This is the best advice I have for new nurses. Often I see the new girls in our unit so concerned about the numbers on the monitor that they forget to actually assess the baby. Most of the time the monitor is not picking up the true heartrate or oxygen saturation because of a faulty lead, or a kicked off O2 probe. Always check the baby.
For instance,
We had a little one pass yesterday. She had Trisomy 13 which is fatal, but some children linger a while with this disorder. The mom spent great time with her. She was able to snuggle with her and love on her for a long time. Then she went home to hug her other children for a bit before coming back. It was in this time that her little one decided her fight was done. We knew mom wanted no heroic measures, so we just watched her, gave her a little oxygen, and waited. As other nurses were off calling the doctor and mom to come back, myself and the charge nurse waited with the baby. Then it happened... the monitor jumped, so we listened again. There was a heart beat. It was faint and way too slow, but it was there. Then the monitor started showing that the baby was fine. Heartrate in the 140s, O2 sat in the 90s. If I had been sitting outside that room watching a monitor I would have thought that child was fine. But indeed she was not. It is a phenomenon that happens at times with these infants at the time of death. She was able to hang on until mom got there and mom was able to hold her and say her final goodbyes, which I think was good. But we did just turn off the monitor completely because it was reading completely false.
Never look only at the monitor, it is only a tool. As one of our doctors says often, "The monitor is NOT your patient." Pay attention to what the patient is doing, what he looks like, what he is telling you a whole lot more than the monitor.
Monday, August 12, 2013
Friday, August 9, 2013
OMG, we are so slow!
Slow days. This is something I'd never say at work. Never utter the words "slow" or "I'm bored" or "we need to pick up." Or anything else like that. It is the kiss of death (literally for some of our little ones I think).
However, now that I'm home and not back for a while I'll write about it. We are so very sloooooow at work right now. All our poor PRN nurses haven't worked in ages. It is a little ridiculous at this point.
And this is where it gets a little hairy being a nurse in the NICU (or I guess I nurse anywhere). Saying things like, "Ok, we need more tiny babies" sounds pretty awful to anyone who doesn't exist in our world. But really, we need more preemies. Ok, I guess the thought is, we need more babies being born in general. Because even our well-baby area in our hospital is slow. Fewer and fewer people are electing to have children right now. I guess the economy and the uncertainty of the future employment plays a big role.
It makes my employment difficult too though. Everything really is very tied together.
However, now that I'm home and not back for a while I'll write about it. We are so very sloooooow at work right now. All our poor PRN nurses haven't worked in ages. It is a little ridiculous at this point.
And this is where it gets a little hairy being a nurse in the NICU (or I guess I nurse anywhere). Saying things like, "Ok, we need more tiny babies" sounds pretty awful to anyone who doesn't exist in our world. But really, we need more preemies. Ok, I guess the thought is, we need more babies being born in general. Because even our well-baby area in our hospital is slow. Fewer and fewer people are electing to have children right now. I guess the economy and the uncertainty of the future employment plays a big role.
It makes my employment difficult too though. Everything really is very tied together.
Wednesday, May 22, 2013
Discharge Day!
One of my most favorite duties in my job is to discharge patients. Not because I don't like them, but because I'm so excited for their families. This is the day they've been waiting to reach! I got to discharge one of my favorite little girls this week. She had spent a long 98 days in the NICU and had a lot of reasons that she shouldn't have ever been able to leave, but she did. She smiled in her car seat as her mom loaded her up into their new car.
I whispered to her to have a wonderful life and I hugged her mom and I said goodbye.
I've been asked if I get attached to these little ones and the answer is OF COURSE! Especially little ones like her who have been with us for a long time. But I would never want them to stay forever. They have a family, a home, people who have prayed and hoped and wished for them to be home. I want to help them get there. That is the most fulfilling thing about being a NICU nurse. When you say goodbye, it is sad to know you probably won't get to see her again, but more than that is the hope for what will come with her!
So, goodbye, little one. Have a great life. Make the most of everyday!
I whispered to her to have a wonderful life and I hugged her mom and I said goodbye.
I've been asked if I get attached to these little ones and the answer is OF COURSE! Especially little ones like her who have been with us for a long time. But I would never want them to stay forever. They have a family, a home, people who have prayed and hoped and wished for them to be home. I want to help them get there. That is the most fulfilling thing about being a NICU nurse. When you say goodbye, it is sad to know you probably won't get to see her again, but more than that is the hope for what will come with her!
So, goodbye, little one. Have a great life. Make the most of everyday!
Monday, May 13, 2013
Observations
Observations from this past week of work...
1. Getting a handprint that looks like a handprint of a baby is extremely difficult! Babies like to ball their little hands up the minute you put it down on the paper. And trying to explain to a tiny that we're making their mommy a cute Mother's Day card does nothing to help the situation. So sorry, hospital, for the amount of printing paper I went through. But the cards did turn out super cute and a tiny handprint makes every mother tear up.
2. Sometimes Mother's Day sucks. My friend had a baby a number of months back, but her baby was stillborn. The most devastating thing in the world... to lose a child... I'm convinced. She was at work yesterday. We talked a lot, since I too have had a stillborn son. And Mother's Day for her, just a painful reminder that her arms are empty.
