[marnie]

I posted a message here about a month ago, looking for advice about becoming a NICU nurse. Kristi was wonderful about giving me a lot of information, and it was a great help! (Thanks Kristi! ) I will start in a level 3 NICU in two weeks. It’s a 30 bed (isolette?) unit, and there’s also a 20 bed intermediate care NICU.

Of course, even though I’m very excited, I’m also scared! The one thing I kept asking the nurse manager about was the orientation/training. She said there is a three month long training period that combines classroom learning and time with a preceptor. This is very comforting to me, but some friends (nurses, but not in ICU areas) keep telling me that I’m dreaming if I believe that the orientation will last for three months. What is the normal length for orientation to the NICU for a nurse who has never worked in this unit?

[SheaTabRN]

I'm in a 12-16 week orientation...

[NICU_Nurse]

Marnie!!! You got the job! I'm so excited for you!! Will you be working solely in the Level III, or do they float you? Tell us what you did to prepare for your interviews! The last time you'd posted, you were just signing up for NRP I think...? Give us the scoop!

I think 3 months is fabulous, but don't be surprised if you're taking patient assignments practically from the start- hopefully you'll have a wonderful preceptor who will act as a resource for you; someone who will be there to answer questions and give assistance when needed, as opposed to doing it herself.

Personally, I've found NICU nurses to be a particular kind of breed- we're extremely protective of our babies! Because of that, I've met SO many wonderful people who went out of their way to help me learn, rather than that throw-you-in-and-watch-you-drown thing you find in some other areas. You'll do fantastic!!!

Usually, when they say 'bed', they mean either Isolettes, Radiant Warmers, or open cribs (depending on the baby). You will likely have a nice mix of all three. For instance:

A 24 week preemie who's vented and has umbilical lines and lots of drips would be on a RW so that you can have easy access to them (for routine care and emergency situations)- the radiant warmers have an overhead (radiant) heat source, but are open on all four sides so more than one person can get in there without the walls/doors getting in the way (like in a code situation).

A 32 weeker with reflux who's receiving, say, oral antibiotic therapy but has no IV's or maybe one peripheral IV, might be in an Isolette. They're more stable, so you don't need to have them open to you, but maybe they need that heat source from the Isolette because they're still gaining weight.

An older baby or chronic baby who is maintaining their temps without assistance from a heat source would go in an open crib (sometimes, depending on how large they are, you'll have the cribs you've seen in the Well Baby nsy or they might have a large Pediatric-sized crib). For instance, a baby who has a trach and is vent dependant, is eleven months old, and relatively stable (but can't breathe without that vent) may be in a larger crib.

That's a pretty large unit (for this area, anyway!)! We've got a little over half that capacity in our level III (but the ones we get are really, really sick). You're bound to be working with some experienced nurses, and with a large unit like that, there should be no shortage of others nearby to help you out.

Good luck! Tell us more!!!

(((((((((((((((hugs to you for kicking interview butt))))))))))))))))

[TiffyRN]

I've worked at a level III NICU for just over a year now. We really do orient people for 3 months solid. You are only released from orientation then if you have completed a skills checklist and state that you feel comfortable going off orientation. You do start taking over an entire assignment as the orientation period ends but always with a dedicated preceptor that shares only your assignment. The only "stretch" of this I've seen is if there is a heavier assignment the preceptor may volunteer to take this as the preceptor/orientee assignment have more "manpower" in their assignment. But the preceptor would only do this if he/she felt it wasn't shortchanging the orientee in needed experiences. Our hospital also offers classroom sessions to accompany the floor orientation though the subjects are not really coordinated. The only people that don't get the 3 month assignment are individuals that have previous experience.

[marnie]

Thanks for your replies! I feel a little better now. When I worked on a med-surg unit, I had that “throw-you-in-and-watch-you-drown” experience. I’m really glad that NICU is different. After all, these are tiny helpless babies!

I’ve been hired for a position in the level 3 unit, but they float nurses back and forth between level 3 and the intermediate nursery. Hopefully, by being trained for the higher level unit, floating to the intermediate unit won’t be as overwhelming.

There are a lot of nurses on the unit who have been there for a long time. I’m hoping to find some good role models, and to ask lots of questions to learn as much as I can.

To prepare for interviews, I took the NRP course, and I’ve been reading everything I can get my hands on! I bought just about every book that has been recommended on this board. My credit card bill is at an all time high! But these books are definitely a good investment. There is so much to learn-it’s amazing.
I’ve been reading old posts on this board, and it’s so nice how the “older” nurses encourage the new ones. It’s also fun to see how those who used to be new have become experienced and confident. I’m sure I’ll have a LOT more questions after I start the new job...it’s nice to know you all are here for answers and support!

[CallaRN]

They're testing a new RN Residency Program at my hospital in hopes to recruit and retain new nurses...It's 6 months and a combination of (4) 6-hour classes per pay period and the rest of the hours made up in regular 12 hour shifts. We also have unit specific classes that are really great! I'm lovin it so far, and the classes are great, sometimes it feels like a little too much like college. All new grads from the whole pediatric hospital go, so sometimes I'm learning about scoliosis or guilliane barre knowing i'll never see this in my unit, but everything is all "GOOD TO KNOWS". 6 months seems long, but we're not getting as much clinical experience because of classroom time. After almost 2 months, I'm starting to feel some confidence on the unit, but I know that I will need much more time to learn as much as I can before I'm on my own.... WE're a level III/IV, so the acuity it very high. Good luck to you in your NICU... I"m sure you will love it, and take each day to learn something new!! Offer help to other nurses, starting IVs, foleys, etc... Enjoy it!!! and always make time to cuddle those little ones!!!

[marnie]

Wow, that sounds great. I always wonder why all hospitals don't invest in a really good orientation program. It seems like too many new nurses are thrown into situations they aren't prepared for and then end up discouraged, and leave. If the hospitals spent the time to make their nurses feel comfortable with their skills, there might not be such a shortage of nurses.
What's a level IV unit? I didn't know they went that high!
I'm glad you're starting to feel a bit confident already. That's great! Good luck to you too! And thanks for the advice-not just about learning everything possible, but also to enjoy it. I sure will make time to cuddle those little cuties!

[CallaRN]

Now I'm comfused...bc is there such thing as as level IV??? I swear thats what they call my unit...I'll have to ask again tomorrow!!! We are the cardiac referral center...we also do ECMO, and INO...We have an ALS RN led transport team....hmmm.... I really dont know about the level III/IV... I'll let you know!

[nicudaynurse]

I think that some NICU call themselves level IV because they do hearts and have ECMO, but I am not sure if that is an official level. Most textbooks will describe NICU as level I, II, or III.

[rox4synch]

Hi,
Yep....Level IV is "official" and it is because they do surgeries, cardiacs, ECMO, etc. They are designated at this level due to some "specialty". About 3 yrs ago, the 50 bed unit I work in was "reclassified" from a Level III to a IV. We get transports from other Level III NICU's.