by Jerico

I've been an NICU RN for two years. I love NICU III and am technically very competent except other than a problem with emergency admits. I know this sounds stupid, but when emergent admits happen and all the personnel in the NICU "gather" and "take over" what is supposed to be my baby to admit...how do I get near the baby to LEARN to do this??? Now, admittedly this happened twice at a teaching NICU, so docs & NNPs get in the way because they all want experience, learning. BUT I need to LEARN, too!! People won't get out of my way, or they shout things at me way too fast that I don't understand (due to my inexperience and need to confirm for safety issues...) what do I do? I tend to just freeze up and back away, in tears as I get so frazzled and intimidated at all the confusion, as no one seems to be in charge, and everyone gets so impatient and won't SLOW down. I realize a baby needs all these things done quickly, but when I get near all the hub-bub I tend to shut down and begin to panic, as I get very intimidated. Any suggestions? I have helped resusitate a baby with one or two people helping and that does not bother me...but when there gets to be a crowd around and I don't know half the people, I just want to run away and hide! It is a terrible feeling and I haven't the guts to pipe up and say: "Go away! Because I am not sure who I may need and who I may not need. I do FINE working alone, or with one or two people, but when a crowd gathers and crap is flying everywhere, I just shut down. I need tips...

Re: Some pointers please...NICU admits

I am assuming that you work at a large hospital so I may not be much help. Our unit is a medium size NICU and I have worked here for a year. My best advice is pick a buddy. Pick a person who you feel has a lot of experience and seems to "get in there" during an emergency situation. Let that person know of your struggles and that you want to learn at these critical times; then during those situations you can pair with that person and "take over" together. It's hard for one person to take charge, but not when 2 people begin to complete the major tasks at hand. Then everyone else usually just falls in line with the petty tasks that you are already familiar with. Also, after these emergencies get with your "buddy" and go over what took place. Let them critique your skills and help you in areas that you could use some work. For all the other hoopla thats going on, try to shut it all out. Don't worry about what everyone else is doing. Keep focused on the task that you were given and do it to your best ability. Hope this helps and good luck!!!

Re: Some pointers please...NICU admits

Thank you.

I will do try that. Also, there does not seem to be any sort of "list" of what to do when the baby arrives and when I am stressed anything I remember goes right out the window.

If I had a list or at least a outline of a routine as to what comes first, and is most important, etc.

For example:

Check bed for set up, equipment etc.
When baby arrives-

1) attach leads, ox probe, temp probe
2) start IV line....
3) draw ABG...

Could you elaborate?

It is about the time the IV needs to be started that I kind of collapse, because I am so still so slow at starting IVs on itty bitties...and then someone will kind of shove me over and grab everything.

It all seems very rude to me, but it happens that way... They get impatient. So perhaps I should just have a "partner" start the IV and I do everything else?

Re: Some pointers please...NICU admits

My unit has a protocol on Vital Signs, frequency, and blood sugars on new admits. As a new grad, I also received a checklist of things I should have at my admit bedside and I added in every single item I would need to start an IV (tegaderm, needles, male adapters, saline flush, etc) so in the rush of an actual admission, I don't have to think about it and everything's already there. Also, I usually get duplicates of things like saline flushes, alligator clamps, etc to avoid running back to the supply room for simple stuff.

If I were to do a list, it would be something like:

1. Prior to admission arriving, set up bedside and all supplies.
2. Once baby arrives, hook up blood pressure cuff, attach leads/probe, and take temperature so you can take first set of vitals.
3. Do a heelstick (per our protocol).
4. Get a weight (docs usually want this right away so they can order proper dose of meds) and other measurements.
5. You've probably been assessing already if it's from the delivery room, but I would then complete any other assessment stuff.
6. After this, I play it by ear. The docs don't always order that we start an IV or want an ABG.

When I first started, I experienced the same thing where everyone would flock around the bedside and sort of take over, and I would do more observing. Now I still always have people just automatically come over, but they tend to ask what I need now. I do more of the hands on stuff, and they will do things like faxing orders to pharmacy or printing lab labels. Maybe just try delegating from the get go when people come over, so you can practice the skills you want to work on and feel more in control.

Re: Some pointers please...NICU admits

Thanks so much. It helps to know I am not the only one who felt this way! Now I think I can go in this knowing I CAN do it, I just need to delegate and at least appear to know what am doing...I think my hesitating signals to others I need help. Am perfectionist type and when I don't think I have something down "cold" I tend to avoid doing it. Appreciate the great input.