnot" for everyday use. Although we just switched to this watery foam junk that's less like snot and more like... um... another bodily fluid. Which I am even less eager to rub into my hands. We call it "the spooge".
  15. elizabells

    You Know You're a Nurse When...

    You know you're a nurse when you find yourself trying to convince your cardiologist that it's different when YOU look to Dr Google for theories on what's wrong with you, not like when a REGULAR patient does it and it's annoying. Ahem.
  16. elizabells

    One of those weeks

    Jesus mercy. Now we have a neonatal leukemia. Our fellow told me today we've had fourteen deaths this month. The NEC kid died. We got another bad, bad NEC from an OSH a few days ago, and today they brought in her twin, also with terrible NEC. The hell is going on out there?
  17. elizabells

    pain management in infants with chest tubes

    Well, we do have a new TEN PAGE flowsheet for PCAs and drips... that'll fix everything!
  18. elizabells

    pain management in infants with chest tubes

    yappy, the thing that's frustrating is that we've DONE all that. JHACO hit us hard on our (total lack of) pain management this summer. The issue is a total culture change at this point. The knowledge is there, but the will is not.
  19. elizabells

    pain management in infants with chest tubes

    You guys, if I told you how hard I had to fight and kick and scream today to get ONE DOSE of PO Tylenol for a kid who'd just been circed, who was lying there going ballistic, PIPP score of 10, with no fewer than FIVE doctors at my bedside watching him lose his mind, all "Oh, he just wants his pacifier" and "Maybe he's hungry!" No, maybe he just got the END OF HIS PENIS CHOPPED OFF. Jesus mercy, there are three residents and two attendings who are very, very lucky they made it home without having an isolette thrown at their heads today.
  20. Phenergan IM hurts like a million angry bees. I had it ONCE, dorsogluteal, and I'm suspicious that that's why I still limp and have near-constant pain in that hip and leg, eight years later.
  21. 1. PLEASE stop pretending you understand more than the most basic English. The doctors are starting to think I'm crazy when I call them back for the tenth time to explain the gravity of your child's condition to you because you keep saying "Okay" and "Yes" when they ask if you understand what they've told you and then ask me the most baffling questions the moment they leave. I know you're scared, I know you don't understand what's happening, and I know you don't want to look foolish for not speaking English. But it's okay not to speak English. This is why we have translators. 2. When you come to visit your child with a bandage on your arm and you tell me you just came from the ER because you have an infected sore for which you are taking Keflex, please don't get huffy with me when I ask you to wear gloves to touch your extremely sick child. 3. When I carefully explain HIPAA to you for the second time in under five minutes (seriously)and why it means you can't wander up and down the halls peering at every other baby in here, do not tell me you are looking for a clock. I promise there isn't one in the isolette with that 500gm preemie.
  22. "If the smell of smoke coming off you can knock me, who has smoked a pack a day for ten years, halfway off my feet and make me instantly nauseated when you come to visit your just-had-open-heart-surgery BABY, perhaps you should look into changing your shirt when you get here." Oh wait, I totally did say that. But, you know, nicer. I say this all the time. Sometimes it actually gets them to stop complaining for, oh, at least a minute and a half.
  23. elizabells

    pain management in infants with chest tubes

    Oh, bitty, they hate me too. I got called into the principal's office and warned that my Pyxis usage was being monitored because I actually, you know, GAVE PRN's when they were ordered on an ECMO baby.
  24. elizabells

    pain management in infants with chest tubes

    Pain meds for chest tubes? Oh, that would be nice. Most of the time I can't get them to order meds when they're putting the chest tube IN, like not even lidocaine, let alone Fentanyl or somesuch.
  25. elizabells

    nursing assistants mixing breastmilk

    Man, we don't even let moms put their own breast milk in the fridge anymore. Like Steve said, triple scan with the barcode dealie. When a junior nurse screwed up EBM, they got suspended. Once it happened to a senior nurse, oh, hey, it's a SYSTEMS error, let's make a new policy. Siiiigh.
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