Tag Archives: neonatal Intensive Care Unit

Updating Training in the NICU

Most recently a nurse working in the neonatal intensive care unit (NICU) approached me to ask about changing policies at her hospital regarding the updated training that they offer the new nurses on the unit.  In discussing the policy that she wanted changed in her unit, I would have to agree with her after reading about the training that they are giving the new staff.  If the new staff is watching old videos and training with different staff that have a different approach on how to do things, this will create stress in the learner.  There should be two trainers dedicated to teaching the new staff the preliminary things with several nurses trained as preceptors.  During the preceptor time, additional staff should be brought in so that the preceptor can properly train the new nurse without ignoring the learner and their needs or neglecting the patients.

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The new parents coming in to the nicu to spend time with their babies are already highly stressed, this is why it is imperative that they have a nurse who is confident in the care of their infant.  The only way that this can be carried out is through the staff being properly trained.  Using a program with a check off system is good as far as having the information taught, but there needs to be a return demonstration on it.  Once the new nurse has been taught the things that are required about the unit and has completed the checklist, then the roles should be reversed.  Meaning the preceptor becomes the nurse and the nurse becomes the preceptor going through the day with what the job entails and the preceptor documenting how well the nurse mastered the information.  This will allow the preceptor to know if the new staff needs further instruction.

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In thinking about what the nurse stated that the hospital has to spend money to send staff to conferences, purchase new training videos and new computers, this is a necessity. There is not any amount of money or value that can be placed on the life of a premature baby that a large hospital can’t do to properly train staff.  There are online courses and  expert teachers that may come and do continuing education monthly at the hospital so that they can save some money on sending staff to conferences.  Also sending someone to the conference is a good idea, because they can come back with a wealth of knowledge to update the staff that did not go. Hospitals can also check if there is an option to purchase the conference material after the conference for those that could not attend. Implementation is considered the fourth step in the evidence based practice process.  The problem is identified and the solution is noted, however implementing it is what is left to do (Fineout-Overhult & Johnston, 2006).

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The preceptor NICU nurse, should make every effort to make the environment for the new nurse, conducive to learning, the focus should be on the new nurse.  The environment should be very comfortable and peaceful, allowing the new nurse to ask the necessary questions that they may have (Pilcher, 2012).  In the end, if the investment to properly train new nurses is taken and continued throughout their employment, imagine the efficiency that the unit would have decreasing the stress level of this unit and increasing the patient satisfaction.

References

Fineout-Overhult, E., & Johnston, L. (2006). Teaching EBP Implementation of Evidence: Moving from Evidence to Action. Worldviews on Evidence Based Nursing, 194-200.

Pilcher, J. (2012, January/February). Toolkit for NICU Nurse Preceptors. Neonatal Network, 31(1), 39-44.

Feeding Readiness for Preemies

One of the most exciting moments for a parent of a NICU baby is when you can start feeding the baby from the bottle. Most are not able to do the breast feeding due to the difficulty latching on, but what a joy to feed your baby even if by bottle whether it is your breast milk or specialized formula.  There are different opinions in the medical community around feeding readiness.    My passion for the neonatal intensive care unit arose from having a premature infant myself.  My son was given breast milk initially via NG Tube until he was ready to try a bottle.  Initially the bottle feeding was started once per day and increased and they would leave the bottle feeding for when the parents were there to feed the baby to create that bonding experience.  One day  I arrived at the NICU on a weekend ready to spend the entire day with my son.  I was excited to feed him several times per day, but I was greeted by the shift nurse telling me that I was doing it wrong.  She took over the feeding entirely and when the rest of the feedings occurred that day, she took over stating that I was making the baby aspirate due to my inexperience.  I was only allowed to hold him.  When change of shift occurred she said okay time to go, I stated that we were in a private room and the nurses close the door so that we do not have to leave during change of shift.  We were in a private room because at one point the baby had developed a hospital borne infection called serratia and would remain in a private room until discharge.   Staying in the room was an arrangement that I made with upper management due to the fact that I worked full-time as did my husband and we did not have much visit time with him during the week.  She proceeded about her business and ripped the baby right out of my arms.

 

I cried for days until Monday came and I made a complaint to my head nurse who assured me that this was documented in my chart right on the front that I was allowed to stay whenever I needed to. She showed me the chart and stated that she would speak to the nurse about her abruptness.  The weekend nurse apologized to us a few days later, but by then my feelings were already crushed.   It was later discovered that the baby was aspirating even when he was fed via g-tube it had nothing to do with how I was holding or feeding him.  It was inevitable.  In the end, it was decided that the baby would have a Mickey G-tube inserted surgically for feedings to expedite his discharge to home.

As nursing professionals we need to be sensitive to the needs of our patients and their families.  We should always read the chart prior to walking in the baby’s room and talking with the family to see if there are any new changes since last you saw the baby. How could the nurse that  was in charge of my baby rip him right  out of my hands and ask us to leave.? When you look at how he was being fed here vs those those nurses that truly cared about bonding .

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These nurses were Kaleb’s primary day and night nurses…sheer joy to watch nurses caring about their patients….

 

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Written by Rosie Moore, RN, BSN, LNC