Bookworm14

I worked adult critical care for almost 12 years before I switched to the NICU. I was already familiar with many things and just had to "translate" my knowledge to how it applied to the NICU. Of course there are issues that are unique to the NICU, but I think my critical care background helped tremendously in making the transition. I would keep looking for a hospital job, especially if the hospitals near you are union and base job bids on seniority. Good luck!

We can go from a Clinical Nurse II to a III or a IV. Each step is worth 5% in pay. It sounds like the work that goes into our clinical ladder for a 10% raise is worth much more than some of you that get a $1 raise. I wouldn't bother with all of the extra work if it wasn't worth 10%.

Congratulations!!!

I am lucky to work with people who are more than happy to help. I worked with vented adults for almost 12 years and switched to NICU recently. THE most nerve-wracking thing for me so far has been repositioning babies on vents. It still makes me nervous that the tubes aren't cuffed and just have a neobar holding them in. Plus the babies I have taken care of so far aren't sedated much at all and can get very squirmy during the turn. I am used to adults who are paralyzed and/or sedated on propofol and don't move much during the turn. I have had other RN's help me so I could see how they coordinate the turn. I have also asked Respiratory to help me and they were more than happy to help. The thing that I found made it easier to turn them, was to disconnect the suction tubing. I have had the tubing get "stuck" part way through a turn on the ends of the isolette. Of course this means you need to hook it back up quickly if they need suctioned right away after the turn. I am getting more comfortable with turning them by myself but I will NEVER hesitate to ask for help if that's what is needed to keep the baby safe and intubated.

I barely restrained from voicing this one out loud to a patient's girlfriend. He was detoxing, on the vent, wild and combative despite major sedation. "Oh, I am so sorry he can't afford his meds. Perhaps if he didn't drink two CASES of beer a day and smoke three packs of cigarettes a day, he could afford them. Or better yet, he might not even NEED the meds."

I know exactly what you mean dawngloves! I recently switched from adult critical care to the NICU (and loving every minute of it). You definitely need to realize that VS for the NICU population are very different than adults. I was laughing the other night when I took a BP and the systolic was in the 50's. I told my co-worker that a BP like that in my "old world" would have had me running like a loon grabbing saline, levophed, etc. Now I just write it down. It didn't take long to learn that a heart rate of 70 is not good, but a HR of 180 is ok. lol I thought there was a zero missing when I heard the TV setting on the vent. The dosages are much different and I think there is more math involved in the NICU than adults. Between figuring out dosages and fluids/calories per 24 hours, there is a lot of math. I don't think it's hard, just more math than I ever used to do in the adult world. I think a lot of your assessment skills will carry over but there are many new things to learn about assessing a newborn and/or preemie. There are also many diseases or prenatal conditions to learn about and how they affect the baby and what type of things to be watching for based on those diseases/disorders. As many things that are different, I will NEVER be going back to adults. I love the NICU and have wanted to work there for a very long time. I never had the urge to smooch any of my adult patients and I have to fight that urge every shift with the little kiddos. If you have wanted to work in the NICU for a long time, I say go for it. Good luck!

I worked adult critical care for almost 12 years and now I am in the NICU. I am very familiar with arterial blood gases but would like to know more about capillary blood gases. How do they correlate with ABG's? What situations or results would lead you to want an ABG rather than a CBG? Thank you.

I am making a switch in the opposite direction. I have worked in adult critical care for over 11 years and finally got into the NICU. I can tell you that there are some things that are very similar, but there are also things that are very different. I can't imagine leaving NICU to work with adults since I have wanted INTO the NICU for years, but good luck if that's what you want to do. You will be starting over....just not from square one. Your assessment skills, critical thinking, experiences with relaying information to physicians and families will all carry over to a new area. You will have to reset the "normals" for vital signs and things in your head. You will be dealing with different settings on the vents but the general skills will be the same. So....it can be done without totally feeling like a new grad again. Good luck!

Thanks for the suggestions. I figured I would probably have to wait until I started orientation and see shat they use but I am just trying to be prepared. Plus my iPod is pretty new and exciting and any excuse to play with it works for me.

After 11 years in adult critical care, I am making the change to peds and nicu. I have wanted to work nicu for YEARS and finally landed a night float job that I will be working nicu, picu and regular peds floor. I am super excited and wanted suggestions for programs to load onto my iPod Touch that will be helpful resources during this transition. Thanks for any advice and I am sure I will be back with many questions once I get started.

I would wish that they never eliminate weekend only positions.

This would be wonderful. We have computer orders but the doctors aren't required to enter their own orders (except the residents) so sometimes they will leave the unit and call from their cell phones to give verbal orders that the nurse now has to enter. Or they scribble orders on a post it note and say, "I'm really in a hurry....can you enter these?". Or even worse, they just write things in the progress note and when you get a chance to read them later you realize that they never ordered the things they talked about in their progress notes. So, did they change their mind about what to order or did they just "forget". Then you have to call them and clarify what is needed so yet again, the nurse ends up entering the orders. I don't know what they are going to do when progress notes will be entered on the computer. I hope they don't think they can write it out the way they do now and expect the nurses to transcribe their notes into the computer!!

