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.

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.

A near miss, a close call, and the inevitable...

Last night (night of snow/sleet/ice storm) I was almost sent out on a transport call, I was very nearly mandated to return to work for the 11a-3p portion of a sick call's shift (my schedule would have been: a 12 hour shift, four hours off, four hours mandated work, four hours off, and another 12 hour shift), and a was pooped on.

Lovely night. I hear the weather was fun too. It took me 30-35 minutes to make a normally 20 minute drive. Not terrible, certainly, and I took it smooth and slow.

And I got to watch an idiot pass me 'cause he wanted to go faster than my cautious crawl, and proceed to skid out of control into a snowbank. Niiiice.

And I'm back for more tonight.

A tense pause in the action...

While not attempting to get into a stay-at-home vs. working mother debate, I do have one teensy little comment to make...

I think that is it neither appropriate nor kind to say that "mothers who work outside the home are not true mothers at all"... while surrounded by a roomful of nurses taking care of your sick grandchild, many of whom are working mothers themselves.

A thought

You know what must really stink? Being born with herpes on your head.

Yeah, you heard me.

Those special moments

There are occasionally little treats from life in the NICU, like when the withdrawing baby you're caring for finally settles down and snuggles sleepily into your shoulder, turns his face up to yours, looks at you with drooping eyelids... and burps milk breath right in your face.

Check out...

this post. Weirdest thing the blogger has ever seen. It really is quite nifty.

Vacuum Extraction

*shiver*

Even the name is rather unpleasant, isn't it?

In my line of work, it's far more likely for me to run into a negative outcome related to the use of vacuums in the delivery room, rather than the (so I've been told) many times when this method has been used without problems.

Despite knowing this, however, I still can't help but frown when I hear or read about the vac-assist during report or chart review. Gut reaction, I suppose, stemming from the relatively few negative outcomes I've witnessed.

One in particular stands out, because it was one of the first times that I remember feeling both pride in my skills and fear of what I don't know at the same time.

One patient of mine had the unfortunate experience of receiving multiple failed vacuum attempts during an attempted vaginal delivery, which ended in a c-section (and the thought of having to push the baby back up to be delivered... *shudder*). In the note from the other hospital, the word "multiple" was underlined twice. Once delivered, it was clear that all was not well. Extremely boggy head, baby difficult to arouse at times, and clearly in pain when she was awake. Every movement and attempt at repositioning her resulted in a sad grimace and heart-wrenching squeaky whimper.

I've yet to feel a head quite like hers since. She had a suspected subgaleal hemorrhage. I was unable to find the picture that a coworker used to teach me a little bit about a subgaleal bleed, but here's what I was able to find with a very "quick and dirty" google image search (so I guess what I'm trying to say is: hey, it's google, take 'em with a grain of salt)

Image 1
Image 2

It was that shift that I first noticed a patient of mine having a seizure. Hardly willing to believe myself due to the subtle nature of the seizure (I was practically glowing in the dark I was so green), I asked another nurse to come have a look, and she confirmed my observation and asked one of the house staff to step in and assess. This was the pride - finally trusting my skills

Being a newly transported admission, I had a 1:1 ratio with this baby, and was able to watch her closely, so when she started to look "off" we got to take a trip for a CT scan in the middle of the night. This was the first baby I'd ever had to do any sort of transport on, even if it was only in-house. This was (one of) the fears - taking a baby with head trauma for a test alone (in the end I asked for and received help from an experienced nurse), in which the baby would have to be removed from monitors for the test and I couldn't be standing right nearby to assess her myself. This resulted in the discovery of a skull fracture.

There's no dramatic ending to this encounter. The baby's condition gradually improved, her pain decreased, and after a few days she was no longer exhibiting any clinical seizure activity. She eventually went home on medication and with f/u appointments to see how she progressed.

So, not a disastrous ending, necessarily, though I've never heard any sort of update from the family, but still enough to stick with me, and make me cringe slightly every time I see the "vac-assist" box checked off. I suppose everybody has their quirks.

In search of CEUs, a nurse's grand quest

Ah, conferences. The chance to get a kick start on CEUs, an adequate dinner, and hopefully go home with something new to think about, and perhaps incorporate into nursing practice.

Why kick off the blog with a post about a conference, instead of sharing a funny story about a NICU graduate, or a heart-wrenching remembrance of a lost patient? There will be plenty of time for that later, and, as new as I am, there's likely to be many more to come.

For now, there's a little bit about me. I like to learn. Perhaps it's the nursing student in me fighting to be rereleased, or the graduate in me that can't let go of school habits and "grow up". I like learning new things, having interests piqued, having thoughts supported or challenged, and having new information presented to me. I dislike stagnation, or perhaps it's just the stagnation I'm sensing in myself.

At the very least, I'm hoping this blog will provide me with a little insight into my experiences, thoughts, and feelings as pertains to my "nursing self". Maybe after writing something down, I can walk away for a few hours, then return with a new view and see aspects of care or personalities I hadn't had the clarity to see before. Perhaps new ideas will pop up, or at the very least new dedication to my craft. And sometimes I may need to vent, or cry, or laugh, or express the vastness of my disbelief, just for the feeling of "freedom" that will result.

Those in the NICU, nursing, or healthcare in general know: sometimes, ya just need to get it out.

And so, a conference. Perinatal emergencies. Yetone more example of times when, as a nurse only 1 year out of school, I can get a better realization of how much I don't know. Hopefully more on this later.