Burnvegas

Run in a fluid bolus over fifteen minutes, regardless of the volume. the rate will change depending on the volume, so the lower the volume, the lower rate will actually be.

We use them, but not for any heparins. But that's mostly because we don't use heparins very often (no cardiac in our unit) and pharmacy got annoyed folk weren't rotating the site so it was a bit outlawed by them. There does exist insulin needles with a safety device, which we use for the insuflon for insulin

Take ICU. Gen paeds is nothing like nicu. Nicu is very niche, and more like ICU then it is a paediatric floor, and experience with vents and lines/monitoring will be more valuable to them.

We have some nurses like that too, who want to know every minute detail down to the total number of poops this eight week admission, and what drugs they had in theatre 4 weeks ago... Some are genuinely interested in such matters, others are just being awkward or testing me (less so as I'm more senior than most of them). My standard response is usually "why do you want to know?" And if they give me a good reason I'll look it up. If they say "just wondering" as they usually do, I tell them to look it up themselves if they're that interested, but I have a home to go to. Handover should be concise, not the entire journey start to finish, just what's relevant. If you go into too much detail, people stop listening and will then claim you didn't hand something over, or ask you a question at the end you already covered in your longass handover Giving a good concise and safe handover comes with experience. Use a brain or abcde. I usually just state the history (often from the review done by the intensivist that day) and then "from the top down..." And summarise abcde assessment, family and go through the medication orders - with an "any questions?" at the end. Also, you should really stop coming into work an hour early. It doesn't matter if you think it's safer, or you don't mind wasting your item time doing it... It will give a certain impression and it might not be a positive one. It's pretty much always unnecessary to go through every note to provide safe effective care.

I wonder if mum gave it too. I've had parents give meds before without our knowledge when they shouldn't have had them. I've had a baby double dosed with domperidone because the mum didn't believe we had given it... We ultimately got the blame when the docs found out and all hell broke loose, she watched smugly as we had to do an ECG and hourly obs. And still had the gall to complain about the incident to management resulting in the two of us nurses being reprimanded for giving the domp... Even though she gave the overdose but changed her version of events for the complaint... There's hundreds of parents like that, sadly. Personally, I wouldn't be happy to give an ace inhibitor to a child without a written prescription... but maybe an adult trained nurse would think less of it because it's a more common drug to them?

the vast majority of people who go to any icu hate it for a good length of time. some people stick it out and finally "get" it, others leave within the first year. you have to make that decision on your own because there isn't a right answer. just be reassured that you are not the first and won't be the last person trying to get out after less than a year because they hate it.

I also did this for a few years, and I really enjoyed it. I agree with phil pretty much entirely and had a similar experience. Just want to say though... You absolutely can't just work in one area and refuse all others, especially if you're limiting yourself to one trust. I started only working in my old unit, but then they hired tons of new staff and went into quiet season... ergo, no work. I then would only take surgical wards, but again the work dried up. Ended up working in paediatrics one night because rent was due (something i'd vowed never to do) and now i'm several years into my paediatric career. You don't know until you try. Conversely, be prepared to be out your comfort zone and do things you might not enjoy so much. I worked in a prison for three weeks, and decided it really REALLY wasn't for me. But I had to do it a few times, because bills don't pay themselves. ultimately, they are giving you a lot of flexibility, it's only fair you have to give them some flexibility in return. nothing worse than a bank nurse who is digging their heels in about being moved because they'll "only" work in a&e. It's part of the gig, just get on with it. Long story short: if you want guaranteed shifts in one particular a&e and are unwilling or unable to work elsewhere, just stay where you are, you're not ready.

I think a lot of us have survived the transition to higher acuity. Lots of learning curves, but if you know your basic vent and inotropes and stuff, everything else will come to you in time. Don't forget your basics and assessment skills, cause they're the same (the just have a silo now). Don't get second unit syndrome. Use your orientation time wisely. And don't feel like you can't ask for help or refuse an assignment just because you're experienced in neonatal. Because that's all the mistakes i made :). The rest will come, so don't worry too much. I hope you get a lot out of it. Level IV i find is a lot more interesting and you'll gain great skills if you choose to go back to different levels.

Congratulations!

Yeah, it was the same story in my old unit as well. It was put down to the nurses not strapping the tube correctly (surprise surprise, nurses blamed). I argued at the time (2009) that there was no evidence that preferred one over the other, and we were used to oral, so why change. The response was this brief that keeping the mouth free from tubes results in better developmental outcomes with feeding and weaning to solids... That came from our nidcap people. I've had difficulty finding what research that standpoint came from. Maybe it's not the way forward then, i dunno.

My understanding of dial a flo was they were set to certain drop factors, so using one for a gtt of 60 wouldn't work on an infusion set with a calibration of 20... My understanding is also it doesn't eliminate the need to count the drops all together and just set it to 100 and trust in the wee bit of plastic to do your job for you. So yes, you're quite right the drops should be counted. And your maths is correct, too.

In the UK, I've known people that have become an nnp who worked in a level 3 centre, even one that had predominantly worked in a level 1. So it is possible here at least.

It's fine. Human error happens to everyone. What's important is you did the right thing.

Go where you want to be, is my opinion. But you'll get a mixed response. Some people value general experience before specialising, some don't see the point. All depends on you or who you ask - up to you to decide.

Stimulating a baby at delivery with a hand under the towel and rubbing up and down the back of the baby. If that doesn't work, the baby has 100% of the time always needed tubed. Always shocked at the amount of l&d staff who don't know this trick.