SteveNNP MSN, NP

Neonatal ICU (Cardiothoracic)
Member Member Expert Nurse
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  1. Too often, nursing students are abruptly dropped off at the NICU door, handed a scrub sponge, and abandoned by their nursing instructor, who is equally petrified of what lies beyond the glass-paneled door... We all know that students rarely get a gli...
  2. SteveNNP

    Level 4 NICU suggestions

    I agree with the others... try looking for the major academic center in your area. I work as an NNP in a large RPC Level IV+ECMO+open heart NICU, and we are constantly overloaded with acuity haha. On my average shift, I have a few preop cardiac, a po...
  3. SteveNNP

    30 weeker with PDA

    How old is this baby? The nice thing about fetal hemoglobin is that it holds onto a LOT more oxygen at lower saturations than our blood. So you can rest assured that even if sats are in the 70s, she's still probably not getting too hypoxic...as long ...
  4. SteveNNP

    Daily Weights?

    This is why any warmer or isolette manufactured in the past 5 or so years has a built in scale. Unless a child is on ECMO (and sometimes we weigh those kids too...) or is a comfort care, babies should be weighed at least every other day. As a NNP pro...
  5. SteveNNP

    What are your call requirements??

    We do not do call shifts in my unit. IMHO, call shifts are an excuse by management to not hire or adequately staff a unit. Part of it here is that we are unionized, and have set patient ratios. Hell would break loose if management tried to mandate ex...
  6. The role you are describing can be done by several different nurses, including L&D, Newborn Nursery, and NICU. It's typically an assigned role for the day, not a "hired-into" position. You would also likely need some solid newborn experience befo...
  7. SteveNNP

    GIR calculator for iOS

    Hey all, Just wanted to let you in on something helpful that I use in NICU a lot, especially on micros who are on a lot of trickle drips and whose d-sticks are all over the place. It's called GIRCalculator (search for it - one word- in the app store ...
  8. SteveNNP

    GIR calculator for iOS

    Hi RN.amour- my recommendation would be to sift through the threads on this forum. All those questions have been asked and answered many times. Good luck!
  9. SteveNNP

    Which Milk Warmer Do You Use?

    When I was a bedside RN, we used pink water jugs with warm water. The unit then used the Penguin for awhile, and then in a push to avoid contact with tap water, we now have a Medela waterless warmer at every bedside. I believe at the time it was a ri...
  10. SteveNNP

    Advice about last night

    Albuterol ABSOLUTELY causes tachycardia, especially when given frequently and in higher doses. This is why a lot of units used to (and some still do) give Xopenex instead. Sounds to me like you properly assessed pain, and found that the infant didn'...
  11. SteveNNP

    HFOV

    Absorb the bounce? This is the most ridiculous thing I've ever heard The chest wiggle that is seen with HFOV use is from the lungs expanding and contracting using tiny tidal volumes at a steady MAP. If the theory were true, neonatal chest wall compl...
  12. SteveNNP

    PNPs with Neonatals

    I am from the NYC area, and it's true that the number of schools offering NNP degrees have decreased recently, including Columbia University, my own grad school. The NNP market is a bit oversaturated here on the island of Manhattan, and even in NJ an...
  13. SteveNNP

    types of patients

    Well, this is what we have today: Prematurity Transient Tachypnea of the Newborn Presumed sepsis r/t maternal chorioamnionitis Sepsis Congenital heart disease (pre/post/periop) Congenital autoimmune myocarditis Gastroschisis Omphalocele PPHN/pulmonar...
  14. SteveNNP

    Medicinal Honey

    Can I ask how there is any antibacterial activity left if it's been irradiated? Isn't it just then a topical sugar application?
  15. SteveNNP

    How does your NICU unit run?

    In my unit (Level IV) routine VS and cares/feeds are at 8-11-2-5. Fluids are done by day shift, and routine labs are done at 0400.
  16. SteveNNP

    Sedation/Intubation

    We don't sedate or give pain meds for simply being intubated, EXCEPT if they are pulmonary hypertension patients who are having spells, our cardiacs who can't tolerate increased SVR, and/or our postops. That being said we are a huge bubble cpap cente...
  17. SteveNNP

    Men in Neonatal nursing

    I'd recommend applying to every hospital with a NICU position in NYC and the burbs. We hire several new grads here in our NICU. Most managers I feel actually prefer new grads over seasoned nurses from other departments, because there are no bad habit...
  18. SteveNNP

    Neonatal Nurse vs Neonatal Nurse Practitioner

    Wow this situation sounds ghastly for an NNP. Frankly I wouldn't work for a place that put so many restrictions on me as a practitioner. Where I am now, while I of course involve the fellow and attending in my decision-making, I am fully functional i...
  19. SteveNNP

    Unplanned extubation while on orientation

    I agree with everything else EXCEPT this quote. I sure hope this isn't the standard practice. At my facility (Level IV with ADC=75 including open hearts, ECMO, head cooling, and one-lung ventilation) and we rarely get daily CXR on stable intubated ba...
  20. SteveNNP

    DNP for Neonatal Nurse Practitioners?

    There is no way they can mandate that NPs be doctorally prepared until they decide that the BSN is the entry degree to nursing... and that hasn't happened yet, over a hundred years later haha. There's nowhere near the amount of faculty available to ...
  21. SteveNNP

    Transfusion associated NEC

    As a general rule, we make babies NPO 4 hours before, during, and 4 hours after transfusion. We start an additional line to deliver IVF/TPN during the transfusion. We currently have research in progress looking at the age of donor blood at time of t...
  22. SteveNNP

    NNP Outlook

    "If it's just neo CICU, at what age will you transfer them to the "regular" peds CICU?" We almost always discharge to home from our current NeoCICU section of our NICU now. It's the rare kid who's waiting for transplant or on a 6 wk course of ABX for...
  23. SteveNNP

    Single vs. Double lumen

    We do not use double lumen lines for our UACs. We only use double-lumen UVCs in certain situations - ONLY on our pre/postop cardiac patients that require pressors, PGE1, Flolan, etc... The vast majority of our patients only need a single lumen UVC, a...
  24. SteveNNP

    Best time to become NNP

    BabyNP offers some great advice, so I won't add too much... but I think with that much bedside experience by the time you enter clinicals is great. My added advice is to seek out learning opportunities. Take care of the sicker babies...get used to in...
  25. SteveNNP

    NNP Outlook

    As an NNP who has worked in NICU for 10 years, nearly 5 as an NNP, I can tell you there are never enough NNPs to go around. Especially as you said with units expanding rapidly, some even with 100+ beds. We are fortunate to be a NNP friendly unit, wit...