Week #3

prmenrs, RN · Jul 4, 2006

That's pretty heavy for the 3rd week, imo.

Make your self a worksheet for each pt. Should be ~ 5x8. Draw a vertical line down the middle, more or less, then divide one side of that into 8 or 12 little boxes (8 or 12 hour shifts). Number the boxes w/the hours. Write feedings, meds, anything that needs to be done on time in that hour's box, and cross them off as completed.

The rest of the sheet can be divided up: Put historical stuff on the back for both baby and mom; put CURRENT stuff on the front. Top of the sheet should have name, today's date, today's wt (loss or gain from yest), today's "conceptual age".

Another section should be respiratory: current support, latest blood gas and/or X-Ray info.

Next: IV's.

Next: lab data, current results, pending labs, labs to be drawn (put them in the timed boxes, too).

Then feedings: what, when, how. When was the last stool?

Leave a box for anything else. Put d/c plans, teaching plans, social stuff on the back.

Needless to say, keep these papers in your pockets or under your charts. Shred them @ the end of the shift, or tear off/black out the names. (I prefer the shred method.)

EricJRN, MSN, RN · Jul 4, 2006

Another vote for a worksheet. I absolutely wouldn't survive the day without my hourly cheat sheet.

Gompers, BSN, RN · Jul 4, 2006

I do a cheat sheet as well. We just use a piece of paper towel (the long rectangle kind) and put the hours of our shift on the left side. Then we'll write "VS" on the hours they need vitals and mark what their feedings are (type and amount) on those hours as well. We cross off stuff as we go along. My system is to write the meds at the time they're due on the hours as well, and I use a highlighter to mark them. If they have respiratory treatments, X-rays, or labs, I'll write this down on the hours they're due as well, and draw a box around them. These are just things I do out of habit so I can see what I need to do at a glance, and so I can cross thing off when I've done them. I make a cheat sheet for each baby I'm caring for and put it on their bedside clipboards so it's right there when I'm working with the baby.

We personally don't write any history or anything on our cheatsheets because we have printed patient care summaries from our computer system where we've already typed in all the history, social issues, and the orders (vent settings, etc.) are already on there too. Saves us a lot of writing!

If I'm caring for more than two babies, I make a second cheat sheet to keep in my pocket. On this one, I'll expand the paper towel to full-sheet size and write in all my hours. I'll write in each baby's name at the times they are due for vitals and feeds, and I'll put all their meds on this sheet as well and highlight them, so that when I'm running around I can just look at the sheet in my pocket and see who is due for what.

It takes a while to get organized in any nursing job and to develop your own personal system. Three weeks is just the beginning, so don't be so hard on yourself! It'll come with time.

prmenrs, RN · Jul 4, 2006

No matter how you organize it, 3 babies alone is too much @ this stage. Talk to your unit manager or whoever is in charge of the orientation.

Gompers, BSN, RN · Jul 4, 2006

No matter how you organize it, 3 babies alone is too much @ this stage. Talk to your unit manager or whoever is in charge of the orientation.

Well, how sick were these babies? The OP said that these were the special care/healthier babies. When we do orientation, the first few weeks are spent in our step-down room, where typical assignments are 3-4 babies. The first week, we give them 2 babies, the second week 3, the third week 3-4. They are still working 1:1 with a preceptor at this point, of course.

slu_rn · Jul 4, 2006

My patients were:

1 - NEC, 27 weeker at birth, now 34 weeks - TPN and q3 gavage - no nippling - ostomy - going to be reattached this week - CPT and bag/mask breaths with vitals (q3) HH via NC - no A/B

2 - NEC - 26 weeker - now 36 weeks - nipple BID - gavage remainder - ostomy, refluxer - A/B with emesis, 1/2 L NC

3 - Severe IUGR - born at 32 2/7 wks, now full term, genetics work up for Russel Silver - Feeder/Grower, very difficult feed because of extremely small mouth, nipple as tol, gavage remainder (thankfully mom and dad were very involved), ? g-tube placement

BittyBabyGrower, MSN, RN · Jul 4, 2006

That is the type of assignment we give our people at that stage. They are stable and not too much going on. We have weekly guidelines we follow. She is still with her preceptor and this person should be helping out. Are you truly alone, or are you with your preceptor? If you aren't with your preceptor, then that isn't right.

Your preceptor probably also wants to see how you handle 3 kids and where your weaknesses are. Make a sheet with each hour on it and then write in what you have to do at each time. Also, can you draw up all your feeds and label them and put them in the fridge? This will save you time for each feed. We can draw up 2 feeds and leave them at the bedside as long as we use them in a 4 hour time frame. Also, grab your meds before you start anything with the baby, then you won't have to leave the bedside once you get started.

In our unit by week 4-5 we have moved on to very stable vents with a feeder and then progess to a stable vent with 2 feeders, then 2 vents. We do individualize it as we need to. During week 7-8 we put them on their own with a resource person with 3-4 feeders to see if they can do that. Then we move into unstable kids, OR's, etc.

Gompers, BSN, RN · Jul 4, 2006

My patients were:
1 - NEC, 27 weeker at birth, now 34 weeks - TPN and q3 gavage - no nippling - ostomy - going to be reattached this week - CPT and bag/mask breaths with vitals (q3) HH via NC - no A/B
2 - NEC - 26 weeker - now 36 weeks - nipple BID - gavage remainder - ostomy, refluxer - A/B with emesis, 1/2 L NC
3 - Severe IUGR - born at 32 2/7 wks, now full term, genetics work up for Russel Silver - Feeder/Grower, very difficult feed because of extremely small mouth, nipple as tol, gavage remainder (thankfully mom and dad were very involved), ? g-tube placement

These to me are not special care nursery/step-down type babies. Two ostomies is a heavy assignment right there!

When I'm talking about 3 baby assignments, I'm referring to grower-feeders. Vitals and feeds Q3-4H, some PO AD LIB, others PO/NG. No IVs whatsoever. Maybe a nasal cannula, but regular, not high flow or CPAP.

When we get busy, yes, we'll have 3 busier babies like the OP mentioned, with IVs, ostomies, etc. But that's not the kind of 3-baby assignment I thought she was talking about! Yeah, that is a bit much already.

BittyBabyGrower, MSN, RN · Jul 4, 2006

Lately, that is the kind of assignment we have had to have with first admit. Last person I oriented, we had an assignment like that because they were the best of the bunch LOL

Really, the only bad thing is the ostomies when you think about it. At week three we are doing IV's also. I find it interesting how each unit is different in how they orient.

prmenrs, RN · Jul 4, 2006

The thing that tends to make feeder-growers deceiving is that after being in ICU, the parents are now present and involved a much greater % of teh time than before, so you have more teaching, support, breastfeeding assistance and lots of other nickel and dime distractions.

A newer nurse not only has to get the work done, s/he needs time to analyze the data she's gathering in terms of significance. No one wants to get to the end of the shift and realize something happened 3-4 hrs ago that they really shoulda told someone about then, but they were so busy trying to get other baby's Mama's breast and baby's mouth in one place @ the same time, that piece of info didn't set off any mental bells. I hope I'm communicating better than I think I am.

nell · Jul 5, 2006

... and then progess to a stable vent with 2 feeders, then 2 vents.

We don't have assignments like these ever, whether it's orientation or we've worked here for decades.

nell