ncbeachgrl

Drugs such as ampicillin can cause the artery to spasm even if given slowly, but there definitely isn't any hard set rule that states you can't give abx through the UAC. I agree with others; it will depend on your unit policy (and there really should be one). I have worked in units where you gave meds via the UAC routinely, in other units where you only did it if you couldn't get peripheral access, and yet in another that you couldn't give meds through it unless you had a physician's order. Unfortunately it's like most things in the NICU; what is common practice in your unit? Hope this helps!

Have you thought of moving to the Nashville area? Try Vanderbilt Childrens, Centennial Hospital or Baptist Hospital. Good luck and you're in my prayers!

I applied to the NNP program and just got my letter today. When I called admissions back in February, they said it might be through the middle of March before everyone got their letters. I am not sure if the PNP program is the same as NNP, though. Hope this helps and good luck!

Does anyone have any idea what the graduate nurse pay is at Vandy? I have seven years of experience, but it would be helpful to know what the base pay is for new grads. Also, does Vandy offer sign on, retention, and/or relocation packages? Thanks!

Does anyone know the diff for working night shift at Vandy? I am planning on moving to Nashville next summer and would like to continue working night shift.

$7.25/hr as a CNA in Fayetteville, NC in 2000 $17.59 as a new grad in 2001 in Durham, NC In 2005, I moved to Abilene, Texas and even with over 3 years of experience, I started out at $19.08/hr, which was less than I was making when I left N.C. Speaking of starting pay, my husband and I are moving to Nashville, Tn next May. I will have seven years of experience by then. I was just wondering what the starting pay was in that area, and by what percentage your pay is "bumped" for each year of experience you have. Thanks!

We have 1 LVN in our NICU, and she has been there for several years. In our nursery, LVN's cannot actively admit (they can do the work, but cannot chart the admission assessment, initiate a care plan, chart discharge needs, etc.), and an RN has to do their initial assessment every shift. They also cannot charge, take transport call, or precept (which isn't necessarily bad, if you ask me! :)). As everyone else has said, go for your RN! Good luck!

Thanks for the responses! I too, had often wondered about not warming the affecting foot, but knew I had only been taught to warm the unaffected foot. You're right, if the baby really does have "cath toes", the best thing to do is pull the line.

This may be a dumb question, but can someone accurately explain why the opposite foot is warmed if a baby has cath toes, and never the affected foot? As a new grad, I was taught warming the opposite foot is correct, but am working somewhere now that puts heel warmers on both feet. I thought this process was wrong, but wanted to be sure of my theory before saying something.

I was wondering, where do you work? When I worked in NC, that was our policy too, using those same beds.

We take axillary temps on babies in open cribs. I usually will take a manual temp on a baby who is in an isolette or on a warmer bed too, because most of the time, the baby is cool or has overheated. At the last hospital I worked at, we had SpaceLab Monitors and there was a temperature probe that did show up on the screen. That probe was placed in the axillary region, and a second probe was placed over the liver and recorded as the skin temp. We would use the axillary temp on the monitor as a reference for setting the bed/skin temp, and very seldom, did a baby ever overheat or get cold. It worked out really well.

Hi VegRN2Be! I have lived in both Durham and Raleigh and even worked at Duke for a while! When I first got out of nursing school, I lived off the freeway near North Carolina Central University. I lived in a fairly safe area (Courtney Creek Apartments) but had to travel through a rough area of town to get to the freeway. In hindsight, it probably wasn't safe at all! :) Most of my friends lived off 15-501 and it was a 15 minute or less commute to Duke for them. I can't remember the name of the apartment complexes, but I know my friends really liked them. Anything in or near RTP will be nice, but pricey. Briar Creek is really nice with lots of shopping conveniences, and they have both apartments and townhouses there. It is less than 20 minutes, and that's with traffic. There is tons of real estate, but if you will be living on your own, it may again, be too costly. Anything down from Duke's campus will also be nice, but again, pricey. And the closer you live to the hospital/campus, the more college students you will be near. Hope this helps! What area will you be working in? Duke is an awesome hospital. I really miss working there!

Has anyone gone to IV vit K for the ELBW kids? We have had 2 kids with necrosis in the thigh due to the Vit K, both these kids were like 400 grams? They have no fat and it probably isn't great to give them that route. Our attendings and peds pharm are looking into this as an alternative route for our tiny baby protocol. When I first started nursing, we would give Vit. K IV to the micropremies, but I remember us stopping that practice; I was told that a baby died somewhere as a direct result of IV Vit. K being given too quickly or something like that. Don't know how true that is. But I know we went back to giving every admit Vit. K IM, and yes, I have seen a few bad thighs as a result.

At my current hospital, all of the nurses have to take transport call one week at a time. It sucks because you have to be available to go out on transport within 30 minutes if you are called. We receive 1.75/hr while on call which seems to be about the going rate, but it still sucks because for one week you essentially can't do anything. Luckily we don't get called out very often, but it would be my luck the one night I have a sip of wine or go to the movies, I'd get the call.