3. Apparently, I'm the queen of finding infants who need a blood transfusion. And it is amazing how a tiny amount of blood help those tinies perk right back up.
4. No matter the day, I still love my job.
1. Getting a handprint that looks like a handprint of a baby is extremely difficult! Babies like to ball their little hands up the minute you put it down on the paper. And trying to explain to a tiny that we're making their mommy a cute Mother's Day card does nothing to help the situation. So sorry, hospital, for the amount of printing paper I went through. But the cards did turn out super cute and a tiny handprint makes every mother tear up.
2. Sometimes Mother's Day sucks. My friend had a baby a number of months back, but her baby was stillborn. The most devastating thing in the world... to lose a child... I'm convinced. She was at work yesterday. We talked a lot, since I too have had a stillborn son. And Mother's Day for her, just a painful reminder that her arms are empty.
3. Apparently, I'm the queen of finding infants who need a blood transfusion. And it is amazing how a tiny amount of blood help those tinies perk right back up.
4. No matter the day, I still love my job.
Saturday, May 11, 2013
Funny of the Day
If you have a 9lb, full term healthy and strong baby boy and tell me you had no idea you were pregnant I'm going to wonder what you put those kicks off on all that time. Perhaps you normally have gas the size of a 9lb baby?
Thursday, May 9, 2013
Different Types of Moms
Obviously, we see a lot of mom's in the NICU. It is a place created to care for infants... so they all must in turn have a mom somewhere, right? As Mother's Day is approaching in the US this week I was thinking about the different types of moms we have in the unit. Please note, this is in no way to say one mom is better or worse than another... just observation. I've given them titles because, well, honestly... that is what I call them in my head.
The Crunchy Mom
She had a birth plan that was specific to the minute and it has all been thrown out the window because the NICU is never in the birth plan. She didn't want her child to have any medications (even the eye oinment to fight any infection acquired during birth or Vitamin K shot that is really needed to help promote natural clotting of the blood) and now her child is hooked to an IV being pumped full of antibiotics and fluids. She only wanted to breastfeed and never allow her child to take a bottle, but the child is too sick to eat anything by mouth, so we have put a tube down his throat to give him milk that way. And although we support breastfeeding completely, she isn't getting any milk yet due to the stress of the situation and that makes her more stressed and now we have to give her child formula. Another chemical being forced on her baby in her mind. She hates that we use disposable diapers. She hates that she cannot hold her infant all the time. She hates that she has to leave the unit at times to allow us to do a procedure. She hates us. Period. We, as the nurses and doctors and staff of this unit, are completely destroying her first few days with her child and it is our fault.
These moms aren't bad. They are just angry and usually take it out on us. We get that. We roll our eyes sometimes and soldier through. We explain the way things work. We overly explain all the monitors and tubes and wires and bed and ventilator and everything. It isn't good enough, but we do try. We try to allow her to do as much as possible. And sometimes they end up liking us and sometimes not. But their babies usually get to go home with no lasting ill affects... in our mind anyway.
The Emotional Mom
She sits at the bedside of her infant and sobs. Every time she is in the unit. She cries at every new thing her child does. I'll say, "He pooped for the first time today." And she is bawling. I say, "He got 1mL of formula for the first time." And she is a puddle on the floor. Sometimes these are moms of our micropreemies... the tiniest of the tinies... and I almost understand the overboard emotion. But sometimes these are the moms of our big kids who might be with us a week tops and I don't understand. I guess it is still hard because the NICU isn't the place you want your newborn for any length of time, but I want to introduce these moms to the Steel Moms (see below) and tell them to suck it up sometimes. But they love their babies and are happy and sad at the same time and deal with their emotions by putting them all out there.
The Steel Mom
She is pure steel. She adores her child and does all she can as we let her. But she never really cries. She smiles when her infant is doing well and sits quietly when he isn't. She listens as we explain what we are doing and nods. She asks appropriate questions and listens to our answers. She isn't chatty. She doesn't really want us to sit at the bedside and hang out with her. She wants to be with her baby. When she brings in vistors (rarely) she is strict with them... more so than even I would be. They cannot touch the baby. They can look, but don't talk over him because he gets stressed out. She understands most of the things we do. I'm sure she has strong emotions, but they aren't obvious to us. She is strength only. This is where they are at this time and there are specific things that need to be done so she does them. Interestingly enough, these are usually moms of our tiniest or sickest. I expect them to be the emotional ones, but more often than not, they are just steel. I usually relate a lot to these moms.
The Long-Term Mom
She has been in the NICU with her baby for a long time. We know her and most of her family by first name. She comes in at the same times almost everyday and we could set our watches by it. We even know when she calls. She knows most of our first names too. She can do the care for her baby better than we can sometimes. She asks about a blood transfusion because her daughter looks really pale and has been having a lot of oxygen desaturations (desats) and she says her last hematocit on the 25th was only 26 then... shouldn't we ask the doctor to order another H&H and see? She has learned the lingo and has researched everything. She comes for rounds everyday and asks the doctors specific and intelligent questions. I almost think that she might be getting a little too used to our unit. Then I realize that was probably me when my daughter was in the unit and probably why I went back to school, got my nursing license and got a job here in the first place.
