missapoo

That is so sad Nicky:( Hang in there ok! We just had a bad code last week with a one-month old and the night girls were very upset by it...the kid had pnuemonia and just quit breathing--was totally unresponsive to all resus. attempts. Two days later we had a demise that ended up in the NICU briefly because the L&D nurse came running in with this 23 wk spontaneous delivery (mom had been admitted in our L&D for several days with PROM). Our neo intubated and was working to resus. when they came running back and said the parents didn't want anything done....that is tough, watching a little bitty thing gasp for breath and HR still going for several hours...we just had to respect the parents wishes but it was not fun. Since they had brought the baby to us we had to admit it and "observe" the pt until she passed. The parents held the baby and all then sent her back to us to deal with...so sad:( Days like that will drag ya down if ya let em. :icon_hug:

Thanks Steve for your post...I loved it and sent it to all my NICU co-workers I would add that for all the years I have been doing this, every once in a while you get the reward of seeing your little pts out and about, for instance I was in Walmart yesterday and saw a kid I helped care for last year. When I spoke to him he grinned from ear to ear--such a beautiful smile...he doesn't remember all the bad stuff he had to go through and he just smiled so sweetly that I just about had to cry right then and there:) Of course mom had to give me a great big hug as well and it's very nice to get to see that other side of the sick babies...makes it all worth while!!

My Unit is split into well-baby and NICU/PICU. Of course the NICU and PICU admits don't ever leave the unit unless we are getting ready to d/c and are doing a parents-in-attendance prior to sending them home. RE the last names on chart spines, we were able to keep them as-is after we got a special cart on which to keep all our charts...it has a closing cover/gate on the front that covers all the charts and keeps them out of sight until needed. In the well-baby unit we use the generic Enfamil blue and pink cards with last names only and boy or girl. Mother's Dr, Baby's Dr and date/time of delivery along with measurments of baby are included and only written with ball point pen so it would be difficult to read if not very close to the crib. Mom's room # and whether bottle or breast fed is also included. We went through a time when they would not allow the window shades to be opened for baths or diaper changes due to HIPPA policy, however that did not last very long at all. Now the curtains are open during the day excepting procedures, Dr's rounds and etc...Our administration is currently formulating a policy on cameras, phone cams and pictures/videos in delivery rooms & through nursery windows and so on so we'll see if things change in that regard. Right now there is no standing rule except that parents have to consent to others taking photos prior to it being allowed. Our unit is also closed with tight security (HUGs electronic bands are applied shortly after delivery, and only nursing staff with appropriate visible ID are to transport infants to and from parent rooms). We also use a verbal password system so that parents know the person coming to pick up their infant is truly who they say they are to prevent abductions. Our babies spend much time with parents on a flexible schedule and parents are instructed to keep babies in the room with them at all times--only nursing staff may bring them in and out. Infants are ideally only in the nursery for VS, wts, baths, Dr's rounds and procedures, although this varies depending on the situation (ie: if a recent CS mom has no one to help with the baby or is too groggy with pain meds to functionally care for infant). Our policy is also much in need of review and my director is currenlty working on that with about 10 jillion other irons in the fire as well so it could be a while before we see any changes. Hope this helps!!

I too am lost without my coffee...I drink it black mostly but a little ffmilk/sugar substitute from time to time to change it up. I totally quit for a while and found myself struggling with being sluggish and tired to the point that I just threw up my hands and said forget it....give me some coffee. I do definitely feel a difference if I overdo it with the caffeine...heart palpitations and nervousness. I try to keep it to 3-4 cups, spread out during a 12 hr shift and I don't drink any after about 5-6pm to avoid messing up sleep time. So, yeah I am a caffeine addict but there are much worse things I am thinking. They come out with new research on caffeine all the time and most of it says that a little coffee is good for you...actually has antioxidants and health benefits....too much is not good. All things in moderation:)

Let me clarify my question: do you use the betadyne and alcohol on your unit for CVL dressing changes....some research says this combo causes skin breakdown and we are in the process of trying to get the powers that be to change and let us use chloroprep solution for our CVL dressing changes. Also, right now we do these every 72 hrs and PRN. Any differences, comments, suggestions? Thanks!

Hey everyone, I am in search of the latest policy used in your facility for CVL dressing changes. We are updating ours and hope to go to the chloroprep as opposed to alcohol and betadyne for our dressing changes. Any help on this topic would be greatly appreciated!!! Thanks and God bless!

