Identification

It is hospital and JCAHO requirement to wear your identification badge at all times when working. Makes sense - it's good for our parents to be able to identify those they can rely on in the nursery to aid them as well as works as a verification that you belong there.

Fine and dandy.

Wearing the ID on a "necklace" type badge holder is all fine a good, however when holding, feeding, performing sterile procedures, etc, they can get in the way easily and cause problems or contaminate your field. Turning the necklace holder around so it drapes down your back during the procedure is an option, but then it doesn't "announce" itself well back there, does it? It also feels like you are being choked since we have three cards and a key - minimum - handing from the damn thing.

But you aren't allowed to shove them into a pocket. Not visible.

You aren't allowed to clip them to the lower (waist height) pocket of your scrubs - not visible enough.

And now JCAHO is calling for all badges to be located at eye-level. Not waist level, not boob level (and yes, it's always SO FUNNY when someone leans WAY over to "better read the name on your badge" so they can get up close and personal with your cleavage), not on your back... but eye-level.

So I can only assume that they will be either stapling our badges directly to our foreheads or giving us all a halo to wear from which we can dangle our badges for all to see.

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.