The Mom Allowing Her Child to Be Adopted
A lot of people in our unit call these moms "birth moms" but I feel it puts too little emphasis on them. These moms did not only give birth to their child and then run away. They are doing a great act of service for their child. I admire these women... even the ones who don't act particularly nice. I think they must be getting a lot of flack for their decision everywhere. I try to make sure they understand that I admire them. That I think they are making a loving decision. I try to allow them to do what feels best to them... holding the infant or not, changing him or not, being in the room with the new mom or not. I've watched a this mom has held her son and cried and said goodbye and she loved him. I've seen the love in her eyes and she places her son in the arms of his new mom.
The Adoptive Mom
This mom is precious. She has waited, prayed, hoped for and worked for this child for ages. She usually adores the first mom too. Which too many nurses forget and try to make the first mom sound bad for "giving up her beautiful baby." But she understands the sacrifice and love that mom as much as this little baby in her arms. She is hopeful but reserved. When asked what the child's name will be after adoption and she gives you the full name including her own last name she breaks down a bit into tears, because, well... she had always wondered if it was possible for her to have a child bear her last name. As she looks into his eyes, she talks about how much love she has for him already. She is over the moon with excitement when waiting period for first mom to change her mind has passed and the infant is officially hers. She has more visitors than anyone because her entire village (so to speak) has hoped and prayed with her for this moment. Discharge day is amazing as the rows of people cheer them down the hall.
The Remorseful Drug Mom
She had a problem with drugs. She knew it. She was trying to get treatment for it. She got pregnant. Now her baby is also withdrawing from these drugs (the legal ones that she was using to come off her first addiction). Her baby is in pain and she knows it stems from when he was in her womb. She doesn't mind us using medications to help him with the withdrawals. She calls when she has to leave to make sure he is ok. She is in the unit to hold him and comfort him through his wild screaming as much as possible. She tries to do what we ask. Even though her decisions put him in our unit, I like this mom. She made mistakes, she knows it, she is trying her best to fix it.
The NOT Remorseful Drug Mom/ The DENIAL Drug Mom
She doesn't believe anything she did caused her child's issues. As he lays in a puddle of his own sweat, screaming his high pitched scream, wildly thrashing and causing scrapes on his face from rubbing on the blankets, and tremoring involuntarily, she tells me not to dare give her child drugs. I should just hold him and he'll calm down. She picks him up to prove it and he continues to scream. He's in pain. She either thinks the drugs she was taking don't affect infants, or she denies drug use at all (though I'm holding the positive on admission drug screen from L&D). Sigh... this is the one mom I simply endure. Thankfully(??)... she rarely if ever comes in after she is discharged from the hospital. She doesn't like to hear his screams I think. And often these children are removed from her care anyway.
The Foster Mom
Most of these moms are great. She comes in a week or two after the baby has been born and learn about what is needed to care for this child. She has mostly hand-me-down clothes for the infant, but they are clean and well cared for, so it is totally fine. She often has been through this before, so she knows most of our procedures. She is excited... all foster parents seem really excited to get newborns. That isn't usually the case. She can swaddle as well as me. She has had over a 100 children through her home throughout the years. She is seasoned in most drug additions and withdrawal symptoms. She gets attached... almost immediately... you can see it. But she also knows this child isn't her own and she works with the children's mother to learn the care for the baby too. She is sometimes like a grandmother type figure and sometimes young. She is always strong.
The Absentee Mom
She isn't here. Her baby has been here for weeks or even months and she might have visited 5 times. She might say she has transportation issues or other children and no sitter. But she also never calls. We aren't sure why these moms do this, but it is always awkward as we approach discharge and have to call her to force her to come to the hospital and learn to care for her child before she takes him home. We've even been asked, "Don't discharge him on Saturday. I already have plans." Sigh... I really don't understand these moms.
The Mom with Empty Arms
She silently weeps as we place her tiny infant in her arms. Finally he is disconnected from his wires, tubes and monitors. Finally she can see his whole sweet face. He gasps a few more tiny breaths and slips away as she weeps over him. She knows these are the final moments she will be able to hold him, study his face, memorize his features. She brushes her finger lightly across his tiny face and sings a quiet song to him. Sometimes so striking -- "Please don't take my sunshine away." It is only her and her baby in that moment. No one else matters... nothing else matters. She wishes that her love could be strong enough to save him. She wishes that it could be a Disney movie and the tears falling onto his tiny body would revive him. But they cannot. They don't. And she weeps. And she leaves the unit with empty arms... an empty blanket held tightly to her face as she tries to smell his smell one last time. This one, obviously, rips my heart out every time.
That is all I can think of at the moment. As I said, none are really bad (well, perhaps the drug mom who is not remorseful at all). But all are moms. No matter what happens in the end, they will always be mothers. Happy Mother's Day to all!
The Crunchy Mom
She had a birth plan that was specific to the minute and it has all been thrown out the window because the NICU is never in the birth plan. She didn't want her child to have any medications (even the eye oinment to fight any infection acquired during birth or Vitamin K shot that is really needed to help promote natural clotting of the blood) and now her child is hooked to an IV being pumped full of antibiotics and fluids. She only wanted to breastfeed and never allow her child to take a bottle, but the child is too sick to eat anything by mouth, so we have put a tube down his throat to give him milk that way. And although we support breastfeeding completely, she isn't getting any milk yet due to the stress of the situation and that makes her more stressed and now we have to give her child formula. Another chemical being forced on her baby in her mind. She hates that we use disposable diapers. She hates that she cannot hold her infant all the time. She hates that she has to leave the unit at times to allow us to do a procedure. She hates us. Period. We, as the nurses and doctors and staff of this unit, are completely destroying her first few days with her child and it is our fault.
