Wonderful

I love this. Kangaroo Care for a new mom and her 35ish weeker that started with some priceless bonding time and progressed to the baby waking up from a nice sleep, wriggling around until he found the breast, latching on, and breastfeeding for the very first time. Mom's expression of happiness was priceless. Little dude did well, too.

A Little Encouragement

One of my premature patients has this sign at her bedside, placed there lovingly by her parents. They are wonderful and have a great sense of humor to help them tackle the many challenges associated with having a premie.

This has been one of the times that I've never met the parents in person. They visit frequently during the daytime, and I'm a night shifter, so it's been phone contact only. I still feel as though I've had the chance to form a better "working relationship" with them via phone than I have with some other families I've worked with for multiple days and hours of face-to-face contact.

Is it personality? Readiness to connect? Sense of shared history with a baby (some of my best family contacts have been with families of babies I've done the delivery room or transport on - maybe it's that "first contact" bond?).

NEC

Just the name sends a shiver down my spine, a reaction shared by many who work in a NICU. I don't really intend to make a full post about the disease right now, but perhaps this will serve as a reminder for me to do it at a later date.

It is horrific how quickly a baby can go from a seemingly-healthy feeder/grower to a critically ill child with limited long-term hope to share with his or her family. If I hadn't been too busy with 8 million things to do then I likely would have cried. And I don't think I've cried at work in all the time I've been in the NICU.

And I hate watching a wonderful family fall to pieces before my eyes, and to not be able to do anything to help.

Breastfeeding

Our hospital touts itself as a baby friendly hospital. Among other things, we encourage moms who want to breastfeed or pump for their babies to do so. We try to support them, as best we can, to be successful and happy with that decision. We do not, however, sacrifice children at the alter of "Give Me Breast or Give Me Death" idealism. Sometimes babies need help - IV therapy, tube feeding, or even giving expressed milk by bottle if need be. We try to transition them off IV fluids and onto feeds as soon as is possible and reasonable.

If you refuse to allow your borderline premature child to receive nutrition from any source other than your breasts and your child has not peed in over 16 hours and their bili is increasing, then we will have a problem.

We will not unnecessarily replace the IV for an indefinite period of time if your child can handle digesting his food just fine but is too tired to breastfeed sufficient amounts around the clock. He is a premie- it's not unusual to need some time to grow and catch up. It isn't unusual to need a gavage feed here and there. It's not a knock against your baby or your beliefs. Your child needs to eat somehow, and if they cannot do it exclusively by breast yet, then we need to find another option.

Just a little poke...

When I first started work on my unit, being competent in infant IV insertion skills was not a requirement. All of the APRNs, PAs, and MDs were IV skilled, and a number of the RNs were, but it wasn't an absolute requirement. It was often convenient to be able to place IVs yourself rather than wait for whomever was able to do the job to be available, but we got by.

Some of my friends who graduated at the same time I did found it amazing that IV insertion wasn't a required skill, since many of them completed their IV training while still on general orientation for their jobs (examples were ICU, Med/Surg, and L&D/Antepartum). Since my unit usually operates the ICU portion of the unit on 10-14 nurses, there were always a couple nurses to ask for IV placement help before having to go to the APRNs/PAs on the night shift for the task, which is probably why it wasn't a requirement for so long.

I wanted to become IV self-sufficient, so after an appropriate amount of time "settling in" to my new position, I began the (rather informal, at the time) training on IV insertion. I observed and read, then assisted, and finally began attempting insertions myself. I successfully placed my first two IVs, with lots of help from the experienced nurses teaching me the technique. I then failed two attempts. All were good learning experiences.

Then The Powers That Be decided that it would become a requirement for all RNs on the unit to be IV competent. They did not give a date by which this goal was expected to be achieved, but they did institute a formal program for IV training. So I started over, reading the self-learning packets, attending the classes, and using the plastic practice baby arms and legs (creeeeeeepy!) with food-coloring blood. A few of my coworkers seem to be testing the limits of this new decree by seeing how long they can go before needing to actually pursue the training, which will be "interesting" to see how it plays out.

(The "power struggle" portion of the workplace came a quite a surprise to me. Is it like that everywhere?)

Anyways, ss of my last shift, I finally (re)completed my competency sheet with my final "observed IV placement" section signed off.

Why yes, I do feel rather accomplished. Even if many of my contemporaries have been successfully placing IVs for a couple years now.

The time has come

I have completed my safety training for going out on transport calls. Oh boy, this will be terrifying/interesting/mind-numbing. Now I can only hope that the charge nurses will be kind to me when the time comes to send me out for the first time.

On the other side of the badge

My grandmother died this morning. My mother and I arrived at the hospital about 10 minutes after she passed. We might have made it on time had we been quicker out the door, or had I not mentioned that we might want to have a copy of her living will available to give to the ER staff, or had we not had to make a "pit stop" due to my mom's "nervous stomach" prior to going into the ER.

Everyone in the ER was professional and kind (and yes, it most certainly is possible to be both, despite the occasional grumbling you hear), from the ER physician who broke the news, the nurse who was sympathetic and understanding, to the chaplain who came and sat with us and comforted my mother with a prayer.

My grandmother's nurse repeatedly assured us that there was no rush, and encouraged us to call any family we needed to and to wait for their arrival. She answered our questions, was open about what went on when my grandmother was brought into the ER (Grandma was unresponsive and slowly worsening as they worked on her, but did not appear to pass in pain, nor was she alone when she died), and was most of all kind.

I can't even really put my finger on what precisely she did to make the whole experience just a little bit better for us, but she did, and I appreciate that so very much.


Thinking back on this morning, that interaction is one of the many, many reasons that I am proud to be a nurse - the skills, the caring, the knowledge required, and so much more. I am proud to be a nurse.

Why yes, I AM rather bad at regular posting, why do you ask?

I've finally realized that I hadn't gotten the settings correct for the blog, so from now on I'll (theoretically) be receiving emails when someone posts a comment to an entry. That way I can actually engage in discussion, be polite and respond to people's kind comments, etc.

As a small update to a previous entry here, the parents of the baby sent us a lovely card with a picture of the baby and a brief update. After months of medication and seeing neurologists, she has been weaned from medication and "cleared" as a normal little girl. She is meeting or exceeding all of her developmental milestones.

I LOVE to hear about NICU graduates. Even when the updates are on babies that predate my employment at my facility, I still love to hear how they are doing, their triumphs, their concerns, and the parents' memories of their time in the NICU.

I am approaching the completion of my second year as a NICU nurse. I can remember the names of each of my long-term primaries/associates. The ones I only cared for a few times before they were discharged or transferred to step down or a home hospital I'm a bit fuzzier on, but when I looked at our "Holiday Card/Update" bulletin board during the holidays, I found that names, faces, and stories did come back to me.

I wonder how well my memory will work in 3 years or more. Will I still be able to remember to details?


To veer off the contemplative path, I received my tax refund the other day. Most of it is already spent, going towards a breastfeeding conference coming up in a few months. The rest is earmarked for some new scrubs and a new pair of shoes. Ah well, it was nice while it lasted.