Working in new NICU unit

Published

Hi everyone, I just started a new job in a NICU and find this NICU very different from the other 4 I have worked in. I just want to cover some things I see in this unit and then you tell me what your unit does for comparison sakes.

This unit does not have regular pacifiers for the babies. Instead, they take bottle nipples, stuff them with gauze and then tape them to a rolled up baby shirt that is also taped up. Are there any other units out there that don't offer pacifiers?

The unit is so worried about saving money they want us to share formula. I have never heard of this and it bothers me that the bottle says to discard after 1 hour and this unit thinks it is okay to have it sit out for hours and hours at room temperature.

All babies on oxygen here have the high alarm limits set at 100%. I though the new standard was to have limits set somewhere in the mid 90s. Also, nurses aren't allowed to adjust the 02 without a doctor's order.

Here they do narrative charting plus the check box charting. The narrative is really redundant and they want you to re write everything every 3 hours.

TPN tubing is changed daily here. Everywhere else I've worked it is q 3 days.

Nurse here don't answer alarms (rarely) since it is so hard to determine who is alarming. Most of the monitors (Drager brand) are flashing when I look around the room and it is even hard for me to determine who to save.

No accurate diaper scales. Here they have to put diapers on a regular baby scale so it rounds to either 5, 10, 15, 20, etc.

Hand written MAR. Handwriting is hard to read sometimes so I would think this would be a big no no. Anyone else doing this?

No developmental Snuggle Ups, gel pillows, Bendy Bumpers, etc. Any other units out there without these?

Lights on bright at all times. Any other units out there refuse to dim lights at night?

During report time most nurses are always late so the rule is to have whatever nurse who gets there first to get report on ALL babies so they can relieve you. I am just used to giving report only to the nurse who has my patients.

OG tubes only here. Guess I am just used to NG tubes!

Blue dye on umbilicus. Thought this was a bit outdated.

That is all I can think of for now. Please compare and let me know what your unit does.

Up Vote Up Vote ×
Specializes in PICU/NICU.

Did you get into some kind of time warp?? Sounds like the 1980s to me!:uhoh3:

No, really, it does seem a bid outdated. Is this a smaller unit that perhaps does not have an educator or developmental specialist?

Maybe they have no budget for the developmental aids, or maybe they do not realize how important pacifiers and positional aids are. As for alarms, I would think any NICU nurse should know how important is is to answer them promptly. And as for O2 sat settings this too, I thought was standard of care. As for the triple dye to the cords- I think most places got away from that when I was in school!

Did you realize this when you took the job? Is this a level III or II- I've heard of some smaller hospital level II nsys doing some pretty weird stuff.

Have you brought your concerns to your preceptor or supervisor? What do you coworkers think?

Up Vote Up Vote ×
Specializes in NICU Level III.

My current unit still does triple dye and teaches parents to alcohol w/ each diaper change. I was a bit shocked...EBP anyone?!

The formula thing is ick. The only sharing I've done is with twins when they both get a few CCs at the same time so I don't have to open two bottles for what I can get out of one.

Up Vote Up Vote ×
Specializes in Neonatal ICU (Cardiothoracic).

Not to mention all the air those kids are swallowing from those "pacifiers" with holes in the nipple...

Up Vote Up Vote ×
Specializes in NICU, adult med-tele.

Maybe you can be a catalyst for changes for the better!

I have transported infants from smaller facilities that had no paci's or developmental care positioning aids. However these hospitals never claimed to have NICU's either.

My 3rd child who is 3 mos old came home with triple dye on her cord. I was weirded out by it. What is EBP?

I am having a hard time deciding what to do in my own career right now since we have relocated, the unit in the town we live closest to ships anything less than 36 weeks (the hospital with the triple dye.) After working where I was before for so long, I just don't know how well that would work out. I have a feeling I might be making a list similar to yours if I got a job there!

One thing about those high alarm limits is that is a big liablity issue, ROP is becomming one of those conditions that malpractice lawyers advertise for and they say that has alot to do with it. What is the Chief Neo like there?

Up Vote Up Vote ×
Specializes in NICU.
hi everyone, i just started a new job in a nicu and find this nicu very different from the other 4 i have worked in. i just want to cover some things i see in this unit and then you tell me what your unit does for comparison sakes.

this unit does not have regular pacifiers for the babies. instead, they take bottle nipples, stuff them with gauze and then tape them to a rolled up baby shirt that is also taped up. are there any other units out there that don't offer pacifiers?

the unit is so worried about saving money they want us to share formula. i have never heard of this and it bothers me that the bottle says to discard after 1 hour and this unit thinks it is okay to have it sit out for hours and hours at room temperature.

all babies on oxygen here have the high alarm limits set at 100%. i though the new standard was to have limits set somewhere in the mid 90s. also, nurses aren't allowed to adjust the 02 without a doctor's order.

here they do narrative charting plus the check box charting. the narrative is really redundant and they want you to re write everything every 3 hours.

tpn tubing is changed daily here. everywhere else i've worked it is q 3 days.

nurse here don't answer alarms (rarely) since it is so hard to determine who is alarming. most of the monitors (drager brand) are flashing when i look around the room and it is even hard for me to determine who to save.

no accurate diaper scales. here they have to put diapers on a regular baby scale so it rounds to either 5, 10, 15, 20, etc.

hand written mar. handwriting is hard to read sometimes so i would think this would be a big no no. anyone else doing this?

no developmental snuggle ups, gel pillows, bendy bumpers, etc. any other units out there without these?