I too think things will be fine for you....like others have said there is no 100% surity but the stats for 37 weekers are definately in your favor for a trouble free delivery and transition.

I agree with the above....the politics of nursing gets under my skin at times and even though I love what I do, I am thankful for my time off and would work less if given the chance....just to keep my sanity LOL. I work out of necessity and would love to be able to say I work just because I love helping people, but that simply isn't the entire truth....it comes down to having to pay the bills each month and this is how it gets done. If it would get the job done to work only 8 hrs a week I would do it in a hot minute....think about all the other good things I could do in the meantime? Volunteer, take mission trips, work on our house....etc

Thanks to all of you that replied...I feel like I am getting somewhere in the search:) This is great....why didn't I find allnurses sooner LOL!!! Ya'll are great:)

Hey everyone! Hope there is someone out there who will be able to steer me in the right direction for finding info on code checklists and med sheets for codes. We have had 2 codes that ended up badly within the last month or so and our director has put me in charge of trying to come up with something useful as far as organizing the way we handle a code and also documenting what goes on in a code ie a code record sheet and possibly a med sheet that is wt specific for each pt that is put at the bedside upon admission to the unit in anticipation of a possible code situation. We don't even have a unit-specific policy for codes so I am starting from the ground up. I am working with pharmacy on this as well...they are looking for a computer program that we could use to enter our pt info in and get a printout on common code meds. Currently we don't have meds locked up on a crash cart in our unit (we have a computerized omnicell in the unit that requires login and password to access drugs which takes precious time). The old timers argue that if we get the locked crashcart with meds we will have to start counting drugs monthly or more often and this will require more work/effort to keep up etc...I think it is time to have it all there, ready to go as much as possible and within easy reach so we aren't scrambling in the event of a code situation. I just see this working out better especially in light of the fact that we just had the 2 codes that passed and I am reviewing everything I can get my hands on and trying to make a rational decision that will effectively get us better results in the future. I am just wanting some input from other NICU nurses as to what you do on your units as well.....thanks a bunch!! Melissa

When I was a student, the nurses where we rotated wore scrubs provided by the hospital: when they came in they changed from street clothes into scrubs. Now, at my hospital, we wear scrubs within the parameters of a dress code color and all the nurses wear scrubs from home to work. We are required to buy our own scrubs beginning last year when they made a mandatory dress code to help differentiate nursing staff from other hospital staff. We only gown up if a pt is in iso. but we are supposed to gown prior to bathing newborns and etc... We rotate from Newborn to NICU and all nurses on our wing wear the same color pants but any coordinating tops/jackets of our choice. We scrub up to elbows 3 mins when we come in and are not supposed to wear long sleeves due to increased transmission of infection especially from one baby to the next. Our unit is a closed unit so we don't get pulled to other units but when census is high others may get pulled in to help us and these are required to change into clean scrubs provided by the hospital if they come from a "dirty" unit. Docs come in street clothes or hospital scrubs and are required to scrub in like the rest of us. Parents are also required to scrub but not to gown unless they are visibly dirty (ie dads coming in from working a dirty job....we've seen that before and even had to make them change into clean scrubs a time or 2). Just common sense stuff.

Just over a year ago, my level II unit underwent a transition from a cramped one-room unit to a brand new unit with 4 private/isolation rooms and 4 pod stations, along with a room equipped to hold about 4-6 growers at a time...we are a small hospital with approximately 8-14 NICU/intermediate beds. The staffing matrix is generally 2-3 babies per RN but occasionally we have 1:1 patients and when the census is high we are usually short handed and everyone has to take a heavier pt load. We team up and help each other even when pt assignments are made...this is usually very relaxed and casual and usually works out pretty well. Everyone pretty much gets to choose what they want to do. The problems we have encountered are pretty simple staffing issues since our NICU and Newborn nursery used to be in the same unit and now they are split up between 2 floors, this makes us shorthanded when the census is up because we have to staff both units with pretty much the same # of nurses we had before the transition. Nursery/NICU nurses are required to go to all deliveries and when the nurse pt ratio in newborn is 1 nurse to up to 5 babies it is difficult when deliveries are happening at the same time and you are the only one. Our director is supposed to be working on this....to be able to staff an extra nurse to go to all deliveries and help transition newborns. NICU has to step in and help out when the nursery is full, which is only a problem when our unit is also full (spells trouble from my perspective). Anyway, after a year of this we are closer to working all of the kinks out of the system and hopefully things are flowing much more smoothly than at first. Our director is also supposedly working on getting the L&D gals trained to do initial newborn care and transitioning in the same room as moms unless baby has problems....so far it hasn't even come close to happening and we are still responsible for all newborn care. The issue is that many of the L&D nurses are resistant to change and thus our dillemma! Hope this helps:)

