Week #3

Gompers, BSN, RN · Jul 5, 2006

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

California has different staffing laws than most of the country.

In the Midwest where I am, it's rare to have two vents together, but it has happened once in a while if they're very very stable. But nowadays with Vapotherm/Fisher Paykel, we don't have the long-term "stable" vents that we used to. Anyways, there are no laws here against having two vents together if necessary. And if we are very busy, it's not uncommon to have one vent and two other babies besides.

KRVRN, BSN, RN · Jul 5, 2006

Well the real issue seems to be the preceptor.

I precept a lot and you have to walk a fine line between challenging the preceptee to learn and yet not allowing he/she to drown. At the 3 week mark I usually encourage newbies to try to do all 3 pts but I keep track of where he/she is so meds and such don't get forgotten. It all depends on how hard the assignemnt is and where the preceptee is ability-wise. But the preceptor really needs to be right there keeping track of what's getting done and what's running late, etc.

Gompers, BSN, RN · Jul 5, 2006

Well the real issue seems to be the preceptor.
I precept a lot and you have to walk a fine line between challenging the preceptee to learn and yet not allowing he/she to drown. At the 3 week mark I usually encourage newbies to try to do all 3 pts but I keep track of where he/she is so meds and such don't get forgotten. It all depends on how hard the assignemnt is and where the preceptee is ability-wise. But the preceptor really needs to be right there keeping track of what's getting done and what's running late, etc.

Excellent point!

BittyBabyGrower, MSN, RN · Jul 6, 2006

Good point. If she missed meds, did the preceptor not get report or what? I have a cheat sheet just like they do and tick off what has been done. We also co-sign meds until they are done with orientation.

nell, give me 2 vents over 3 feeders any day! I can't stand to sit and feed kids for 30 minutes, especially if they are totally awful. Seems like all you do is catch up LOL. We don't have the same staffing laws as you do. We don't take 2 unstable vents together, if they are unstable, they are 1:1.

When we precept, we let the orienter do the "manual" work and we take care of the parents....we don't expect them to do both at first. We may even tell the parents that this is a new person, so forgive us if we are slow or not doing things according to the usual routine you usually follow.

justjenny · Jul 6, 2006

Well the real issue seems to be the preceptor.
I precept a lot and you have to walk a fine line between challenging the preceptee to learn and yet not allowing he/she to drown. At the 3 week mark I usually encourage newbies to try to do all 3 pts but I keep track of where he/she is so meds and such don't get forgotten. It all depends on how hard the assignemnt is and where the preceptee is ability-wise. But the preceptor really needs to be right there keeping track of what's getting done and what's running late, etc.

Excellent point!

Also,don't be afraid to ask your preceptor for help! I have flat out said "I am drowning here" and they (should) jump to action and help!

At one point, though, my preceptor kept doing things FOR me - it kept the day smooth and I didn't feel overwhelmed - that is until I was on my own and had no one to bail me out! Talk about overwhelmed - my first week off orientation sucked!

Jenny

nell · Jul 6, 2006

California has different staffing laws than most of the country.

CA Title 22 does allow double-vent assignments and one hospital around here does staff that way (the one that has trouble keeping staff and has to pay huge sign-on bonuses to get what they have).

For the most part, we don't have "stable vents" because if they're stable enough, we're weaning them - - bringing the potential for instability. Gone are the days when kids were vented for months because of immature lungs.

Also, the standard of care in our area is for hands on full assessment/vs(except BP) q 3-4 hours for growers and q 4-6 hours for unstable/micros. We have very demanding parents too...

nell

MA Nurse · Jul 12, 2006

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.

I'm so glad my unit doesn't assign 4 baby assignments.

MA Nurse · Jul 12, 2006

California has different staffing laws than most of the country.
In the Midwest where I am, it's rare to have two vents together, but it has happened once in a while if they're very very stable. But nowadays with Vapotherm/Fisher Paykel, we don't have the long-term "stable" vents that we used to. Anyways, there are no laws here against having two vents together if necessary. And if we are very busy, it's not uncommon to have one vent and two other babies besides.

Thank goodness I'm in Ca. too! I couldn't imagine having 4 NICU babies, or a vent and 2 feeders. That's why a lot of travelers like to come here I guess.

Gompers, BSN, RN · Jul 12, 2006

I'm so glad my unit doesn't assign 4 baby assignments.

I think our 4 baby assignments are perfectly reasonable. We're talking babies in step-down, here. We don't have a different unit that we send them to - we keep all of our babies in our Level III until the day of discharge. We have a separate area of the unit for the "grower-feeder" babies, and when you're in this area, you have 3-4 babies assigned to you. These kids have no IVs, sometimes a cannula, and are all either PO/NG transitioning or PO ad lib.

In a Level II nursery or special care nursery, this would be a typical assignment. We just don't have one of those step-down units, that's all. We also space the babies' feeds out so that you usually don't have more than 2 due on the same hour. Our Q3H feeders, for example, don't all eat on the same schedule. Some are due at 2-5-8-11, some 3-6-9-12, and others 1-4-7-10.

slu_rn · Jul 12, 2006

Thank you for all the repies! I tried the index card method the last couple of weeks and it worked great! The thing I'm left struggling with are the PO babies who eat all at the same time. My last assignment I had 3 grower/feeders (one who started having As&Bs the night before) all who ate q3 (00, 03, 06, 09, 12 etc) Gompers, I like your schedule where the babies are all on q3 but on a different schedule. I'm still struggling with 3 babies who all have assessments and feeds due at the same time.

I start my orientation in the NICU side in 2 weeks and I'm really looking forward to that. I think that having fewer kids, even though they have more going, will be easier to coordinate. We'll have to see.

prmenrs, RN · Jul 12, 2006

My favorite kind of assignment in the "back" nursery has a premie in it that is just learning to eat, a term newborn linebacker, and some other nippler.

@ some point, the big guy just ate, but is screaming his fat head off anyway, the other nippler (due next hour) is beginning to stir, and the premie in my hands is just sitting there, contemplating the meaning of life. Or something. But he sure as heck isn't eating. Or even interested. :banghead: :confused:

usameisje · Jul 12, 2006

Don't worry too much... you will develop a rhythm for when three kids are all due at the same time. It comes with experience (it did for me at least)

In my unit, you could have two intubated patients, but usually you would not be expected to do an admission with such an assignment. Usually we try to even out the acuity for the ICU assignments so nobody is dumped on more than anyone else is;)

Intermediate level assignments can have up to four babies. We try to make sure nobody has four IVs. The worst assignment I had in intermediate was a full term kid with a UVC, and the rest of my babies were PIV. Thank goodness nobody's IV access infiltrated, came loose...etc. The unit was an absolute zoo with admissions, and none of my kiddos had anything more than a regular nasal cannula.

Find a "brain" sheet that works for you and keeps you organized. Some nurses make fun of me with mine...but I don't really give a meconium about that :lol2: