astral92

I think HillRom incubators wouldn't cool lower than 27C especially if the humidity is still on. When a babe reaches 33 weeks corrected age and steadily gained weight to min. 1.6kg AND stable clinically, our policy states nurses can start weaning from incubator to a cot. Of course there are exemptions and that's why the principle of individualized care is so wonderful. Hope this helped.

Our unit is sectioned in Pods and I must agree with you that is better from a developmental point of view to have rooms instead - less traffic=less noise. In level 3 assignments are 2:1 for a stable vent and an unstable CPaP or 1:1 if the ventilated babe is on high settings AND inotrops, chest tubes etc. In level 2 nursery is usually 3:1 as they are mainly feeders and growers and/or some cannula O2. Very seldom a nurse in level 2 would get the 4th assignment - a babe lodging with mom overnight, before discharge. And yes we shuffle babies around a lot, especially when busy. I hope this helped.

So here's my story: RN, former Lactation Consultant, 3 years in this particular level 3 and 2 NICU, and 7 years prior to coming to Canada. Yet I hardly ever get challenging assignments, whereas younger and less experienced nurses get them routinely. I spoke to my manager more than a year ago and she said she will inform charge nurses about my "desire". In the meantime I enrolled myself in a university-level neonatal certificate (15 credit course) - very intense and interesting, I've learned a lot - and waiting for opportunities to arise.. But still nothing, I feel I forgot how to take care of a 26 weeker, or inotrops/sedation/paralytics, or chest tubes or on jet ventilator/oscillator and all since I took this job in Canada. Recently I went back to my manager and she told me that "I have to prove myself first" or to be more assertive (she told me that I look like I have no confidence and perhaps I should fake it by putting some make up on my face or color my hair because "you look tired all the time") and since I was there.." she said that a couple of charge nurses complained about me saying I am disorganized and not willing to go for breaks when busy, etc.. I was shocked at all I was hearing and could not believe how judgmental pple were, including my boss! My attempt to find a family physician and get diagnosed and treated for anemia took me more than a year (yeah, this is Canada's health system...) and just now I found out that the charge nurses deemed me less professional for looking pale and tired and none of them told me so to my face! Our manager is very laissez-faire in a sense that there is no clinical support for nurses like me, nurses that are willing to learn more, to improve or enrich their skills. I spoke to the two nurse educators we have in our unit and they totally support me - morally - but they have no power; all the power is with the charge nurses, they get to chose/assign who gets whom and the gap between them and us, the bedside nurses is getting wider with time. It's hard to believe for you guys but some of the charge nurses on my unit don't even have the neonatal certificate completed, don't have any kind of lactation or BFing course done just because is not mandatory (!) and only about 3years nicu experience which is less that my 10 years and one can imagine I know more than them and have to go right to the resident when we don't agree over clinical issues. Obviously they hate to be anything but right and although I have a very good rapport with all the doctors, just because some of the in-charges don't like me, here I am stuck in a situation that feels like a dead-end job. I used to be in love with my job and smile everytime I would see a tiny foot/hand behind an incubator's drapes.. that was a lot of smiling in a 12 hr shift but NO, not anymore and I fear I lost all that unique joy for ever. Please, please give me an advice or just share your opinion with me. This would help me more than counseling - which I've consider if found depressed! Thank you so much for reading this!

By OT you mean occupational therapist? Than you are as precious as gold, especially since you did some Lactation Consultant/breast feeding courses. Good luck!

Hi Pepperlady, I would love to do a BN at the U of C, but last time I've checked they didn't run such bridging course anymore. I am a single mom of a teen, in my 17th year post nursing diploma and feel ready to go back to school even if I'd have to relocate to Edmonton from Calgary. Do you still keep in touch with the nursing faculty from U of C? Are they going to run that bridging program again? Thank you for any tips, have a great day!

Hello there!! I am a Romanian nurse awaiting Canadian Embassy's decision regarding my work visa. I got the job offer and the Labour Market Opinion from Canada but don't know what to expect from the Embassy before they will send me for medicals. Can you share more of your experience or other pple's.. you may know others in the same situation. Also, what should I expect from the interview at the Embassy? Thanx in advance for yr reply!

Now, how is possible that a hospital would do the employment process? Is that implying that the nurse is sorting out her own registration, green card etc herself? Isn't that suppose to be such a big headache? Maybe is faster? Would anyone explain us, here with some examples? Thank you!!!!