Gerry wrote: And what do you make of the fast trac BSN programs for those with prior Bachelors. The nursing portion of the programs in my area are 18 months. So would it be safe for me to assume that one can actually finish a nursing education in under 2 years? Not if you count the 2 yrs of prior training that is factored in. I think that as long as they have done the core curriculum that is required (I had to have 64 hrs of prerequisites that were not specifically related to nursing, prior to applying to my BSN program). The actual nursing part of the program once I was in, lasted 2 years. I didn't do the fast track since I went straight for the BSN and didn't even have an associates degree prior, but that doesn't mean I didn't still have to have all the core basics that the program requires. Again, the BSN degree only means that you have taken more classes and training to prepare you to do more in the area of leadership and management if you choose to pursue that. The basic nursing curriculum and training as far as clinicals and etc...is probably very comparable to ADN programs....there are simply more prerequisites in order to enter the program and from my experience, nursing schools can be very picky about who they let into the BSN program. They look at other things besides your overall GPA and need convincing that you have what it takes, not everyone that applies gets into the program. All in all, at the end of the day it's just a piece of paper that says I have gone to school for that long to obtain that degree....what I choose to do with it is what matters.

Ok, I didn't mean to imply that BSN's make decisions that ADNs can't...in my experience that is totally untrue. That is the problem with putting words on paper...they can be easily missunderstood. I know nursing school in general is tough whether it's ADN, BSN or LPN, nursing is a tough field...there is no denying that. I am no better than my ADN associates and many of them have been in nursing so much longer and have so much more experience and I totally respect them. I go to my colleages for advise without bias as to what degree they have obtained and I know there are many ADN's in charge positions and leading other nurses....I see nothing wrong with that. I for one owe so much to the nurses that had a hand in my training, both ADN, BSN and LPN. I agree that all new grads are wet behind the ears and need on the job experience without preconceived expectations and I will say, on the flip side, that there are those out there that expect a BSN grad to know more and do more upon entering the work force and this is so unfortunate....as many have said before, you have to earn the right to lead and be respected because you have worn those shoes of the staff/floor nurse, and even on to critical care areas, and you know what it takes to get the job done. You learn by experience how it takes a team to make everything flow naturally. I totally understand those that believe all entry level nurses should receive the same pay scale. I can see that side of the discussion. I do think it would be safe to say that most of the people saying that are probably not BSN RN's, for the simple reason that I stated before...if you go to school and do the extra work for a 4yr degree then it only seems right to be compensated for it. All of the old-timers at work fuss about the new grads coming in that are making close to what some of us make at our base pay rate. It just goes to show how desperate times call for desperate measures as hospitals try to recruit and retain nursing staff....that is a fine line and I for one don't want to be the one making that kind of call. You will never find a perfect solution that will make everyone happy so there needs to be some middle ground where we could call a truce wouldn't you agree?

I would argue that the NCLEX exam is designed to measure your clinical knowledge base and not your ability to be a leader. The difference in my mind is that a BSN gives the basic groundwork toward leadership and management skills and that is, imho why they should be considered with a slightly higher compensation even when starting out fresh out of school. The BSN takes longer to complete and is more involved and in-depth. The same basic nursing training is given and similar clinical experience, but when you go for the BSN you are getting the training you need to go on and become a leader/teacher/manager. In a way, there are much tougher hurdles in the BSN program because not only are you expected to learn to care for your patients, but your are put in the position of making management decisions, solving staffing issues, doing research, ie things that make you think on a more global level. I agree that anyone with initiative can get their BSN but not everyone is born to be a leader. In part that is an in-born thing in our nature, and it is also partly a learned behavior. To compensate or not for the extra training I think is a no-brainer. Most places that are interested in furthering progress should agree that if you do the time you should be compensated. I am sorry for those of you out there where that isn't the case...I thought I was in a pretty backward place until I read most of the posts and saw that I actually have it pretty good where I am (BSN's get 1$ more per hr than ADN's).