Strengths and weaknesses

RainDreamer, BSN, RN · Oct 9, 2007

Cool idea! I'm interested to see everyone's replies and to see what your theory is lol.

I work in a 65 bed level III NICU ...... we do all surgeries, cardiacs, etc. Nothing is flown out, we keep it all and we get all kinds of weird transports from all over, even as far away as Las Vegas.

We're good at the surgeries too and getting these kiddos fixed up and shipped back to their hospitals. Our rates for infection are extremely low, quite a bit lower than the national average.

We're not so great with pain management, and a lot of times it takes nurses advocating for the patients to get pain meds. And we're not good with parent/baby bonding. Some of us try to offer kangaroo as often as we can, but it isn't the norm.

Sweeper933 · Oct 9, 2007

I work in a 50+ bed level III unit. We do pretty much everything except complex cardiac kids / echmo...

We are good at appropriate developmental care 9and long-term care guidelines for chronics), low infection rates, primary nursing / bonding w/ the families, and evidence based protocol. In my unit, the nursing staff has a lot of autonomy compared to a lot of other level III units in the area, so I think that helps a lot. Our docs will ask for our input on our babies, especially if the nurse is one of the primaries, a lot of the time.

Things we need to work on: better pain management (we are working hard on this), having babies breast feed more frequently before they go home, and neuro babies. We just in the past year or so got back a peds neuro surgeon, so we are still working on re-doing protocols and everything for these babies.

SteveNNP, MSN, NP · Oct 9, 2007

OMG. Elizabells, you are so right. I'm still horrified and I've only been here for a few months. I've been frustrated about the same things you mentioned. What good is being great at a few things, but mediocre at a lot of important other ones. What bugs me the most is that a lot of new, improved, and generally better equipment, techniques and procedures are ignored because of ONE MAN's influence. (You know who I mean):angryfire

Preemienurse23 · Oct 10, 2007

We are a 40 bed level III unit. We do general surgeries, and right now only PDA ligations for cardiac. We are starting ECMO in a few months.

I just started, so I'm still learning.

I think pain management is pretty good. We do an assessment every 24 hrs, and we are about to go every shift. I think we also have a pretty good survival rate with our micros.

As far as weaknesses:From what I have seen, family centered care, and developmental support for the older babies need improvement. We also have really high ROP rates per one of our docs.

cherokeesummer · Oct 10, 2007

Being a new orientee I don't have a lot of input but from what I have learned so far:

We are a 56 bed unit, they are saying level 4 but I've not heard anyone else ever refer to that number. Our level 3 NICU in the area does not do echmo or any big surgeries but this hospital where I am at, does all of those things...so maybe its different in this area LOL (the levels I mean) but they told me we are a level four :)

Anyway, from what I have heard/learned we are very good at family centered care, developmental support/positioning/care, pain management (I think I heard that right) and respiratory things. But I've also heard we have a lot of infections so that is probably a weakness for us. They have a lot of rules instituted to reduce/prevent infections that I have not seen at the other hospital where I did clinicals however I guess it works to help or at least offers some additional prevention.

Sorry I can't be of more help but give me another year and hopefully I will be more knowledgable!

palesarah · Oct 11, 2007

I work in a 24-bed Level 3 with a separate 11-bed Level 2. We do pretty much everything short of organ transplants and ECMO, but cardiac surgeries (besides PDA ligations) go elsewhere in the hospital to recover. We're moving to a 50-bed, single room unit in less than a year.(with Level 2/Level 3 still somewhat serapte but no longer separated by other units!)

I don't know our actual rates, but I'm told our NEC and IVH rates are low. Something our docs are VERY good at is not supporting futile care. The Neos and Neuros are very upfront with the parents and most of the time, when it is appropriate, the parents choose to take these kids off the vent- and are supported by medical & nursing staff. Evidence-based practice is encouraged by medical and nursing, but a lot of change has to be nursing-initiated. If a nurse is willing to make the effort to find the evidence, changes can be made. We have a strong core of experienced nurses- some who have been in our unit for 20-30+ years. Many of the experienced nurses are the ones who initiate these changes- unlike other floors/other hospitals where it is more common (in my limited experience) for such experienced nurses to just go with the flow, awaiting their retirement.