I used to look up to the American nursing credentialing and assessment system until 2003 when after I passed the cgfns exam I received a letter saying I was not elligible to sit the exam due to the lack of documentation not received from my country of training. I re-checked my file on their web-site and found my file was cancelled. They just cut me off so promptly, all my trials of explaining my situation and my 2nd nursing schools' attempt to re-send my transcripts all failed. After more of a year I got partially reimbursed. How about my flight ticket to UK and hotel expences for 2 days in London? I would have never gone there for the fun of it. Plus I am a Romanian nurse, earning a crap salary in contry with a higher cost of living than Germany. The birocracy within cgfns is getting worse, I can tell...

thank you, all of you for your quick replies! An answer for Gompers: yes, baby had aminophilline when weaned from CMV to SIMV. Thanks God, baby seems to be fine but you never know how her brains will turn out to be on the long run. And another problem I might face: I will not be allowed to work on level 3 for quite some time...

my 2 days old 24 weeker (decided she was actually 26 weeks, by appearance) collapsed post extubation, while on nCPAP for 12-15 minutes... I know they do that sometimes, but in this case I'm afraid is my fault She was breathing 40, on her own while on SIMV, RR20 Fio2air. After extubation I didn't put her straight to nCPAP. She was doing well in air so I cleaned her mouth, eyes, ears, AND since the Xray technician was there ready for my baby, I hold her straight for that XRay. At the end of the procedure she went bradicardic and apnoeic I had to mask+bag her with 100% O2, than I put her on nCPAP. She did well on nCPAP for 15-20 minutes then went apnoic, bradicardic, saturations dropped to 20%. We bagged her, but this time chest wouldn't move. Sats dropped to 8, HR 20 , off colored. Quickly reintubated and ventilated on CMV, she needed FIO2 40-50% and PIP 18! I feel very guilty about the whole situation. But is not the first time I cleaned baby's face between extubation and nCPAP and nothing went wrong. Is it because I kept baby in air for too long this time, by doing the XRay as well?? pLEASE, HELP ME TO LEARN FROM THIS INCIDENT, as I find myself willing to find excuses and blame everybody like "the baby didn't crashed while cleaning her face or doing the XRay, but after being on nCPAP for 15 minutes!!" or "she perhaps still had lots of secretions in her lungs since the ETT was coted in yellow thick secretions" or maby because she was given one dose of survanta only?? I have to write an incident report tonight, so I'll be waiting here at the edge of my com for any word of comfort And I thank you all from now for any reading/training sugestions that I might need to consder, so I will never put a baby at risk again :uhoh21:

No, your baby is not hyperventilating. If he/she did so, then you would get a low PCO2. Hyperventilating=washig-out CO2. A low Pco2 can cause brain damage. In your scenario PO2 is high, so decrease FIO2 given via nCPAP or oxihood. Or decrease PEEP on the nCPAP if FIO2 is 21%. Hope this helps

Thank you two for the replys. I thaught everything has to be filtered. What drips you don't filter? And smth else: Do you ever run TPN or D12.5 thru UAC??? Thank you very much, once again!

Hi, everyone! Our hospital here in the United Arab Emirates is going through some political and clinical changes so everyone is expected to bring their own contribution towards meeting international standards of care. My question is how you guys are setting up the UVC lines. Our current practice is: D10/TPN bag, giving set, the "traffic lights" (discofix= the in-line taps for drips like dopamine/morfine and so), FILTER (we don't have any of the special filter-needles), 3-way-tap(which we use for intralipids or blood only), and UVC (or plain IV cannula when the doc decides baby is not so sick...) But when we have a stable baby and the IV Fluids are going into a periferal vein, we find ourself not consistent: the filter goes often before the 3-way-tap...which brings the risk of tiny glass and rubber particles into the blood stream. Some people argue that no matter how we change the policy we will always have double standards regarding this issue unless we start using filter-needles. In heplocked cannulas we don't attach a filter to the T-piece...so here we are! We need to do smth about it. I hope some of you can help us bring light to this issue :wink2: and plz excuse my English! I am Romanian :sofahider

very true, I thought my 15 years of experience would give me a chance to get to US. None, because I've been trained in Romania during communist regimme when nursing training, 4 years full time(6days out of seven) was done during high school. My UK flatmate wasn't acceted into US, and thousand of filipinos or indian nurses are massively immigrating to US...so easy! Just because the goverments of these 2 countries are very clever and copied US or UK nursing curriculum. They don't even bother to translate the American books into their own language...Hmmm..very "practical" people...

and got accepted by AARN, exept I need to take 2 modules of theory and clinical rotations in obstetrics and psychiatry with Grand McEwan College. It's been almost 2 years since I started all this...first time my transcripts from Ro got lost in the mail... than 5-6 mo ago when I went to the canadian Ambassy here in the United Arab Emirates, I found out I have 2 show proof of funds for 1 yer of study: 10000cad beside the tuition fee of 4000cad. I would never have done this from Ro! Ever! Here in the UAE my salary is 800$/mo, plus accomodation. And I'm lucky to have friends from work who lent me money, so I can meet all student visa requirements. I had all the paperwork in order: the AARN eligibility letter, GrantMcEwan acceptance letter, IELTS scores, refference letters and proof of funds. Yet I did not get the visa! Reason? I cant guarantee I will leave Canada at the end of my bridging course! It just doesnt make sense to me at all. This happened 3 mo ago. I am still so frustrated :uhoh21: Please help!!! I have a kid in Ro and I want to return to my country, but after 5 years of working in NICU here it will be almost impossible to get my RO licence renewed because I missed out all the equivalency courses. All I want is to further my education so I can leave this country where there's no chance to be reunited with my son. And I genuinly want to be a better nurse!!