These moms aren't bad. They are just angry and usually take it out on us. We get that. We roll our eyes sometimes and soldier through. We explain the way things work. We overly explain all the monitors and tubes and wires and bed and ventilator and everything. It isn't good enough, but we do try. We try to allow her to do as much as possible. And sometimes they end up liking us and sometimes not. But their babies usually get to go home with no lasting ill affects... in our mind anyway.
The Emotional Mom
She sits at the bedside of her infant and sobs. Every time she is in the unit. She cries at every new thing her child does. I'll say, "He pooped for the first time today." And she is bawling. I say, "He got 1mL of formula for the first time." And she is a puddle on the floor. Sometimes these are moms of our micropreemies... the tiniest of the tinies... and I almost understand the overboard emotion. But sometimes these are the moms of our big kids who might be with us a week tops and I don't understand. I guess it is still hard because the NICU isn't the place you want your newborn for any length of time, but I want to introduce these moms to the Steel Moms (see below) and tell them to suck it up sometimes. But they love their babies and are happy and sad at the same time and deal with their emotions by putting them all out there.
The Steel Mom
She is pure steel. She adores her child and does all she can as we let her. But she never really cries. She smiles when her infant is doing well and sits quietly when he isn't. She listens as we explain what we are doing and nods. She asks appropriate questions and listens to our answers. She isn't chatty. She doesn't really want us to sit at the bedside and hang out with her. She wants to be with her baby. When she brings in vistors (rarely) she is strict with them... more so than even I would be. They cannot touch the baby. They can look, but don't talk over him because he gets stressed out. She understands most of the things we do. I'm sure she has strong emotions, but they aren't obvious to us. She is strength only. This is where they are at this time and there are specific things that need to be done so she does them. Interestingly enough, these are usually moms of our tiniest or sickest. I expect them to be the emotional ones, but more often than not, they are just steel. I usually relate a lot to these moms.
The Long-Term Mom
She has been in the NICU with her baby for a long time. We know her and most of her family by first name. She comes in at the same times almost everyday and we could set our watches by it. We even know when she calls. She knows most of our first names too. She can do the care for her baby better than we can sometimes. She asks about a blood transfusion because her daughter looks really pale and has been having a lot of oxygen desaturations (desats) and she says her last hematocit on the 25th was only 26 then... shouldn't we ask the doctor to order another H&H and see? She has learned the lingo and has researched everything. She comes for rounds everyday and asks the doctors specific and intelligent questions. I almost think that she might be getting a little too used to our unit. Then I realize that was probably me when my daughter was in the unit and probably why I went back to school, got my nursing license and got a job here in the first place.
The Mom Allowing Her Child to Be Adopted
A lot of people in our unit call these moms "birth moms" but I feel it puts too little emphasis on them. These moms did not only give birth to their child and then run away. They are doing a great act of service for their child. I admire these women... even the ones who don't act particularly nice. I think they must be getting a lot of flack for their decision everywhere. I try to make sure they understand that I admire them. That I think they are making a loving decision. I try to allow them to do what feels best to them... holding the infant or not, changing him or not, being in the room with the new mom or not. I've watched a this mom has held her son and cried and said goodbye and she loved him. I've seen the love in her eyes and she places her son in the arms of his new mom.
The Adoptive Mom
This mom is precious. She has waited, prayed, hoped for and worked for this child for ages. She usually adores the first mom too. Which too many nurses forget and try to make the first mom sound bad for "giving up her beautiful baby." But she understands the sacrifice and love that mom as much as this little baby in her arms. She is hopeful but reserved. When asked what the child's name will be after adoption and she gives you the full name including her own last name she breaks down a bit into tears, because, well... she had always wondered if it was possible for her to have a child bear her last name. As she looks into his eyes, she talks about how much love she has for him already. She is over the moon with excitement when waiting period for first mom to change her mind has passed and the infant is officially hers. She has more visitors than anyone because her entire village (so to speak) has hoped and prayed with her for this moment. Discharge day is amazing as the rows of people cheer them down the hall.
The Remorseful Drug Mom
She had a problem with drugs. She knew it. She was trying to get treatment for it. She got pregnant. Now her baby is also withdrawing from these drugs (the legal ones that she was using to come off her first addiction). Her baby is in pain and she knows it stems from when he was in her womb. She doesn't mind us using medications to help him with the withdrawals. She calls when she has to leave to make sure he is ok. She is in the unit to hold him and comfort him through his wild screaming as much as possible. She tries to do what we ask. Even though her decisions put him in our unit, I like this mom. She made mistakes, she knows it, she is trying her best to fix it.
