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RNtoNNP's Latest Activity

  1. RNtoNNP

    MSN vs. DNP in NNP

    I personally chose to get my DNP for a couple reasons, but that isn't to say that the DNP is the right path for everybody. I went back for my DNP after only 3 years of NICU experience, so adding another year of school was actually beneficial for me so I could get more experience before graduation. The other main reason I went for the DNP was because some NNP job openings at bigger children's hospitals said "DNP preferred". I wasn't sure where I wanted to work when I was done, so I wanted to give myself that edge up if possible. I also just really wanted to be done with school now before I have kids and life gets more chaotic. That all being said, there were plenty of times during my DNP program where I wished I had gone for the MSN instead. The DNP is a lot of fluff classes that, just like the BSN, feel pointless at times. I actually did enjoy the focus on QI projects/research more than I thought I would, but a DNP is not necessary to work on QI projects in your unit. My preceptor who oversaw my project does tons of projects on our unit and does not have her DNP. Basically, I don't think either choice is wrong, and you have to pick what feels right for you. If you think you're going to have to take out large student loans to get the DNP, then it may be best to get your MSN and then finish the DNP once you graduate. If you do decide to do it that way, though, I would recommend continuing on with your DNP right away while you're still in the school mode and before you lose motivation to do it. You'll be earning more money as an NNP, so that last year to finish your DNP shouldn't be as hard financially. Best of luck whichever path you choose!
  2. RNtoNNP

    Working Holidays? 5 Ways to Make It Work for You

    I agree that having a positive attitude makes a huge difference in how we handle working the holidays. Yes, it stinks to work the holidays, but it stinks for our patients and their families to have to spend holidays in the hospital too. Reminding myself of this helps me have a better attitude about it. Also, while I hate being away from my family on the holidays (especially Christmas), holidays at work can actually be fun. There is typically a more relaxed atmosphere with no management there and there's always food! If nothing else, at least nurses know how to throw a good potluck!
  3. RNtoNNP

    MSN vs DNP for NNP

    I do like it. It is a good program. It's almost entirely online, so I am able to do it while working full-time in a different state.
  4. RNtoNNP

    MSN vs DNP for NNP

    I am in the DNP program through Creighton University in Omaha.
  5. RNtoNNP

    BSN to Nurse Practioner

    First, you need to know what types of patients you would like to work with as a nurse practitioner. There are many different specialties to choose from. Then, start looking at school websites for a program that fits your needs. You will end up getting either a MSN degree (master's) or DNP (doctorate). I am currently in a part-time DNP program for neonatal nurse practitioner and am working full-time. The program is all online. Since you live in Nebraska, I would suggest looking into Creighton University as a starting point. They have MSN and DNP programs in many different specialties and I believe most of them are online programs. Good luck!
  6. RNtoNNP

    MSN vs DNP for NNP

    I think it somewhat depends on where you are hoping to work when you are done. I am in a BSN to DNP NNP program and I chose to do the DNP now partly because this is the best time in my life to do it (I don't want to go back to school later), and because I have seen job postings for NNPs at large children's hospitals that do say "DNP preferred". I'm not sure where I am going to end up working when I am done with school, so I wanted to give myself the best advantage possible. My adviser also told me that doing the BSN to DNP program actually will give me more hands-on clinical hours than doing a MSN program and then going back for the DNP later. Not sure if this is the case for every program, but it was definitely an added benefit for me. Best of luck with your decision!
  7. RNtoNNP

    Sedation/Analgesia for HFOV, HFJV, Vents?

