Friday, December 31, 2010

First night in the Nursery....

So in order to work in Mom/Baby, one must have NRP training in case a baby does something dumb like stop breathing. I'd been asking about getting my certification since I transferred back in September, and was told "Don't worry about it, we'll take care of it."

Until my manager got a call from The Powers That Be who said "If PurpleRN doesn't have her NRP, she'll be suspended without pay until she is." There were no classes available that I could go to, so I got sent home with the manual and a DVD and told to study while I was in Montreal for Xmas.

I then woke up at 0645 so I could be at work at 0800 to do the written test and practice "megacode." Luckily, it only took about 2 hours since it was a class of one :) The instructor said I'd get my NRP card in a week or so.

So imagine my surprise when I'm listed for Nursery duty when I get to work that night. Okay. Can't be that bad, right? Even if I don't have the card, I have the training.

I was blown away by the busyness. At max, I only had 5 babies at a time, but the 3 that stayed most of the night kept me crazy busy.

Started off the night with just one baby while everyone was getting report. Then the littl'uns slowly started trickling in. Nurses just wheelin' them in, saying "Purple, can you do my baby?" and walking back out. Again, I don't get that. It's one thing if you plan on having the baby stay the night; then it's my baby. But I am not a 10-minute oil change place. Or maybe I'm misunderstanding the job.

Then the overnighters started coming in. One nurse had 3 of her babies with me; she felt bad about it lol. So I'm assessing my charges and whatnot, and one of them starts spitting up. Okay, no biggy. Babies do that.

But over the course of the night, she spit up at least 6 times. I couldn't get her to hold formula down (exclusively bottle fed *frownyface*)

You know how crying is contagious with babies? Apparently so is vomiting. At least with my luck that night. When I got baby #1 cleaned and settled, baby #2 started spitting up. Ok. Turn on side, bulb suction. Meanwhile #1 spits up again so I turn and suction and then baby #3 starts. I'm thinking "WTF! I only have 2 hands!"

When the synchronized puking is finally over, someone wheels in a baby and says "This one needs Bili and PKU. Was supposed to be done last night, but lab missed him."

Ok. So drawing from a heelstick is *not* my strong suit. But I gamely put on the heel warmer and gather my supplies, and then spend the next 10 min torturing this tiny soul. Had to milk the leg to keep the blood going, and ended up having to poke him a second time to get the second lab. And while I'm drawing this baby, someone brings another one in for labs as well. I'm thinking "You sure this has to be done now? Can't it wait till 0600 labs come?" Meanwhile the nurse who brought first baby in comes back and wonders why I'm not done yet (cuz I'm bad at this, duh!) and someone recommends keeping the baby under the warmer so the blood flows more easily.

So with 2nd lab baby I fire up the warmer and get my supplies. And I dunno if it was the warmer or this baby had better blood flow but it took *waaaay* less time and the kid barely noticed. And my back hurt way less since the warmer is higher up and requires less hunching over. Body mechanics are not my strong suit.

So lab babies are finished and baby #1 starts throwing up again. I give up trying to feed her, regardless of how hungry she's acting. I look through her chart to figure out why there might be a problem. C-section baby, okay, can be a reason. Then I see a note wherein I discover that at 2 hours of age, the parents gave 25mL formula by bottle. A fresh newborn's stomach capacity is <10mL generally, and the only reason she would have to take in that much formula is if she just kept sucking for comfort...

So I give her some extra time before feeding again, and turns out she is terrible at sucking. All jaw action, no coordinated tongue movement. So at 0600 I finally give her 3mL by syringe, drop by drop under her tongue. She manages to keep it down and finally fall asleep for more than 10 min the first time in the shift.

In addition to baby care, also have to check the emergency equipment and do the Quality Control on the glucometers.

All in all, I think I like Nursery duty all right. I think the best part is that it's more reactionary need-meeting care rather than plan-for-the-shift care. Easier on the brain when you're just playing defense.

I am looking forward to when the rotation lands back on me for Nursery, if only so I can get more practice....

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