To echo the words of everyone else, bonuses do not make for a happy career! I worked somewhere where there was a decent retention bonus for staying 3 years. And honestly, by the time Uncle Sam was done with me, it wasn't much of a bonus to speak of. The difference is, I liked my job and I received much better incentives, perks, and rewards within that three year period. A few years back, my husband got a job in Texas, and we moved and I took a substantial bonus (in which increments of thousands of dollars-literally- are given to me every six months for three years). And I absolutely despise where I work now. I only have 16 months (and counting) left on my contract, but keep this in mind as an instructor once told me: The more money a hospital throws at you (especially up front), the worse off the place is. You will more than likely be unhappy, have unsafe assignments and receive crappy benefits, and little, if any incentives. Not to mention if you break a contract, you will have to repay the money that has been given to you thus far. Man, do those words ring true for me now...Hope this helps!

At my last hospital, we would let parents hold with an ETT in place, but not with umbilical lines. At my current hospital, I see nurses letting parents hold with umbilical lines but not if they're intubated or even on CPAP. It cracks me up! We keep lines in way too long here, so I don't mind letting parents hold with them. I think it's a nursing preference, how stable the infant is, and knowing that the nurse is ultimately responsible should something happen. I will say that my current hospital does a much better job securing lines so that may be the difference between here and my last job.

I am currently studying to take the CCRN. However, other than the amount of hours required to take the exam, and how recently you have to have had those hours, I don't see a big difference between CCRN and RNC. I have read that a long time ago, you couldn't take the CCRN if you didn't have a BSN, although that is no longer true. Can anyone add to this? Most people in my current hospital have their RNC, but at my last hospital, CCRN was more popular. Help!

Just like every nurse on your unit does it differently, all of us here on the message boards will tell you diffently as well! :) Kardex's are great if they're set up right. The unit that I float to does recorded report but everyone has the same guidelines for taping so it makes it pretty straightforward. On my unit now, I am the only who goes through body systems. This report might take all of two minutes longer than most, but I never miss anything this way. Reporting on abnormal things only is great, but I have found that for my unit, it leads to people skipping all around without any particular order, and information gets missed. (This may only be my unit though). Even if an infant is on room air, I say so, because many times after report from the offgoing nurse, I've walked over to the bedside and seen that the patient has a nasal cannula. I do agree with what someone else said, listen to other people give report and ask nurses what the guidelines are for giving report. You will never please everyone's expectations (welcome to nursing) but as long as you cover the basics, and remember to report abnormal lab values (or even just say, "labs are WNL"), you should be okay. And don't forget to stand up for youself! I know it's hard at first, but if you don't, you will become very unhappy quick!

On my unit, you have to wear scrubs, but with the all the pretty scrub tops out there and comfortable pants, it's easy to buy cool outfits and almost like wearing pajamas to work! As for shoes, we can wear clogs, traditional nursing shoes, athletic shoes, etc. This is in Texas, but even when I lived in NC, it was the same. And back home, you could wear a t-shirt with your scrub pants if it was a hospital related shirt (like such and such Childrens Hospital or blah blah Medical Center).

We do on call at the 200 bed hospital that I work at, too. Luckily, we only have to float to one unit, other than our own. If hiring more staff (which has helped us cut down on call here lately) isn't an option, then you may be out of luck, because numbers in staff will make the biggest change. Not that money solves everything, but maybe offering more of an overtime incentive (for instance, at my last hospital, we got time and a half plus $10/hr for every hour we worked, plus $25 Chilis/Macaroni Grill gift cards if you signed up at least one week in advance) will encourage people to sign up for scheduled overtime, therefore, cutting down on the number of call shifts you have to take. Although, if your hospital is like my current one, I guess extra money incentives aren't an option. Something else that might take some work, but could be effective is have people who call out on weekends take the place of someone else's call shift. Currently, our policy is that if you call out on a Fri, Sat, or Sun, then you will be placed on the next weekend shift that is short. The only way to have this waived is family death or personal illness requiring a trip to the doctor, which has to be documented and shown the the Nurse Manager. It seemed pretty harsh at first, but it has cut down drastically on call outs and so getting called in because someone else called out has become less of an issue. And people who really need to call out because their children are sick and cannot stay with husband, grandma, etc. have done a better job about calling around to see if someone will fill in for them so that they don't get penalized for calling out. I'm not sure what your absenteeism situation is and which days are the worst or if that is even part of the solution for you, but it's a thought. The other thing is like one person said, hire a float pool team. Again, not sure what your hospital's financial situation is. I'm guessing a for-profit who probably nickles and dimes everything, so a float pool may even be more costly? Hope this helps!

I definitely think I am in a no win situation. However, I did talk to my Neo the other night and told him how I felt, what other hospitals were doing, I even brought up articles, etc. He said he appreciated my concern, but he thought it would be helpful to the nurses if we limited visitation because "it seems like you guys are always running around, answering phones, putting in orders, running labs, etc. and trying to assess patients, all at the same time." So I replied, "well then we need a secretary, not a limitation on visitation". He said he would speak with our nurse manager, but by the end of the conversation, I really don't feel I had gotten anywhere with him. As for the person who asked if there was going to be timer on, ready to go off and boot parents out, the answer would be no. Night shift is extremely lenient with visitation, but we always tell parents, "the rule is currently one hour at the bedside, however, we tend to be a little more lenient. If you tell on us, then we will have to go back to making you leave at one hour". It's bad that we do that, but the parents are always appreciative. Since the Neo did say he would speak with the nurse manager (and I think he will, because he usually stays true to his word), I'm going to see how this pans out, but in the meantime, thanks for everyone's input. Unfortunately, I am in love with NICU nursing and don't see my heart anywhere else.