    I have had similar frustrations in my unit in regards to the neos not wanting pain meds for intubated infants. I do agree with BabyNP that there are risks with using pain meds with our little patients, but there are definitely times when some pain medication is appropriate. The previous NICU I worked in seemed to prescribe pain medications more often for intubated babies (either as a continuous drip or PRN) than my current unit does. I took care of a baby recently who started fighting the ventilator all of a sudden one night so his oxygen requirements went up and his blood gas looked terrible. They almost had to put him on the oscillator, but the neo decided to switch up his vent settings a little and give him Vecuronium. The baby loved it and quickly weaned down on his oxygen requirements. However, the neo on the next day said there was no way we were going to give the baby any more Vec, but he did tell us we could be fairly liberal with the PRN Fentanyl. Thankfully, the Vec helped the baby through the critical period and the PRN Fentanyl was enough to keep him calm the rest of the day shift, but what if the Fentanyl wasn't enough? What do we do when the infant is fighting the vent so hard they almost end up on an oscillator or if they are fighting the oscillator so much that the vent isn't able to do its job? I think there is a fine balance between completely snowing the baby and giving the baby some pain control so that they can let the vent work so their lungs can heal. Like BabyNP, I haven't worked with adults as a nurse, but it does seem that they are often completely sedated when on a ventilator. I was talking to a pediatric nurse who works in the same hospital as me when she floated to the NICU for a shift. She was asking me why we don't sedate our babies on vents because if they have a kid on the vent in PICU, the kid is almost always sedated. She said even if they had a two-week-old infant in PICU, the baby would be sedated. I found it interesting that our two units have such different views on sedation for kids on ventilators. That being said, I do agree that not every baby on the vent NEEDS to be sedated or given pain meds on a regular basis. As BabyNP said, there are plenty of babies on vents who actually are pretty happy. I don't think there can be a hard and fast rule that EVERY baby on a ventilator gets pain meds or is sedated, but having PRN orders available for those babies is important. It is frustrating to have to fight for an order for a PRN pain med while the baby is struggling against the vent or trying to extubate themselves. It's nice when an order for PRN pain meds is already in place so the med can be given as soon as the baby needs it. Thanks for bringing up this issue!
  8. RNtoNNP

    Why have you decided to become a NP and not a Doctor?

    I started college as a biology/pre-med major only to discover that a biology major meant spending most of my time studying plants and animals. I had a friend who was a nursing major and what he was learning looked so much more interesting. When I switched to nursing at the end of my freshman year, I still planned to take the rest of my pre-med requirements and go to med school when done with the nursing major. But, the more time I spent in the hospital, the more I saw the differences in roles between a doctor and a nurse or nurse practitioner. I knew I wanted to work in the NICU and I quickly realized that, in most NICUs, the nurse practitioners do most of the hands-on work. I want to be attending deliveries, putting in lines, and intubating, and I can do that as a practitioner. Also, once I was done with my BSN, I was able to immediately start working in the area I was interested in. If I had gone to med school, I would have had 4 more years of learning about adults and very little about the area I was actually interested in. Going back to school now for neonatal nurse practitioner I get to still learn new things, but it is focused on the patients I will be caring for. Basically, I wanted to be able to do more hands-on work with infants and I didn't want to struggle through 4 more years learning about adults. Also, nursing has a different mindset than medicine, and I love having the scientific knowledge mixed with the compassion of nursing.
  9. RNtoNNP

    Hypoglycemia in the NICU

    Our policy is that in the first 24 hours an infant's blood sugar has to be at least 40 and after 24 hours it has to be at least 50. For admits, we get a blood sugar at 30 minutes of age and then continue to get one every 30 minutes until stable (usually they like it stable above 50, but technically it can be just above 40). If the infant has a low sugar, it is up to the practitioner whether they will just feed the infant or start an IV. It depends on age of the infant and the infant's condition. Typically if the infant is less than 35 weeks, we can anticipate that they will be getting an IV regardless. Aside from admission blood sugars, we also get a sugar 1-2 hours after we change the rate on the IV or change the IV glucose concentration. We very rarely draw a serum glucose level unless the infant has chronic hypoglycemia that we are having trouble controlling.
  10. RNtoNNP

    When death was beautiful

    3ringnursing-I'm so sorry for what you are going through, especially right before the holidays. Death really can be an ugly thing and even when it's not, it's still incredibly hard to cope with. I'm glad that Little Man's story could help at least a little bit.
  11. RNtoNNP

