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Tips for speed without sacrificing accuracy?

NICU   (2,642 Views 17 Comments)
by cherokeesummer cherokeesummer (New Member) New Member

cherokeesummer works as a RN (OBGYN).

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CRDBear has 5 years experience and works as a NICU Nurse.

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I love everyone's tips. I too am a fairly new NICU nurse, and I felt the same way you did cherokeesummer...I wanted to cry some nights when I went home. I think it was worse for me because I had expereince as a nurse with adults but babies are a whole other animal! It takes a little while before you feel somewhat comfortable. Just know that it does get easier. Time management is something that comes with time. Writing down a schedule at the beginning of your shift especially if you don't know the babies was helpful for me. Also, I try to work with one infant at a time and do everything for that baby before moving on and have everything I need at the bedside to make my assessment and cares quick and efficient. Overall, what I an suggest is this: Celebrate your successes, learn from your mistakes, know the only stupid question is the one not asked and know that we are all here to make the babies better! You sound like a great nurse and you will do well!

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elizabells works as a playing science.

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Its like as soon as I come close to the isolette the alarm stops.

Ah, I love the babies who just want you to get up. :lol2:

In all seriousness, though, I feel for you. During my orientation my preceptor was always on me about speed, and my (internal, silent) mantra was "I can do it fast, or I can do it right." One thing that helped me was while I was checking my orders at start of shift I would make a list ALL the supplies I needed. Gavage feeder getting 7ccs q3? I'd get ten 12cc syringes - two for each feed to check residuals and for the feed, plus two more. I'm like that - whenever I go to the supply room I get one extra of whatever it is. Then if it turns out you had the syringes at the bedside already, great, you don't have to stock for the next shift. Assume you have NOTHING at your bedside. This was a huge time-waster for me at the beginning, and sometimes I still have to stop during cares to grab something, but it's much rarer now.

You WILL get it. I promise.

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During my orientation my preceptor was always on me about speed, and my (internal, silent) mantra was "I can do it fast, or I can do it right."

I love it... wonderful advice! :)

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lccougar02 works as a NICU RN.

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Well heres my advice to a new NICU nurse. I started as a new grad in the NICU about 1.5 years ago. What I did to get organized was this...I made a 3x5 index card on one side it listed what I needed to assess on the infant, set up as a "look" then "touch" approach. Heres what is kind of looked like:

Write down: Isolette temp, count respirations/retractions, color, ac/pc isolette, activity, pain, check for any skin lesions/rashes ect

Then put on BP cuff, get temp, change pox probe, feel for liver, check abd for loops/venous patterning, check fontanel

then listen and check aspirate, suction if needed, listen again

change diaper

change gloves

reposition and feed

Thats what i do for my assessments. I hope that helps. On the other side of the card I wrote down what supplies I needed and gather BEFORE entering the baby's bed including for example:

diaper, cottonball, wipes, tape, suction supplies(saline, surgilube and catheter), 6cc syringe, feed and meds ect.

then I would tape the card on the isolette and as I was doing care I would look at it to make sure I didnt forget anything.

It made my time mgment really speed up and it still helps!

Also, when you start your shift get all your med calcs done BEFORE starting your shift so when life in the NICU gets crazy you can just draw up your med without double checking at a crazy time.

And about checking the baby for the alarms...its normal to feel that way until you are used to the baby and why and how much they desat or brady and what your interventions need to be.

I hope that helps! Good luck and message me if you ever need help! :)

Jackie

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LilPeanut has 8 years experience as a MSN, RN, NP and works as a NNP.

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The alarms thing comes with time. We have the same three tones as the poster above has, and you just learn which ones are which. We teach parents too, so they aren't concerned about every little ding.

Part of it is also getting to know the babies in your pod/area. You may have a heart kid who needs sats >70, so when he dips into the 60s every once in a while, no one is panicked. Or a BPD'r who constantly desats and self-stims up.

As for what you do, it depends on what's going on. Brady, first thing after assessing color, whether it's a true brady and equipment (all that though is just a quick glance), you stim. Some kids need vigorous, or if they are vented, they need a breath on their vent. If possible, find the nurse who has the kid so you know whether this is "normal" for them.

Desats are similar, except you don't usually stim, just increase FiO2.

The trick with both is being able to recognize at which point the minor interventions aren't going to work and you need to escalate care, ie bagging, compressions, checking for extubation.

Don't be afraid to call for help. If I have a kid who is vented, I'm comfortable on my own up to bagging. If I'm bagging and still not getting anywhere, I start calling for help! *L* And if you aren't sure, don't turn off the alarm, because even when you are concentrating on the baby, the alarm will bring the attention of other nurses to help.

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