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A local hospital recently (May 2014) added 24/7 NNP coverage for their Women's Center.  They currently deliver low-risk 34 weeks and above and have averaged ~500 deliveries/yr.  With the support of NNP's/Neonatology,  the OB providers hope to increase those numbers and decrease the gestational age at delivery to 32 weeks in the future.  We currently attend all deliveries as support and to introduce the role to the staff and community.  Before NNP's, a pediatrician was on-call (not in-house) and would come from home or clinic for risky deliveries such as MSAF, vacuum extraction, NRFHT, etc.  Several pediatricians were lost due to dissatisfaction with this aspect of their job and the remaining pediatric group were instrumental in bringing NNP's on board.  
Administration is concerned with the cost of NNP's to the system.  Much of our shift is spent in support to nursing, assessing neonates, answering questions, education.  At night, if there are no deliveries, we have a call-room in which to sleep.  Administration/management would like us to provide nursing care to babies.  I am not opposed to helping nursing with neonatal care!  But, we are to be trained on the pixis so we can obtain vit. k, erythromycin, and hep b and give it to the babies after delivery.  We will have computer training so we can chart as the RN's do.  It is unclear what happens if there is an OB issue that we must attend while we are providing nursing care.  I am concerned and confused about my NNP role and would appreciate any comments, thoughts or advice. This seems to be a slippery slope! 
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NANN and NANNP are pleased to announce a Membership Scholarship Program for newly graduated NNPs.

The scholarships will provide one year complimentary NANN/NANNP membership to 20 newly graduating NNPs.  (Scholarship recipients must be graduates of an NNP program in 2014 or plan to graduate by May of 2015.)

 We encourage you to share the value of NANN/NANNP membership, along with this new scholarship opportunity with any NNP students or newly graduated colleagues you may have.  To apply for the scholarship, individuals may use this link. The deadline to submit an application is February 1, 2015.

 Please note that this program was made possible through funding from Abbott Nutrition. We thank them for their generosity.

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NANN and NANNP are pleased to announce a Membership Scholarship Program for newly graduated NNPs.

The scholarships will provide one year complimentary NANN/NANNP membership to 20 newly graduating NNPs.  (Scholarship recipients must be graduates of an NNP program in 2014 or plan to graduate by May of 2015.)

 We encourage you to share the value of NANN/NANNP membership, along with this new scholarship opportunity with any NNP students or newly graduated colleagues you may have.  To apply for the scholarship, individuals may use this link. The deadline to submit an application is February 1, 2015.

We are thrilled to be able to offer a membership scholarship opportunity to new graduates! Please note that this program was made possible through funding from Abbott Nutrition. We thank them for their generosity.
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Our NICU will sometimes have babies stay up to one year of age. We use NPASS scale for all of our patients but these patients are no longer neonates. Does anyone use a pediatric pain scale for patients in the NICU and if so which one? And at what corrected gestational age (>44 weeks CGA?) would you change the pain scale?
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We have recently been utilizing nasal trumpets in the management of pierre robin patients.  We had to improvise a system to keep them in place.  This requires placing a small hole in the outer tip of the trumpet, and threading umbilical ties through the holes,  and then taping the ties in place with tegaderm or use trach ties.  We would appreciate any protocol, procedures or guidelines that have been effective for anyone else.

Thanks

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Our Level 3 NICU has recently been recieving our post op patients back into our units with epidurals in place for pain management.  Because the RNs do not have a protocol for managing the epidural (operating the pump or changing out the medication bags etc), the anesthesiologist changes out the bags and changes the bags.  They would like the RNs to take over this responsibilities.  Do any other NICUs have any policies, procedures, our guidelines for RNs?   We would appreciate any input.

Thanks
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Anyone have a policy on capping and flushing the 2nd lumen on an umbilical linethe would be willin to share?
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We are looking at the hummi draw device and would appreciate any input from other facilities currently using this system.
Kim Deynaka
Director NICU
Tacoma Washington
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Need a reference for use of pulse oximetry(or not) in routine well baby phototherapy.

Facility is considering allowing for in room with parents for routine phototherapy.

Thoughts or feelings...