lights on bright at all times. any other units out there refuse to dim lights at night?

during report time most nurses are always late so the rule is to have whatever nurse who gets there first to get report on all babies so they can relieve you. i am just used to giving report only to the nurse who has my patients.

og tubes only here. guess i am just used to ng tubes!

blue dye on umbilicus. thought this was a bit outdated.

that is all i can think of for now. please compare and let me know what your unit does.

i'm a big joint commission rules person....made up pacifiers? no way!!!! can't be safe! we have 5 different pacies to offer our patients!

formula sharing: think about it: if you are opening a new bottle of formula and using two brand new syringes to draw up the formula, you are not contaminating anything! so as long as you are not taking the formula from one bedside to another....and as long as you are using both within that one hour, i don't see a problem. but....formula is free!!!! formula is not purchased by the hospital-must hospitals receive formula and diapers for free from the companies that manufacture the stuff b/c it is the best marketing they've got!

oxygen: limits should be set based on gestational age at birth.

i think we use:

37+weeks babes should be saturating above 92%.

30-36 should be above 86%

below 30 should be between 85-95%

nurses and rts can decrease fio2 as needed to maintain sats wnl.

not answering to alarms? that is just a bit scary!

diapers: it depends on the baby's condition. once off iv fluids and on full feeds, gaining weight, we just count the number of wet diapers and stools...but if you have a babe on ivf and such...you should get accurate weights!!! one kitchen scale from target isn't that expensive for your cheapo unit!!

hand written mar? i thought this too was no longer approved! yuck....

it's electronic for us.

developmental care: if you don't have bumpers, take baby blankets and make some using lots of blankets to make rolls, and you can even make a "prone pillow". you just have to get creative.

report....late for work is an option w/o consequences?

we have a flash report where we learn the overall status of the unit-very quick. this is also where we receive our assignments and then we go and get report from the outgoing nurse. i would only get report for another baby in the event someone is still out in transport, or going on transport...or someone is late b/c of an accident or traffic....

no dye for us....outdated once again.

no ng tubes? and why not???

it sounds to me like it's time for a new nurse educator, a manager who isn't cheap....

good luck, and i hope this is a temporary job for you. if it isn't, use your experience to make this place a better one!!!

Up Vote Up Vote ×
Specializes in NICU Level III.

ebp = evidence based practice.

Up Vote Up Vote ×
Specializes in Nurse Scientist-Research.

Ok, in general, I agree with everyone else that the OP's unit sounds really out of touch. Two items though might be related to "baby-friendly" initiatives.

1. The regular NB unit no longer has the "good" green soothie pacifiers, only the nuk ones the kids don't like. They are only provided on mom's demand. And allegedly in the next year or so they will get rid of all pacifiers (parents that want their kids to have them will have to provide their own). The good green soothies have started disappearing from our unit (supposed to be exempt from the binky ban) so I have resorted to buying them for myself (my assignment that is) at Wal-mart.

2. Free formula. . . that will soon be a thing of the past in our hospital. Supposed to make us more committed to breastfeeding and less likely to use formula. They've already started phasing out all the diaper bags, we have what we have and we aren't getting any new ones.

Up Vote Up Vote ×
Specializes in NICU Level III.
Ok, in general, I agree with everyone else that the OP's unit sounds really out of touch. Two items though might be related to "baby-friendly" initiatives.

1. The regular NB unit no longer has the "good" green soothie pacifiers, only the nuk ones the kids don't like. They are only provided on mom's demand. And allegedly in the next year or so they will get rid of all pacifiers (parents that want their kids to have them will have to provide their own). The good green soothies have started disappearing from our unit (supposed to be exempt from the binky ban) so I have resorted to buying them for myself (my assignment that is) at Wal-mart.

2. Free formula. . . that will soon be a thing of the past in our hospital. Supposed to make us more committed to breastfeeding and less likely to use formula. They've already started phasing out all the diaper bags, we have what we have and we aren't getting any new ones.

They sell the green pacis? My friend says her baby won't take any other but she can only find the pink CMV pacis in stores.

I agree with the diaper bag thing! Free formula is good..but those diaper bags...

Up Vote Up Vote ×

The unit I'm in still uses triple dye. Most of the kidos that have it are from post partum or L&D. We don't put a lot of it on ours. I think in the year and a half I have been here, I have put it on once.

At the risk of sounding stupid. What are the studies saying about the Triple dye/alcohol?

Up Vote Up Vote ×
Specializes in Neonatal nursing (paediatric trained).

Wow, a lot of that does seem very outdated or just plain ignorant of the manager.

If the Baby Friendly Initiative is eradicating all pacifiers in hospitals, what are we supposed to do about non-nutritive sucking? I thought the BFI only considered pacifiers a problem in babies who have established or are establishing breastfeeding. :uhoh3:

Up Vote Up Vote ×
Specializes in Nurse Scientist-Research.

First of all, I don't buy the theory that the LC's are getting pacifiers taken out of the NICU, but it is a rumor. But please remember that often different entities that have power in the NICU have different principles that occasionally conflict. Our unit forbids swaddling for infants of a certain gestational age and size yet developmental care recommends swaddling.

The point being that there can be divergent, even opposing views of infant care by different authorities. We as nurses get caught in the middle and must use our best judgment on how to best care for the little ones. My judgment on the pacifier situation is that the infants I care for will have soothie pacifiers even if it means I have to buy them out of my pocket.

Up Vote Up Vote ×
+ Join the Discussion