I've been on weekends for 6 years and we always just worked the holidays if they fell on the weekends. Now they are trying to have us go on a holiday rotation. There are several problems with this that they haven't clarified with us yet. 1. If I work a holiday that falls during the week will I still get my weekend rate PLUS holiday pay? If not, then working the holiday only makes me 6 hours more pay instead of 12 hours extra pay like "weekday" people get. (When I work a regular weekend day I get time and a half so I get 18 hours worth of pay. If I work a holiday during the week at straight time plus holiday pay it equals 24 hours worth of pay). 2. We have non-paid holidays on our rotation so if I work one of those during the week I am actually LOSING 6 hours of pay. 3. When Christmas Eve and Christmas Day both fall on the weekend am I expected to work 2 days during the week for straight time (losing 12 hours worth of pay) or will I have to "volunteer" to work one of those days so I can break even on pay? Weekenders are considered part-time for holiday pay benefits so we only get holiday pay if we work it. Full-time people get 8 hours of holiday pay when they don't work the holiday. This new holiday rotation for weekenders was presented to some units as a way to try and be flexible to keep weekend jobs from being eliminated. The wording was something like, "Times are hard right now and weekend people are expensive." But the managers from other units presented it in a casual way that came across that if people wanted to go on the holiday rotation they could and if they didn't want to then it was no big deal. I am torn on this. On one hand I would hate to have the weekend positions eliminated but I also feel like we are being used to fill in holes on the holidays. Our unit has had a lot of turnover on the night shift for full-time positions but none of the weekend people have left. Also, NO ONE volunteered to work any of the holidays when Christmas Eve, Christmas Day, New Year's Eve, New Year's Day all fell on the weekend one year. I worked them without complaint because I knew that once I got thru that rough year or two of them falling on the weekend then I would be good for several years while they were during the week. I have also volunteered to work MANY holidays that didn't fall on the weekend. I have worked 5 out of 6 Thanksgivings (would've been 6 but I got called off this year), I work Sunday night into Monday holidays like Labor Day, Memorial Day when I could schedule myself to work Friday night and Saturday night those weekends and have the holiday off. I have volunteered to work New Year's Eves and Days many times. The only holiday I've never volunteered to work extra was Christmas. I'd be curious to hear about the details of holiday rotations for weekenders at other facilities.

Wow! That sounds like a horrible night. It sounds like you rocked and did what you could do. Did he survive and/or go back to surgery? I've been back on nights for 2 years (after 9 years on day shift) and feel that it is very hard to get the doctors to realize just how critical the patient is. Usually if I had a super critical patient during the day and couldn't get the doctor to listen, another doctor would come around and call the physician himself and basically say what I had been saying. Then, "all of a sudden", the patient was really sick and I got all kinds of orders. It just feels that you are "on your own" at night. What makes it worse, is I work weekends. I can't tell you how many times I've heard, "Maybe we will do that on Monday.", or "I'm just covering. I don't really know the patient."

I had a patient that told me she was allergic to Lasix. When I asked her what the reaction was, she said it "made her pee". Of course she was admitted with CHF.

Which company are you talking about? Arctic sun? We are not going to get new equipment to do this. We get to try this with ice packs and 2 cooling blankets. I am so hoping we will get the Arctic Sun or the transvenous equipment. I didn't find anything on Medivance's website.

We are starting this at my hospital. I've been gathering information on this for almost a year and I'm excited that we are finally going to use this. I am working on education for the nurses and have a lot of information to pass on. Can anyone share or direct me to information on an educational brochure for family members? I located one online in the past but now I can't find it. I was interested in looking at one to give me some ideas on how much information to include, how to explain things in regular terms, etc. Thank you!

I thought I read somewhere that they are custom made for the actresses. They wanted "flattering" scrubs and not the boxy fit.

We also have trouble with "air in line" alarms especially with Diprivan and Lipids.

They are great but keep in mind that they could be set up incorrectly. Make sure you check the setup and don't just go by the med on the screen. I had amiodarone infusing but the rate was wrong. When I looked at the setup, the nurse before me had programmed the wrong concentration into the pump. I love the pumps for titrating weight-based meds such as Diprivan, Levophed, and Dopamine.

I don't totally disagree with your statement. I'm wondering who decides what is noncompliance and what is ignorance and what is apathy. I have heard people say "A full arrest just died in the ER and he was only 58 and had no history." But then it comes out that the man had never gone to the doctor. So "no history" doesn't mean healthy. It could just mean that they had never been to the doctor. What happens to the coverage of a non-smoking spouse who lives with a smoker? Are their benefits cut because of the actions of someone they live with? Trust me, I get frustrated by noncompliance but I'm not sure if or how it should be regulated and penalized.

The great thing about nursing is there are so many areas to go into. If you get bored you can change areas without having to change careers.

So why is CRNA a villain because they have done well financially? I am sure he/she worked very hard to get the education that made their job possible. Why should he/she feel like they have to pass out their money to those that don't have it? I understand some people are just in bad spots and need help from time to time. But you have to admit there are many that live off of government assistance and "time" their babies because their welfare will run out if they don't have another one. I am a generous and caring person but that doesn't mean I should have to share the "extra" that I have earned by working hard. I know someone getting disability because of a drug problem that landed them in prison for a couple of years. Now he is using tax payers money to pay for his cell phone that he doesn't even need! He sits at home jobless complaining that no one will hire him because of his record. I am more than happy to help someone that is trying to help themselves but isn't quite making it, but NOT the ones that won't help themselves.

So would this punishment also apply to people who felt they were healthy and didn't get annual physicals only to find out during a massive heart attack that they had high blood pressure and high cholesterol? Would you say "no CABG for you"?

There are people now who have insurance that are non-compliant or don't use their insurance for preventative medicine. Who's to say that universal health care will improve the amount of preventative medicine that is given? I have seen too many people now that could've, should've, and would've, but didn't.