The NOT Remorseful Drug Mom/ The DENIAL Drug Mom
She doesn't believe anything she did caused her child's issues. As he lays in a puddle of his own sweat, screaming his high pitched scream, wildly thrashing and causing scrapes on his face from rubbing on the blankets, and tremoring involuntarily, she tells me not to dare give her child drugs. I should just hold him and he'll calm down. She picks him up to prove it and he continues to scream. He's in pain. She either thinks the drugs she was taking don't affect infants, or she denies drug use at all (though I'm holding the positive on admission drug screen from L&D). Sigh... this is the one mom I simply endure. Thankfully(??)... she rarely if ever comes in after she is discharged from the hospital. She doesn't like to hear his screams I think. And often these children are removed from her care anyway.
The Foster Mom
Most of these moms are great. She comes in a week or two after the baby has been born and learn about what is needed to care for this child. She has mostly hand-me-down clothes for the infant, but they are clean and well cared for, so it is totally fine. She often has been through this before, so she knows most of our procedures. She is excited... all foster parents seem really excited to get newborns. That isn't usually the case. She can swaddle as well as me. She has had over a 100 children through her home throughout the years. She is seasoned in most drug additions and withdrawal symptoms. She gets attached... almost immediately... you can see it. But she also knows this child isn't her own and she works with the children's mother to learn the care for the baby too. She is sometimes like a grandmother type figure and sometimes young. She is always strong.
The Absentee Mom
She isn't here. Her baby has been here for weeks or even months and she might have visited 5 times. She might say she has transportation issues or other children and no sitter. But she also never calls. We aren't sure why these moms do this, but it is always awkward as we approach discharge and have to call her to force her to come to the hospital and learn to care for her child before she takes him home. We've even been asked, "Don't discharge him on Saturday. I already have plans." Sigh... I really don't understand these moms.
The Mom with Empty Arms
She silently weeps as we place her tiny infant in her arms. Finally he is disconnected from his wires, tubes and monitors. Finally she can see his whole sweet face. He gasps a few more tiny breaths and slips away as she weeps over him. She knows these are the final moments she will be able to hold him, study his face, memorize his features. She brushes her finger lightly across his tiny face and sings a quiet song to him. Sometimes so striking -- "Please don't take my sunshine away." It is only her and her baby in that moment. No one else matters... nothing else matters. She wishes that her love could be strong enough to save him. She wishes that it could be a Disney movie and the tears falling onto his tiny body would revive him. But they cannot. They don't. And she weeps. And she leaves the unit with empty arms... an empty blanket held tightly to her face as she tries to smell his smell one last time. This one, obviously, rips my heart out every time.
That is all I can think of at the moment. As I said, none are really bad (well, perhaps the drug mom who is not remorseful at all). But all are moms. No matter what happens in the end, they will always be mothers. Happy Mother's Day to all!
Friday, May 3, 2013
Sad and Funny
So the little man from my previous post a while back made the decision for all of us. His lungs got much worse and he died. Now I go to work and I'm sad each time I pass his room. I miss him, but I'm also happy he isn't hurting anymore and there are no more "what ifs" in his life.
On a lighter note though...
One of my patients this week has been a tiny little boy. He is only a few days old and born at 25 weeks. His mom looked at me and said, "Do you believe I smoked with him?"
I stepped back and adjusted my nurse face as best I could and said, "Umm, yeah."
She was smiling and happy as if she was proud of it.
So here is a lesson... if you smoke while pregnant you greatly increase your chances of having an extremely premature baby. Everytime you take a puff, you are killing a bit more of that baby's placenta which causes them to have very low birth weights even if they are born at full term. Don't be proud of yourself if this happens.
On a lighter note though...
One of my patients this week has been a tiny little boy. He is only a few days old and born at 25 weeks. His mom looked at me and said, "Do you believe I smoked with him?"
I stepped back and adjusted my nurse face as best I could and said, "Umm, yeah."
She was smiling and happy as if she was proud of it.
So here is a lesson... if you smoke while pregnant you greatly increase your chances of having an extremely premature baby. Everytime you take a puff, you are killing a bit more of that baby's placenta which causes them to have very low birth weights even if they are born at full term. Don't be proud of yourself if this happens.
Tuesday, April 30, 2013
ER and Babies
One thing that I always find interesting about the nursing profession is that even though all of us are nurses, we are definitely not all created the same. For instance, I don't do big people. I just don't. I don't enjoy taking care of people who are older than about 2 years old. Once they can talk... I'm done.
However, I have many friends in the ER field of nursing. That scares the shit out of me. I love the fast pace of the ER, but having that many really sick, really hurt folks all the time would not be what I want. And the nurses there are all like badass... seriously. Don't screw with them.
So the other day, we had to run over to the ER to get a baby who was going to be born in a trauma room due to mom having had a car accident and she was hurt pretty bad as well. We take all our transport gear and head out. We get there with the warmer and the bags of crap and whatnot and are directed to the correct room. The doctor and nurses in there are just wided eyed and (dare I say it) terrified looking until they turned and saw us and said, "Oh, Thank God, we did not want to have this baby without you guys here." So I guess, at that point, we were the badass nurses, right? Kind of made me strut a little until the baby was born and proceeded to pee all over me. Way to put me right back in my place tiny human.
However, I have many friends in the ER field of nursing. That scares the shit out of me. I love the fast pace of the ER, but having that many really sick, really hurt folks all the time would not be what I want. And the nurses there are all like badass... seriously. Don't screw with them.
