NICU Day 35

Baby Girl had another good day.  Dr. Anderson saw her again.  He liked the look of her numbers over the last couple of days so he decided to try and turn her rate down to 15.  I love how he phrased it.  He said he wants to give her "an opportunity to succeed". He further stated that if she doesn't like it, she'll let us know and we can set her rate back.  The two things they'll be watching are the amount of CO2 in the blood gas and the number of alarms she has.

Today was the first day that I've ever had to talk to a charge nurse about our nursing care, for either child.  I'm very much able to tell the difference between personality issues and quality of care issues.  I've had plenty of nurses that I don't enjoy on a personal level, but this is the first nurse where I was actually dissatisfied with the quality of care we were experiencing.

Yesterday, I spoke with her directly about my concerns and explained how important I found it that she vent the OG tube (which means giving the gasses and food in her stomach a way to escape back out of the tube she has in her mouth if they need to).  There were other issues related to speed and clarity of action that made me uncomfortable, but this was one direct example I was able to provide for her.

Today, I spoke with the charge nurse and asked if there was a way to prevent her from being assigned to my daughter in the future.  This hospital doesn't have a way to do that, but they will work very hard to avoid it if possible.  If it cannot be avoided, I'll plan to stay with her all shift to provide backup.  Luckily, she's an agency nurse and she'll be moving on to a new assignment in 3 weeks, so there won't be many more opportunities for her to be assigned to my daughter.

The biggest concern I noticed was an overall lack of attention to detail.  She'd often get lost in what she was trying to get done and fail to complete the task.  She'd have to make several trips when preparing Baby Girl's food, back and forth, getting things she forgot.  I found myself going along after her reviewing settings on the machines to make sure Baby Girl would get the right amount of food and oxygen.  Today, she forgot to vent the OG tube after every feeding I witnessed. She also stopped venting it and checked for residual an hour before she actually got around to feeding Baby Girl.  That meant that out of the 2.5 hours between feedings, she was correctly vented for approximately 45 minutes.  She also failed to keep her correctly contained within the isolette so she'd feel secure and sleep better.  I asked her to fix it and she said she'd forgotten, but that she would.  I should have fixed it myself and I will in the future.

Feedings were generally given late, because of the scattered nature of her care. I'm also not sure she actually did all the cares that she was supposed to accomplish.  I never saw her use the nose gel, though I did see her scan it.  I should have watched more closely to see what she was doing, but I wasn't aware of the extent of the problem at that point.

She also routinely forgot to put the cover back over the isolette, babies at this gestational age do best in dark and quiet.  The goal is to keep her sleeping and calm as much as possible so she can focus on growing.  Several times I had to come along behind her and re-cover the isolette.  The last time was particularly frustrating, because my side as closed and I didn't know she'd left her side open until Baby Girl happened to desat and I looked in to make sure her cannula was in place and saw how light it was.

Later this evening, while thinking back on the care we had today, one other thing that I realized I needed to check on was the process she used to move Baby Girl in and out of her isolette for Kangaroo Care.  She disconnected her vent from her nasal cannula when she moved her.  I questioned the practice but she assured me it was fine and was better than having her nose pulled on by the cords.  No one else in the 5 weeks we've been here has ever disconnected her oxygen and vent when moving her around.

Tonight's nurse is sometimes charge nurse instead of a floor nurse, so I was comfortable talking to her about this situation as she has already been informed about my concerns over the day.  If she'd been a floor nurse, I wouldn't have brought management concerns to her attention, but since she is part of management, I talked to her while I was getting tonight's update instead of the charge nurse.

When I asked our night nurse  if that was common practice or if it was something I should help discourage/educate on in the future to prevent it happening again.  She said that it was not something they would typically do.  She said she can't say that Baby Girl would be harmed, but it would not be something she'd like to see happen routinely.  If the cords were tangled, they would disconnect to untangle them, but generally, not to move her.  I assured her that I watched her numbers on the monitor while it was happening and they looked OK.  I now have more information and will be able to prevent that in the future.

All in all, not a stellar day on the nursing front, but I continue to be impressed with the overall level of care and professionalism at this hospital.  I won't say I'm not happy to know tonight's nurse will be moving on to a new assignment in a few weeks, but she is absolutely an exception to the normal standard of care.

Length: 34.8  (.3) (13.5 inches)
Head Circumference: 25.3 (+.8) (9.9 inches)

Weight: 1210 grams (up 20 grams) - 2 lb 11 oz
Milk: 1210 (40.3 oz) Moved my midnight pump back to 11ish so I can sleep more between 11 and 3am.
Feeds: 23 ml pushed over 30 min, Iron supplement and 1ml, Tri-Vi-Sol, .4 ml protein x 8/day (every feeding)
NIPPV at 20 (dropping to 15 at midnight, will check a gas at 2 am), 23%-36% oxygen.
No labs in the morning
Day Nurse: REDACTED
Night Nurse: Danielle