    When death was beautiful

    When I helped admit Little Man on Friday, I had no idea that five days later I would be sitting by his bed praying he would hold on until his baptism that afternoon. Prenatal tests had indicated some possible genetic abnormalities and this was quickly obvious upon Little Man's admission to the NICU. He had hydrocephalus, a small and asymmetrical chin, low-set ears, a webbed neck, clenched fists with overlapping fingers, and was unable to fully extend his arms. He was also having some respiratory distress so we quickly got him stabilized on NIPPV (CPAP with a respiratory rate) through a nasal cannula. A head ultrasound was performed that showed enlarged ventricles, which correlated with his large head size, but more tests would need to be performed before we truly knew the extent of his condition. I spent the rest of the weekend caring for Little Man and getting to know his parents, who were both in their early 40s. This was their first baby and they were so excited. When I came back to work on Tuesday, I was shocked to hear that Little Man's parents had decided to withdraw support. I learned that Little Man's MRI the previous day had shown large ventricles without a surgical option and very little healthy white matter. He was also continuing to have difficulty breathing due to his underdeveloped lungs and enlarged heart, and he was close to needing intubation. Because of all of this, his parents decided that they would remove his respiratory support the next day. Since I had gotten to know him and his parents all weekend, I requested to care for him that day, even though I was scared. This was going to be my first experience with a patient death and I wasn't sure if I was ready for it, but it felt like something I had to do. The next day, Wednesday, represents one of those "defining moments" of my nursing career, even though I didn't perform any crazy procedures, run a code, or save a life-I didn't even give any medications! What I did do that day, though, was arts and crafts with a family who was about to lose their baby. We made prints of his clenched hands and his feet, I took pictures of him with his family, and I helped his parents get him dressed in clothes for the first time. My only real "job" that day, was to help him make it to his baptism that afternoon. When I had talked to the neonatologist that morning, she had said it would likely take Little Man hours or even more than a day to pass away since he wasn't intubated at that point and was breathing mostly on his own (with support of the NIPPV). However, as the day progressed, I knew that it wouldn't take him that long to die once we removed the respiratory support. He started having more and more episodes of bradycardia and oxygen desaturation as the day went on, but he would recover on his own each time. I kept slowly turning up his FiO2, hoping it would help until it was time for the baptism. His parents just wanted that one little thing-to have him baptized by their pastor-and I was determined to give them that. I stood in the back of the room during the baptism, my eyes trained on his monitor. I kept the monitor paused using a remote so the alarms would not disturb the baptism, and I cranked up his FiO2, just hoping to get him through it. At one point during the baptism, his heart rate dropped severely and I had to give him a couple manual breaths on the ventilator that was providing the NIPPV. One of Little Man's aunts, who was also a nurse, caught my eye, and it was obvious that we both knew he wasn't going to last much longer. After the ceremony was complete, there were a couple family members who still had not held Little Man, so one by one, we got them settled into the chair with him. I stood out in the hallway carefully watching his monitor while Little Man's family held him, entering the room only to transfer Little Man into the next family member's arms. Less than an hour after the baptism, I was leaning against the wall across from Little Man's room while the last family member was holding him. All of a sudden, his heart rate plummeted. His dad met me at the doorway to the room, and it was obvious that he knew-it was time. I quickly picked Little Man up and his mom sat down in the chair. I placed him in her arms, turned off the respiratory support, and carefully removed the nasal cannula from his face. Little Man passed away only minutes later. I knew at that moment that he gave his parents the best gift he could have. He didn't make them have to decide when to remove support; he decided he was ready all on his own. This family didn't want their little boy to suffer, and I think he didn't want them to suffer either. Little Man's parents adopted a baby girl a few months later, and I know that they wouldn't have been able to do this if they had still been trying to care for Little Man. My coworkers kept telling me that I would never forget my first patient death, and they're right-but not just because he was my first. I will never forget Little Man because his death was something that I never though death could be-beautiful.
  12. RNtoNNP

    Level 4 NICU suggestions

    I currently work in a level 3 NICU and am in my first semester of a neonatal nurse practitioner doctorate program. I am getting fairly frustrated in my current unit because we do not have a lot of critical kids on a regular basis. We might have 1 or 2 intubated babies at a time (or none at all), and we have had times where our sickest kid is just a stable kid on CPAP. We use the oscillator ventilator maybe about every 4 months and see the basic surgical patients periodically. Also, when we do get a sick kid, we have to make sure that people who haven't had a sick kid in a while get their turn, so even if we have a sick kid, I may not have the opportunity to care for him/her. I don't mean for this to sound whiny because I obviously understand that everyone needs a chance to care for our sicker patients, but it just gets a little frustrating when it has been months since I have had an intubated patient. I love taking care of the feeder-growers too, but I would like a little variety. I'm concerned that I am not getting good experience to prepare me to be an NNP, so I'm starting to look into relocating. I would really like to work in a level 4 NICU because I would like to see more surgical patients, especially cardiac surgeries. Both NICUs I have worked in have sent cardiac patients out of state for treatment and surgery. I currently live in the midwest and would ideally like to stay in that area, but I'm also willing to consider moving elsewhere if the perfect opportunity arose. Does anyone have any suggestions of level 4 NICUs that are good places to work at? I'm especially interested in the role of NNPs in those units. Do the NNPs only care for feeder-growers or can they care for post-surgical and other sick patients too? Do NNPs go on transports? I'm trying to find somewhere that I want to build a career. I still have 3.5 years of school, so I would start off somewhere as a nurse, and hopefully move into a practitioner position if one is available. Any suggestions of level 4 NICUs (or level 3's with higher acuity or surgical patients) would be greatly appreciated. Thanks!