Sh!t Happens
This post is actually being written at the request of my coworkers. Plural. More than one asked last night. You'll need a little background to understand, but they assured me that my misery should not be self contained; but rather, placed out into the world for all to enjoy. I'm a special care nursery nurse. I take care of premature and sick babies. Last night my patient assignment consisted of 2 babies. They had feeding tubes in place and would only be attempting to eat by bottle 1 time each for my entire shift. It should have been an easy night. Of course, it wasn't. You see, I've also been dubbed the human laxative. Last night I was having a particularly productive night, much to the unending delight of my loving and supportive colleagues.
In an effort to try and promote growth, especially for our most fragile patients, we try to let the infants sleep, only waking them for care time. That's when we do our assessments, vital signs, feedings, changes, etc. We try and schedule any procedures, lab work and medications around this time as well, giving them 3 hours of straight sleep in between. In an 8 hour shift, we generally have 3 "rounds" of this. Like boxing. Or at least, it is in my case.
Round one. This is generally the round we try to weigh the babies at night. Any full assessments are usually contained in this round as well. Then, if the rest of the night should become crazy with admissions, deliveries, or sick babies, at least you've completed the lion's share of your assignment. I began with the smaller of the 2 babies. She was in an isolette, which is essentially a plastic box with sides that drop down. Small babies are placed in here as we can control the heat, making it as warm as they need. It also serves to dampen the sounds of the nursery, promoting better sleep for the babies we lovingly refer to as feeders and growers. Unless we are taking the babies out, any care is performed through portals (small arm holes) to keep as much heat in as possible. Everything was proceeding as planned. Her assessment was unremarkable, vital signs were fabulous, her milk was heating in the warmer. I was even slightly ahead of schedule. All that was left was to change her, weigh her, and hook up her feeding. I should have known.
Whenever I am teaching a parent to care for their baby, I start by sharing what things I am concerned with and what things I am not. I'll say "Your baby has a tenuously placed IV right here. Try not to wiggle, jiggle, or pull it. Obviously the oxygen works better if she keeps the prongs in her nose. That feeding tube is her 33rd one of the day. She has figured out how to rip it out and it is her new favorite past time. All of these things I want to protect. Mostly everything else on her is stickers and wires sending information to her monitor. Don't worry about those at all. Seriously. They'll get in your way, but they aren't anything I want you to worry about." Then I share what I consider to be the most valuable piece of information I can give these parents. Do not EVER change a dirty diaper without a clean one underneath, just in case. Once you remove the dirty diaper, you have one right there ready to go.
As I prepared to change my tiny cherub, I was ready. I thought. As it turns out, she was more prepared. She shot poop everywhere my friends. Everywhere. All over her bedding, new diaper, old diaper, my gloved hands, and dripping down the walls of her isolette. When I gave report the following morning, I made sure to say that though she was only up 5 grams from the night before, I am certain if I had weighed her one diaper change earlier, her weight gain would have been more significant. I hooked up her feeding and moved on to my second opponent. Uh, I mean, baby. Thankfully, she only felt inclined to pee on the scale. Much more manageable.
Round two. As you may understand, I was now wary of my first baby. One of the nurses who had less feedings than me took pity and offered to do her care for that round. She, of course, emerged unscathed. Feeling like I had dodged a bullet, I moved on to my other friend. I had bottle fed her the round before, so this was going to be a cake walk. She was not in an isolette. There was no protection. None. So committed to her cause was she that she shot over the crib, hitting the floor. This was only appropriate I suppose as my colleagues hit the floor next. While I am standing in the middle of a literal shit storm, these 2 women who are supposed to be the essence of care and concern, are of no help to me with tears streaming down their faces while they laugh at the show I am presenting. Several minutes of the night are lost to the perceived hilarity of the situation. Word spreads quickly throughout maternity and labor and delivery of my nursing prowess. On the bright side, though I had previously scribbled on my notes that the baby's belly was slightly distended, I was now able to cross that off.
Round 3. With just one final round to go, I am now terrified of my tiny charges. Though together they weigh less than the bag I bring to work every night, they have proven to be worthy opponents. They are quick, and they are loaded with high calorie breastmilk. (For smaller babies, we often add calories to their feedings to help them gain weight quicker while still taking small volumes of food). They have proven to have no scruples and seem to now believe it is their sole responsibility to amuse and entertain the women I am working with. I am visibly shaken. I suggest that we place them in the isolation nursery, cover the walls with sheets, and take off their diapers. Have you seen what passes for abstract art these days? I am convinced with creative marketing and an exorbitant price tag, we can sell these pieces and retire on the spot. One nurse suggests we label it as scratch and sniff artwork. I believe a 4D art immersion experience will sell better.
I escape relatively unscathed. Sure, the first one tried to get me again. I just managed to catch it all. I am undecided at this point if my reflexes have picked back up, or if she is slowing down for the night. I do not care. For the safety of the nursery, and perhaps because my coworkers really DO love me just a little, my last baby's feeding is covered by someone else. Again, unremarkably.