So the other day, we had to run over to the ER to get a baby who was going to be born in a trauma room due to mom having had a car accident and she was hurt pretty bad as well. We take all our transport gear and head out. We get there with the warmer and the bags of crap and whatnot and are directed to the correct room. The doctor and nurses in there are just wided eyed and (dare I say it) terrified looking until they turned and saw us and said, "Oh, Thank God, we did not want to have this baby without you guys here." So I guess, at that point, we were the badass nurses, right? Kind of made me strut a little until the baby was born and proceeded to pee all over me. Way to put me right back in my place tiny human.
Sunday, April 28, 2013
Flippin Stupid Parents
I got into NICU nursing because I was a NICU parent at one time. I am one of the most caring for the parents nurses in our unit. I really am. I understand the complete fear and lack of control you feel when your child is laying there and there is absolutely nothing you can do about it. So I try really hard to be over the top awesome to the parents in our unit.
However, there are some uberly stupid parents out there.
First time father whose full term baby boy is in our unit because he was in major respiratory distress after delivery and required CPAP. He knows EVERYTHING.
NURSE: We'll be checking your son's bilirubin level tomorrow, let me explain what that is.
FATHER KNOW-IT-ALL: Oh I know all about that. I had 5 younger siblings.
NURSE: Ok, great, so you won't be worried if you come in next time and he is on some bili-lights.
FATHER KNOW-IT-ALL: No way, there is no way you are putting my son on any of that shit. He doesn't need it.
NURSE: Ok, maybe we should go over what this means...
Or...
NURSE: (making casual conversation) So what is it that you do for a living?
FATHER KNOW-IT-ALL: I'm an FBI agent, ex-pro football player, who protects us from the Chinese and Koreans.
NURSE: Oh, really? That's very interesting. How do you do that?
FATHER KNOW-IT-ALL: Oh, it is very involved. A lot more complicated that what you do for a living.
And then we get the awesome, mother's of the year whose children are there because they are withdrawing from the illicit drugs that she took while pregnant with them.
NURSE: We're going to be giving your child some medication because she is in pain. This will help her rest and calm down the withdrawal symptoms.
MOTHER-OF-THE-YEAR: Oh, hell no! You ain't giving my baby any drugs! You keep drugging her up and that's what is making her this way! And don't you even think about giving that damn vaccination. My baby isn't going to get any of those chemicals injected in her!
Sure... ok...
Makes me want to facepalm so hard.
However, there are some uberly stupid parents out there.
First time father whose full term baby boy is in our unit because he was in major respiratory distress after delivery and required CPAP. He knows EVERYTHING.
NURSE: We'll be checking your son's bilirubin level tomorrow, let me explain what that is.
FATHER KNOW-IT-ALL: Oh I know all about that. I had 5 younger siblings.
NURSE: Ok, great, so you won't be worried if you come in next time and he is on some bili-lights.
FATHER KNOW-IT-ALL: No way, there is no way you are putting my son on any of that shit. He doesn't need it.
NURSE: Ok, maybe we should go over what this means...
Or...
NURSE: (making casual conversation) So what is it that you do for a living?
FATHER KNOW-IT-ALL: I'm an FBI agent, ex-pro football player, who protects us from the Chinese and Koreans.
NURSE: Oh, really? That's very interesting. How do you do that?
FATHER KNOW-IT-ALL: Oh, it is very involved. A lot more complicated that what you do for a living.
And then we get the awesome, mother's of the year whose children are there because they are withdrawing from the illicit drugs that she took while pregnant with them.
NURSE: We're going to be giving your child some medication because she is in pain. This will help her rest and calm down the withdrawal symptoms.
MOTHER-OF-THE-YEAR: Oh, hell no! You ain't giving my baby any drugs! You keep drugging her up and that's what is making her this way! And don't you even think about giving that damn vaccination. My baby isn't going to get any of those chemicals injected in her!
Sure... ok...
Makes me want to facepalm so hard.
Saturday, April 27, 2013
Whose Decision?
We have a patient right now who has been in our unit for over 4 months. He was a 24 weeker, just one the cusp of viability outside the womb. He developed many different life-threatening disorders including MRSA (received during the actual delivery), necrotizing enterocolitis - which required multiple surgeries and caused a major wound on his abdomen, and a huge bleed on his brain. His head has grown exponentially with the bleed and the last MRI showed very little brain tissue is left.
So what do we do? We care for him, love him, do all we can, but at this point, where do we go? Most would say, "Let the parents decide." And I totally agree. It is the parents' decision alone. However, his parents have been in only a handful of times during his long NICU stay. They call at times, and have even recently (on urging of the staff nurses and other staff members) stated they would be in to talk with the doctors but then never showed up at the times they said they would come and never called to give any explanation or alternate times. As nurses, we have a hard time getting in touch with them at all.
Now, do I think they love their son, yes. I really do. I think the whole experience has completely overwhelmed them and they don't know what to do and so have shut down. I see this a lot. Either the parents are completely over the top involved and want to know everything, or they can't handle it at all and excuse themselves from the reality of it.
But, especially in this case, what do we do? Do we just "stay the course" and wait on nature to take it's course? There are other treatments for this little boy out there, but with his brain matter basically eaten away, he will never be more than a baby. We can "make" him survive for a time at least. Or we can let him peacefully leave this earth. But it shouldn't be our decision. And yet, we are making it, because there is no one else to make it for him.
