5-6 pm- wake up. Cross my fingers that we have something I can throw together for dinner. Do a happy-dance when I remember that I put something in the crock-pot at 7:45 this morning when I got home from work.
6-10:45 pm- spend time with J. Clean up the place, watch some tv, shower, prepare for work.
10:45 pm- leave for work. Pray there is parking available in the employee garage at the hospital.
10:56 pm- clock in, begin 3 minute finger-tip to elbow scrub, lop off any nails that are too long. Find out assignment: am I in the NICU or the Intermediate Care Nursery? 2 babies or 3? Tonight: NICU & 2 babies.
11-11:30 pm- receive report from evening shift. Get interrupted umpteen times and answer a bazillion alarms. (Well, it just seems like it...)
11:30 pm- safety checks: Are monitor limits correct?, Ventilator settings correct? (if vented), Bag & mask at bedside?, Bulb syringe at bedside?, When are leads & feeding tube due to be changed?, When is crib due to be changed?, Is suction working?
Quickly chart safety checks and scan most recent notes in chart-MD, NNP (neonatal nurse practitioner), Social Work, etc for pertinant information. Answer alarms.
11:45 pm- head to "milk station" and mix up the formula or breast milk concoctions needed for my shift. Our recipes often look like this: MBM + HMF = 24 + 1/4 tsp BP/100 ml = 24 cal/oz. This translated is: Mother's Breast Milk (20 cal/oz) + Human Milk Fortifier = 24 cal/oz + 1/4 tsp BeneProtein = 24 cal/oz. Essentially, preemies need extra calories and protein when compared to healthy term infants. So we fortify MBM to give them the extra needed calories to grow. Stop 4 times to go answer alarms.
12:00 am- begin "care time" on baby #1, if parents are present teach/assist them. Wash hands. Assess IV (if has one). Draw labs, get blood pressure, take temperature, feel skull for fontanel (soft spot) and suture lines, listen to heart, breath sounds, bowel sounds, listen for placement of feeding tube in stomach. Is belly soft & pink? Check residual (how much undigested food is in the stomach from the feeding 3 hours prior). Look over skin for any rashes, bruising (from birth), pustules, area of breakdown (diaper rash, tape removal). Change diaper, weigh diaper. Wash hands. Redress, swaddle, & comfortably position baby. "Drop" feed via feeding tube (for a baby too little/weak to suck from a nipple). Wash hands. Turn off lights. Chart about baby. Answer alarms.
1:00 am- begin "care time" on baby #2. See above.
2-4:00 am- Go to break for an hour at some point in this time period. Catch up on reading the charts. Help other nurses with their babies if necessary-- help with linen changes, assist with an IV start, draw labs, fold laundry, track down formula that we're almost out of from distribution, hold babies still for ultrasounds, rock babies that need some extra loving, re-stock supplies. Answer alarms.
3-4 am- if baby #1 eats every 3 hours, do care at 3 am. If they eat every 4 hours or do not eat at all, do care at 4 am. Ditto with baby # 2 except at 4/5 am.
5 am- get MBM from freezer out to thaw for day shift. Work on updating each baby's care plan. Give updates on babies to Team Leader (charge nurse overseeing both NICU & ICN). Answer more alarms.
6 am- Baby #1 has care time again if 3 hour feeder. Otherwise, X-Ray is here! Don fashionable lead dress, do x-rays on own babies and babies of pregnant co-workers.
6:30 am- last minute "clean-up" for day shift. Enough diapers at the bedside for the next shift? Is the MBM thawed enough for me to fortify it for day shift? Did I get everything charted? Do I need to leave a note for the MD or NNP about anything?
7:00 am- Thank God day shift is here! Give report, while answering many alarms. (Babies really like to alarm, plus our alarms are very sensitive and we get lots of "false" alarms.)
7:30 am- clock out, scrub out, get out!
