Should Be Accomplished by the End of PL1 Year

NICU supervisory seminar

Training objectives:

Should be accomplished by the end of PL1 year:

 Ability to gather history, perform physical exam, generate problem list, formulate differential

 Gather and synthesize data into a report of daily progress and plan for ongoing care, present on rounds

 Primary care of the mild-moderately complex neonate

 Function as member of the resuscitation team

 Perform procedures

o Recongnize need to intervene o O2 delivery o BVM ventilation o Intubation o Chest compressions o Resuscitation drugs o Initiation of IV fluids o Vascular access (IV’s, UAC, UVC placement) o Management of Mec deliveries o NG/OG tube placement o Evaluate progress of resuscitation  Perform administrative duties (routine paperwork, TPN orders, patient orders, consults, radiology requests)

PL2 year training objectives:

 Lead a newborn resuscitation team for uncomplicated and complicated deliveries

 Perform all procedures necessary for care of sick newborn infants

 Primary care for infants with more complex medical conditions

 Ability to supervise and teach PL1’s and medical students

 Better understand physiology and management of complex medical problems Specific details involved in supervising in the NICU

 Learn that your role is more to supervise the interns and not to micromanage the interns

 Do not need to look over every number that is collected by the interns although I would encourage looking over specific numbers if they pertain to overnight issues or if it is crucial to that infant’s physiology.  Need to find out what happened overnight and if there is anything that is important to address before leaving for morning report. Talk to the nurses, be respectful of their opinions and confident in your decisions. Examine critical babies or infants in which something came up overnight. Do not need to examine every single baby in the unit.  You need to start seeing the big picture at this point. Try to understand the reasoning behind making certain decisions. During rounds, you may want to ask questions to direct discussion even if you are aware of the answers already (will drive discussion).  Prioritize and help the team to prioritize. You should know what orders are crucial to get addressed quickly and which ones can wait. Help interns to stay organized and on top of time management.  Know what needs to be checked back on through the day and go back to those things.

 Be more engaged with families at this point. Be more involved in the care of extremely critical infants.  Be supportive of the interns. Allow them to ask you questions and preround with them if they have questions or want to bounce ideas off of you before rounds. Your goal is to make your interns look good.  If the patient load is significant, help interns with notes/ number gathering/ rounding.

 Teach the interns procedures if you feel competent in doing them yourself (art sticks, IV’s, LP’s, umbilical lines). If you are not competent in them yet, it is okay for you to have the first shot at the procedure.  Take the lead in deliveries. Assign roles to the interns.

 Be in charge of the signout sheet/database. Make sure that things are up to date. Know what is important to be signing out to the oncoming night team so that things are not missed and help the interns to understand what things are not as important for signout so that it is efficient and purposeful.  Write watch notes if things change during the day/overnight.

 Keep track of who needs HUS/ROP exams. Keep up with immunizations, hearing screens, newborn screens and any other health maintenance issues.  Consider what patients really need weekly labs/ daily labs/ films