I've read a ton of blogs and articles about when to save a baby and when not to. Most lay-people who comment on these articles are appalled that someone might NOT save the baby. And really, as nurses, as doctors, as people who got into a business of saving lives, the very idea goes against every fiber of our being. But in cases like these, I really feel we do a lot more harm than good. Yes, his heart may continue to beat (and if it starts to stop, we can always place a pacemaker), and his lungs continue to exchange oxygen (and if that isn't working correctly, how about a different ventiltor setting or ECMO), and he is getting the nutrients he needs from the formula we give him (or we'll just stop that and give him nutrition exclusively through his central line). Do you see our problem?
Who makes the decision of when to stop?
So what do we do? We care for him, love him, do all we can, but at this point, where do we go? Most would say, "Let the parents decide." And I totally agree. It is the parents' decision alone. However, his parents have been in only a handful of times during his long NICU stay. They call at times, and have even recently (on urging of the staff nurses and other staff members) stated they would be in to talk with the doctors but then never showed up at the times they said they would come and never called to give any explanation or alternate times. As nurses, we have a hard time getting in touch with them at all.
Now, do I think they love their son, yes. I really do. I think the whole experience has completely overwhelmed them and they don't know what to do and so have shut down. I see this a lot. Either the parents are completely over the top involved and want to know everything, or they can't handle it at all and excuse themselves from the reality of it.
But, especially in this case, what do we do? Do we just "stay the course" and wait on nature to take it's course? There are other treatments for this little boy out there, but with his brain matter basically eaten away, he will never be more than a baby. We can "make" him survive for a time at least. Or we can let him peacefully leave this earth. But it shouldn't be our decision. And yet, we are making it, because there is no one else to make it for him.
I've read a ton of blogs and articles about when to save a baby and when not to. Most lay-people who comment on these articles are appalled that someone might NOT save the baby. And really, as nurses, as doctors, as people who got into a business of saving lives, the very idea goes against every fiber of our being. But in cases like these, I really feel we do a lot more harm than good. Yes, his heart may continue to beat (and if it starts to stop, we can always place a pacemaker), and his lungs continue to exchange oxygen (and if that isn't working correctly, how about a different ventiltor setting or ECMO), and he is getting the nutrients he needs from the formula we give him (or we'll just stop that and give him nutrition exclusively through his central line). Do you see our problem?
Who makes the decision of when to stop?
Tuesday, January 29, 2013
Swaddling
Learning to swaddle an infant well is a skill. It is not something anyone is just born knowing. It isn't something you suddenly know when you first have your own children. In the NICU it is a HUGE necessity.
Why swaddle?
It calms the babies. It makes them feel secure, safe and less stimulated.
Why so tight?
The tighter the better, I think, with some kids. Especially those who are withdrawing from some form of drug. When teaching new nurses to swaddle, I show them first to make a diamond shape from the receiving blanket. Then fold down one corner. Then put the baby's head at that folded corner and tuck one arm in the fold and wrap it over them and tuck it under. Pull up the bottom corner, tuck it over their opposite shoulder. Then, and this is the important part, take the other arm and hold it down while you pull the remaining opening over the baby toward you and chinch it tight. You want the baby to go "Uh!" as you pull. It is a lot like saddling a horse. If you don't pull it tight enough the saddle slips off. If you don't pull the blanket tight enough, the baby escapes and then... oh and then. The wrath of God is less than a drug addicted baby who has just escaped from her swaddle.
Of course you can get a little over zealous. I had a baby once after I first started who was continually desating (dropping the level of oxygen in her blood stream... it makes the monitor alarm and means the baby isn't getting enough oxygen). She was a drug baby. She had no other issues, and she had been relatively healthy up until this point. She was screaming early in the night and I asked a friend who is known for her wonderful tight swaddles to help me wrap her. So after a few times of the alarm going off, I went over to the baby and unswaddled her to check her monitor probes were in the right position. As I untucked the tight swaddle I heard the baby take a huge gasp of air. Ok, maybe that swaddle was a little overboard. But she hadn't cried. Of course, she was having a hard time breathing, but at least she wasn't crying. Anyway, we fixed it and she was fine.
So swaddle... tightly... but not too tight.
Why swaddle?
It calms the babies. It makes them feel secure, safe and less stimulated.
Why so tight?
The tighter the better, I think, with some kids. Especially those who are withdrawing from some form of drug. When teaching new nurses to swaddle, I show them first to make a diamond shape from the receiving blanket. Then fold down one corner. Then put the baby's head at that folded corner and tuck one arm in the fold and wrap it over them and tuck it under. Pull up the bottom corner, tuck it over their opposite shoulder. Then, and this is the important part, take the other arm and hold it down while you pull the remaining opening over the baby toward you and chinch it tight. You want the baby to go "Uh!" as you pull. It is a lot like saddling a horse. If you don't pull it tight enough the saddle slips off. If you don't pull the blanket tight enough, the baby escapes and then... oh and then. The wrath of God is less than a drug addicted baby who has just escaped from her swaddle.