Areas of change:

Developmental care. Going to the new unit in itself will help. Nursing input has been valued in the development of the new unit, BTW. One of our most experienced nurses is also waging what was once a one-woman war to make these developmentally appropriate changes.

Pain control. We have a new Neo who came from a unit that was more aggressive about pain management and I was joyfully surprised to see that our other Neos are not just allowing him to practice as he is used to, but taking a page from his book.

Family-centered care. This is a hospital-initated change... change comes slowly. People seem to be waiting for the new unit to magically "cure" this.

Initiating breast feeding. The level 2 nursery nurses are excellent at teaching & supporting breastfeeding. Most of the level 3 nurses are scared to death of breasts. We really don't recieve any training in breastfeeding teaching and support during orientation. I came from a "Nipple Nazi" LDRP/Level 2, and even I am loosing my confidence and having trouble with teaching. Apparently the hospital has FINALLY agreed to "give" us a part-time LC when we move to the new unit. Right now, we have to pratically chase them down and drag them over to the unit, when we need their help (not their fault, there's too few of them to meet the need) so that will help. The rest of the change has to come from us.

TiffyRN, BSN, PhD · Oct 11, 2007

I don't really know how many beds we have, it really depends on how many they can cram into any given cubby hole. I've seen over 60, but I think our true max is around 55-58. We are level III, no ECMO, Nitric or cardiac. Probably has those limitations because we have a very close children's hospital where all the same Neo's practice so the transfer is extremely easy.

Our NEC rate is high, our BPD rate is high (our docs even admit that). I believe our IVH rate, infection, developmental care, pain management is average.

What are we good at? Well, we have new O2 guidelines that dropped the bottom off our ROP rate. And I think we're really good at shooting them out the door at younger and younger gestational ages. (How's that for a back-handed compliment). Our docs still hesitate to discharge any kid under 34 weeks, but seriously? As Prmenrs says, "Never trust a 35 weeker", so how much do I trust a 34 weeker?

anniesong · Oct 12, 2007

I work in a 50 bed level III unit. We do HFOV, nitric, and transports. We do not do ECMO, and many of our surgeries are shipped to a nearby Children's Hospital with the exceptions of some GI cases, PDA ligations, and ROP surgeries.

Now, if I remember correctly...

Our NEC rates are lower than the national average, our rates of having initial feedings of breastmilk are high, and our infection rates are at the national average (new for us, apparently it used to be higher than the average). Kangaroo care is generally supported and we have protocols to back up the nurses in making decisions to initiate it (we do have some staff that are notoriously shy with the practice, however).

Our BPD rates, however, are higher than the national average and if I'm not mistaken our ROP rate is at or higher than the average. We could always use help with developmental care (including nursery noise levels and lighting).

elizabells, BSN, RN · Oct 15, 2007

Thanks for all the input, guys! I'd really love to hear from some of those who work in smaller units, or those that aren't Level III-IV.

**Speaking of which, is IV official now? I always thought it was a jokey way of saying a baby's gone to heaven. I guess my unit is a IV, then...

I'm going to be away from the internet for a week (horrors!), so when I get back I'll reveal my master plan... mwahahaha!

And Steve: word. Come to nights soon, okay?

LilPeanut, MSN, RN, NP · Oct 15, 2007

I work in a lvl IV (I guess, I hate it when they change it). We do everything, ECMO complex cardiac, nitric, HFOV, etc.

We are good with gastroschisis. (Our area has the highest rates in the country, so that helps) and we have a pretty good short gut program. Our CT surgeons are some of the best in the world and have pioneered new treatment for HLHS.

We're not great with developmental care, preventing BPD (many nurses resist the idea that a preemite can be off a vent), we had some big infection issues but those have improved. We're also not good with futile care and being honest with parents (depending on the attending)

elizabells, BSN, RN · Nov 5, 2007

Okay, so I may as well reveal the big theory...

I can't say one way or another whether I think I was correct, d/t small sample size and no data for lvl 2 or below, but...

So the theory was that the big ole fancy NICUs with the ECMO and the Norwoods lose sight of the "simple" yet incredibly important things like pain control and developmental care. I was wondering if level 2s were maybe better at that stuff.