I agree with some of the others who have posted on this thread. Just because I don't have kids, doesn't mean that I'm not someone else's child, regardless of how old I am! About two years ago, a nurse approached me and asked me to switch so that she could work Christmas Eve (dayshift) and I would work Christmas Day (dayshift). When I said no, (because I had worked it the previous year while she hadn't) she said, "oh well I guess I won't be able to see my 9-year old open presents". So I replied, "But did you get to see your 8-year old open gifts last year, right?" She quickly turned around and walked off! And just a few weeks ago, another coworker said in general conversation, "I know I was off last year because of maternity leave, but my son didn't know anything because he was a newborn. So I don't feel I should have to work Christmas this year either since this will be his first REAL Christmas. This is also the same nurse who said she didn't think it was fair that she has to take transport call (as we all are required to do and were told that in our interviews) because she has a one year old. I quickly told her that just because I don't have children doesn't mean that I should have to be on transport call more to accomodate her. The nerve of some people!

It depends on the student, the nurse preceptor, and the unit itself. I personally have seen other nurses be mean to student nurses, and even ignore their presence altogether. Though I don't endorse that type of behavior, it is especially hard on our unit because, just like all units, we have been busy, but without more staff, so the assignments are heavier. Then to have a student can be even more overwhelming to the nurse. There are also two sides to every story. Just the other morning, I was trying to give signout and two student nurses came to the unit (at 7:10, mind you, whatever happened to showing up at like 6:15 to look at the charts and get yourself together?) and then proceeded to grab a chart on a chronic patient that we had. Obviously the word had spread throughout their class about this pediatric patient who has a syndrome with cranial abnormalities, because the two knew exactly which chart to start looking at. Instead of waiting until the end of the report to look through the chart, they take it while I'm talking so of course as I try to go over orders, I can't find my chart. I had to ask for it back and then at the end of report, the oncoming nurse and I walk to the patient's bedside to look over a few things. I turn around and literally run into the student nurses. They was right up behind me! I love to teach and don't mind students, but students need to be respectful as well, and for goodness sakes, if you want to read through the chart, show up a few minutes early or wait until after report! As for LPN vs. ADN vs. BSN, I've had students from all three and there's cocky ones in all of them. Hope this helps...

Hi! I just found this thread and while it's a few days old now, I can definitely add some insight about changing NICU levels. I have just recently left a level III to work at a level II due to my husband's job. It is true what one person said, if you're younger, a level III is more exciting. I thought going to a level II would be great after I charged for a 50 bed, 130 nurse unit. I was so disapointed. Granted, a lot of your experience in the level II will depend in part on the hospital itself, the area where it's at, and what your nurse manager's (and MD's) philosophy is. Not that I don't love all of my babies, but just last night I was commenting that I was losing my skills because we usually admit 32 weekers and above. Not that I would ever wish prematurity on any baby or parent for that matter. You already know this, but I guess it just comes down to where you are in your life. Hope this helps.

Unfortunately, our nurse manager is who came up with this idea of changing the already horrible visitation policy, and to be honest, does not care any more about developmental care than the next person in this hospital. I feel like I have stepped into a really bad dream at this place! Our nurse director of perinatal services is actually leaving, and she is the second or third in about four years (do you see a theme here?) and we only have one neonatologist. Even if he did agree about kangaroo care, he would say it's a nursing decision, and you know how that will end. I know it seems like I'm justfying why I'm not going up the chain of command, but I have on other things, and it's only gotten me "blackballed". This kind of behavior is stuff we only talked about in nursing school, and while I'm not naive, I guess I got lucky at my first job in a big teaching hospital. Nurses were respected and valued. I feel I am the lone nurse when it comes to patient advocacy or even just good standards of care in this unit. Some of the other nurses agree with me on different policies and procedures, but they won't say anything. In fact, they've told me not to say anything at all, because it will only make it worse on me from my nurse manager. I know, some real professionalism going on in this place, huh? I am newly married (my husband had better love me!) and Dallas Fort Worth is over two hours away so changing jobs is not really an option. I have applied at hospitals in the DFW area because I dislike this hospital that much, and have been turned down because of the traveling distance. Moving is not an option for at least two more years, because of my husband's job. I really want to make a difference at this place, but there is such resistance for change. The whole 30 minutes at a time visitation has just about sent me over the edge, and so that's why I have gone online trying to find articles and policies regarding visitation in NICU's. It is nice to vent here online because even the kindest of coworkers are tiring of my "try to make a change" personality and I feel that it's best if I "lay low" for a bit because in the end, it only makes the few people who agree with me, shy away even more. Do you see this horrible cycle? Somebody pinch me so I can wake up!