Of course you can get a little over zealous. I had a baby once after I first started who was continually desating (dropping the level of oxygen in her blood stream... it makes the monitor alarm and means the baby isn't getting enough oxygen). She was a drug baby. She had no other issues, and she had been relatively healthy up until this point. She was screaming early in the night and I asked a friend who is known for her wonderful tight swaddles to help me wrap her. So after a few times of the alarm going off, I went over to the baby and unswaddled her to check her monitor probes were in the right position. As I untucked the tight swaddle I heard the baby take a huge gasp of air. Ok, maybe that swaddle was a little overboard. But she hadn't cried. Of course, she was having a hard time breathing, but at least she wasn't crying. Anyway, we fixed it and she was fine.
So swaddle... tightly... but not too tight.
Thursday, January 24, 2013
Neonatal Nursing Year One
I've just completed my very first year as a registered nurse. I work in a level 3 Neonatal Intensive Care Unit that is the regional referral center for our state. We have, on average, 50 patients at any given time. We take only newborns who have never left the hospital and only up to age 6 months. At that time they would be transferred to a Pediatric Intensive Care or a long term care facility if that was needed. I adore my job. And it is the hardest thing I've ever done.
Things I've learned in the first year as a neonatal nurse:
1. Night nursing is NOT for sissies! Yes, it can be a little quieter at times than days, but the positives can also be drawbacks. No doctors around ... even sometimes when you really need them. No parents around ... so you get to do all the care for all the babies every care time. No specialities like interpreters or pharmacists or feeding therapists or lactation consultants or social workers ... so congratulations you are EVERYTHING.
2. Coworkers make the job better or horrible. I guess this is true in every job, but in the NICU you NEED people you can trust and who trust you. Lives literally hang in the balance and without trust nothing works. But when you click, it is wonderful.
3. Babies are completely unpredictable. I cannot tell you the times I've come on shift to hear a report that sounds like, "They've slept all day and had no episodes at all on room air." Then the first care time, the baby is starting to look septic and by morning the baby has had a full work up, been put back onto the ventilator and looks horrible. Of course, it can go the other way too, which is by far my preference.
4. Adults are crazy. Especially when it comes to their babies. Or their sister's babies. Or their children's babies. And many times we are made to be the "bad guy" because we have to tell them news they don't want to hear.
5. Some parents are amazing and loving and great to their kids and too many times their children do the worst in the NICU. It is some crazy cruel fate that befalls awesome people that their children are the sickest or even die.
6. Usually the parents whose babies are born addicted to drugs have the best luck in the NICU. Their children should have multiple issues, but nope... they don't... they are beautiful and perfect and once the horrible withdrawals are over they go home with their crappy parents and we all are left to wonder if they will be okay.
7. Some babies are not cute. I know... I know. But it is true. Some babies are simply NOT cute. Of course, I am the crazy nurse who usually falls completely head over heels for the ugliest babies in the unit.
8. Doctors don't know everything. And sometimes I think they don't know anything.
9. Neveah is not an original name. Nor should any awesome family name their child that. Neveah is a crack head's baby's name. Only. Please don't name your child this.
10. Nothing I learned in nursing school could have prepared me for what I see in the real world every day.
So, I'm going to blog about some of these experiences. I'm going to let you in on a tiny piece of the NICU world behind the scenes. I hope you enjoy it.
Things I've learned in the first year as a neonatal nurse:
1. Night nursing is NOT for sissies! Yes, it can be a little quieter at times than days, but the positives can also be drawbacks. No doctors around ... even sometimes when you really need them. No parents around ... so you get to do all the care for all the babies every care time. No specialities like interpreters or pharmacists or feeding therapists or lactation consultants or social workers ... so congratulations you are EVERYTHING.
2. Coworkers make the job better or horrible. I guess this is true in every job, but in the NICU you NEED people you can trust and who trust you. Lives literally hang in the balance and without trust nothing works. But when you click, it is wonderful.
3. Babies are completely unpredictable. I cannot tell you the times I've come on shift to hear a report that sounds like, "They've slept all day and had no episodes at all on room air." Then the first care time, the baby is starting to look septic and by morning the baby has had a full work up, been put back onto the ventilator and looks horrible. Of course, it can go the other way too, which is by far my preference.
4. Adults are crazy. Especially when it comes to their babies. Or their sister's babies. Or their children's babies. And many times we are made to be the "bad guy" because we have to tell them news they don't want to hear.
5. Some parents are amazing and loving and great to their kids and too many times their children do the worst in the NICU. It is some crazy cruel fate that befalls awesome people that their children are the sickest or even die.
6. Usually the parents whose babies are born addicted to drugs have the best luck in the NICU. Their children should have multiple issues, but nope... they don't... they are beautiful and perfect and once the horrible withdrawals are over they go home with their crappy parents and we all are left to wonder if they will be okay.
7. Some babies are not cute. I know... I know. But it is true. Some babies are simply NOT cute. Of course, I am the crazy nurse who usually falls completely head over heels for the ugliest babies in the unit.
8. Doctors don't know everything. And sometimes I think they don't know anything.
9. Neveah is not an original name. Nor should any awesome family name their child that. Neveah is a crack head's baby's name. Only. Please don't name your child this.
10. Nothing I learned in nursing school could have prepared me for what I see in the real world every day.
So, I'm going to blog about some of these experiences. I'm going to let you in on a tiny piece of the NICU world behind the scenes. I hope you enjoy it.
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