So here's to you ladies. May you enjoy laughing now as much as you did in real time! And to the two beautiful babies who kept us so entertained last night, I am back on tonight for the third night with you. For the love of God, show some mercy!
In an effort to try and promote growth, especially for our most fragile patients, we try to let the infants sleep, only waking them for care time. That's when we do our assessments, vital signs, feedings, changes, etc. We try and schedule any procedures, lab work and medications around this time as well, giving them 3 hours of straight sleep in between. In an 8 hour shift, we generally have 3 "rounds" of this. Like boxing. Or at least, it is in my case.
Round one. This is generally the round we try to weigh the babies at night. Any full assessments are usually contained in this round as well. Then, if the rest of the night should become crazy with admissions, deliveries, or sick babies, at least you've completed the lion's share of your assignment. I began with the smaller of the 2 babies. She was in an isolette, which is essentially a plastic box with sides that drop down. Small babies are placed in here as we can control the heat, making it as warm as they need. It also serves to dampen the sounds of the nursery, promoting better sleep for the babies we lovingly refer to as feeders and growers. Unless we are taking the babies out, any care is performed through portals (small arm holes) to keep as much heat in as possible. Everything was proceeding as planned. Her assessment was unremarkable, vital signs were fabulous, her milk was heating in the warmer. I was even slightly ahead of schedule. All that was left was to change her, weigh her, and hook up her feeding. I should have known.
Whenever I am teaching a parent to care for their baby, I start by sharing what things I am concerned with and what things I am not. I'll say "Your baby has a tenuously placed IV right here. Try not to wiggle, jiggle, or pull it. Obviously the oxygen works better if she keeps the prongs in her nose. That feeding tube is her 33rd one of the day. She has figured out how to rip it out and it is her new favorite past time. All of these things I want to protect. Mostly everything else on her is stickers and wires sending information to her monitor. Don't worry about those at all. Seriously. They'll get in your way, but they aren't anything I want you to worry about." Then I share what I consider to be the most valuable piece of information I can give these parents. Do not EVER change a dirty diaper without a clean one underneath, just in case. Once you remove the dirty diaper, you have one right there ready to go.
As I prepared to change my tiny cherub, I was ready. I thought. As it turns out, she was more prepared. She shot poop everywhere my friends. Everywhere. All over her bedding, new diaper, old diaper, my gloved hands, and dripping down the walls of her isolette. When I gave report the following morning, I made sure to say that though she was only up 5 grams from the night before, I am certain if I had weighed her one diaper change earlier, her weight gain would have been more significant. I hooked up her feeding and moved on to my second opponent. Uh, I mean, baby. Thankfully, she only felt inclined to pee on the scale. Much more manageable.
Round two. As you may understand, I was now wary of my first baby. One of the nurses who had less feedings than me took pity and offered to do her care for that round. She, of course, emerged unscathed. Feeling like I had dodged a bullet, I moved on to my other friend. I had bottle fed her the round before, so this was going to be a cake walk. She was not in an isolette. There was no protection. None. So committed to her cause was she that she shot over the crib, hitting the floor. This was only appropriate I suppose as my colleagues hit the floor next. While I am standing in the middle of a literal shit storm, these 2 women who are supposed to be the essence of care and concern, are of no help to me with tears streaming down their faces while they laugh at the show I am presenting. Several minutes of the night are lost to the perceived hilarity of the situation. Word spreads quickly throughout maternity and labor and delivery of my nursing prowess. On the bright side, though I had previously scribbled on my notes that the baby's belly was slightly distended, I was now able to cross that off.
Round 3. With just one final round to go, I am now terrified of my tiny charges. Though together they weigh less than the bag I bring to work every night, they have proven to be worthy opponents. They are quick, and they are loaded with high calorie breastmilk. (For smaller babies, we often add calories to their feedings to help them gain weight quicker while still taking small volumes of food). They have proven to have no scruples and seem to now believe it is their sole responsibility to amuse and entertain the women I am working with. I am visibly shaken. I suggest that we place them in the isolation nursery, cover the walls with sheets, and take off their diapers. Have you seen what passes for abstract art these days? I am convinced with creative marketing and an exorbitant price tag, we can sell these pieces and retire on the spot. One nurse suggests we label it as scratch and sniff artwork. I believe a 4D art immersion experience will sell better.
I escape relatively unscathed. Sure, the first one tried to get me again. I just managed to catch it all. I am undecided at this point if my reflexes have picked back up, or if she is slowing down for the night. I do not care. For the safety of the nursery, and perhaps because my coworkers really DO love me just a little, my last baby's feeding is covered by someone else. Again, unremarkably.
So here's to you ladies. May you enjoy laughing now as much as you did in real time! And to the two beautiful babies who kept us so entertained last night, I am back on tonight for the third night with you. For the love of God, show some mercy!
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