Thank you
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I was wondering what protocols other institutions have regarding the frequency of hands on assessments of our ELBW infants? We currently have a standing order for cares every 2-4 hours, and typically our feedings are every three hours. So, our 24-28 week babies on trophic feeds are handled every 3 hours, and if they are NPO they are handled every 4 hours. Occasionally, some nurses are able to make a case for a particularly unstable ELBW infant to be handled q 6 hours. I was wondering if q 6 hour hands on assessments could be a standard for our ELBW infants?  Based off what I have researched regarding developmental care of ELBW infants (cluster caregiving, only stimulate when infant is in an awake state etc.), and what I have heard at conferences I have attended, the frequency of our routine assessments is excessive. I haven't been able to find much research based articles addressing nursing assessment frequency specifically though, and I need to have evidence of what is appropriate before presenting to our Local Practice Council. If anyone has feedback, suggestions, or research articles that could support a standard of practice or protocol for nursing assessment frequency I would
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The NANN position Statement for the Palliative care for newborns and infants recommends that parents are part of the caregiving team and should participate in the decision making process. It referances the use of a family medical record (e.g.,the Penticuff Family Medical Record, Penticuff & Arheart, 2005). Using this tool allows families to track their infants progress and better understand when the infant is not "getting better".  I  have found the tool, but can not find directions or education for the use of the tool. Can any one help me, or aim me in the correct direction? Thanks
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I am looking for other units' guidelines/protocols regarding ELBW skin care; specifically what is being done to protect the most fragile skin and prevent skin breakdown. I am also searching for evidence based literature on this subject. Please post or email me with any relevant information. Thank you!

Sarah Croop, NNP
University of NC at Chapel Hill
croop@email.unc.edu
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CALL FOR PARTICIPATION
 
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You have perfected your resume.  You have written your cover letter and started to network.  But, have you Googled yourself recently?  It shouldn’t be surprising that in today’s virtual age we often overlook the impact of our online footprint.  If a potential employer were to enter your name into a search engine, what might they find?  Be very mindful that social media content, blogs and pictures are often available to the public.  Everything you say and do online can have an impact on your reputation.  Think before you post. 

 

What about your voicemail message?  Does it sound professional?  Although this may seem like a minor detail, it is important to consider that more times than not, your recorded greeting is the first level of communication.  Voicemail has many benefits as well as advantages, when used properly.   The tone and content of your message are important. 

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We have no protocoll on our neonatal unit for skin to skin, it is done on an adhoc basis, with different members of staff.
I am looking to gather information to put together guidelines for skin to skin for our unit, to include NICU and High Dependency/Special Care
Would anyone be willing to share their guidelines and experiences with me.
I would be really grateful for feedback.
Thanks
Sandra McPherson
Neonatal Community Nurse
Neonatal Unit
Royal Infirmary
Edinburgh
Scotland
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Any policy or practices out there re oral care. What do you use sterile water and breastmilk, when and how often etc Thanks
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I am a NNP developing a Level II nursery with a significant NAS population. Current practice in this nursery only requires 8-hours of CR monitoring once pharmacologic therapy is started with morphine 0.04 mg/kg every 3 hours. My experience at a large level III NICU was to continue monitoring until morphine is discontinued. To optimize safety and outcomes, I need data regarding onset of adverse events associated with morphine administration in NAS babies at different stages of recovery to support this practice.  Any input is appreciated, as I was unsuccessful finding specific information supporting continued monitoring in the literature, although this is a standard practice in large centers and empirically makes sense.

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What do you use to secure your et tubes?
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Hi, All :)

Does anyone have experience with your neonatologists using multiple calculation weights for TPN, intralipids, total fluid, continuous drips (pressors, sedation, etc.) on the same patient?  For example, in the NICU that I work in, we are finding that our neos sometimes use one weight for total fluids, one for pressors, and one for sedation drips with the rationale of wanting the patient to "grow out" of medication doses.  I'm on the Clinical Practice Council for my unit and we are worried about the risk for potential error with having to keep track of the different calc weights for each line change. 

I appreciate any input you might have about current trends and/or how you handle risk for medication errors in this situation.

Thanks,
Kristin Carnall, BS, RNC-NIC
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Many nurses do both, but the RNC requires fewer CEU's to maintain (45) CCRN is 100. Both are for 3 years. I was told when I began working in NICU that the RNC is the "GOLD STANDARD" I had my CCRN in adult Critical care. I feel that either is great and any certification benefits you and your babies! Hope this helps!
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