I feel so stupid in the NICU, will I ever be good enough?

  1. Hey everyone I just started in the NICU with no baby experience. I came from 7 months of med surg experience and am finding everything so difficult. I've been on 4 preceptored shifts so far and every time I come home crying. I feel like I'm too stupid to be there... I feel like there's just SO MUCH to know and I don't know it all yet. I come across new things everyday and it gets me so anxious because I won't have a preceptor soon to help me... I'm on my 4th shift and am taking 2 babies out of 4. The girls that's started with me are super excited they say they're having so much fun and that they love it. I absolutely love the babies but I'm falling back on the time management piece. Babies need to be bottled then one cries then one wakes up then one etc. I just feel so stupid. My preceptor said I can't possibly know everything in 4 shifts she felt comfortable at 8 months to a year. I know there's help everywhere but what happens when a baby needs to go to the OR or I have an admit or etc and I've never done it ... gives me so much anxiety (( is this normal??
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  2. 6 Comments

  3. by   jennylee321
    It is a huge transition coming from med surg from NICU, but it can be done and what you're feeling is normal.

    What will you do the first time you send a baby to the OR or do an admission? You will get help from your colleagues and charge nurse. They are not going to hit you with that kind of stuff right when you come off orientation (we can hope). So next time you see a baby booked for OR, ask the nurse who has them what the steps are. Admissions to NICU are pretty frequent occurrences so take every opportunity you have to help with them. After you've helped with these activities, take the time to make yourself up little checklists. That way next time you get an admission you just whip out your checklist.

    Time management is very different in NICU compared to med surg so be open to completely changing the way you manage your time. On a med surg floor, you would be doing a round a vitals, a round of meds,ect. In NICU you want to cluster as many things as you can. Each time you are about to go into the bedspot think of all the things you can get done in that interaction. For example if you've got an antibiotic due at 1000, in addition to giving that med you should be thinking about the following things that can also be done: checking your lines and rates, charting your vitals, checking IV site (this is a given since your about to give an IV med), do your pressure release of the CPAP mask/prongs (if this is something you do on your unit), if the baby has been unsettled take this time to get in there and reposition them/offer pacifier.

    When you have your feeds/cares/assessment due, I recommend always starting them early especially when you are new because if you don't your feeds start to fall behind and that will just make you stressed.

    A well stocked bedside goes along way, try to make this part of your morning routine as it will save you a lot of time later so you're not running off to the storeroom all day. Same goes for cares, make sure you have everything ready before you go in that incubator (ie. diaper, wipes, thermometer, feed, ect.)

    Going back to what I said about having a morning routine, I'll expand on this a bit. Unless I am handed over a very sick baby who needs immediate attention I like to start off with the following:
    -fill out whatever brain sheet I'm using, often just a divided piece of paper these days (I do this mostly during report but will add in anything else after report)
    -read most recent MD/nurse note ( I realise when your new you might not always have time for this but it is helpful especially for rounds)
    -check my orders, check my med doses on the formulary/ check any unfamiliar meds
    -check most recent labs, plan any labs that I may have to do this shift
    -safety checks (including checking when my lines are due)
    -acuity tool
    -check fridge to see if I have enough defrosted milk to get me through my shift and see if/when I should pull out milk for the next shift
    -stock and clean my bedside (if I have time, might have to leave this cleaning till later depending on the day)

    Quick note about bloodwork- ask yourself and the provider how urgent this lab is, if what they are ordering is routine you shouldn't be disturbing a settled baby to take it, try to cluster bloodwork with your cares

    Brain/Day Planner- all new NICU nurses should definitely be using one whether your unit provides something or you find one/create one. If you search all nurses there is a good NICU brain that was posted way back

    Lastly, the amount of information to learn in NICU can be overwhelming but you don't have to learn it all at once. Take responsibility for your own learning, get a neonatal textbook, print off your units policies and read them at home.

    I know this is a lot of info but I hope it is helpful, hang in there!!
  4. by   rnkaytee
    First of all - I'm kind of glad you're scared and worried, it lets me know you realize what is at stake! I felt the exact same way - I remember going home one morning just thinking I would never get it, I was in over my head, etc, etc. Now I'm an NNP with almost 18 years in the NICU and I love it - can't imagine doing anything else. You'll get the time management piece - 4 babies is a lot on your own anyway. I agree with Jennylee above - start observing the disease states/medications, etc. you are coming across and take learning into your own hands.
  5. by   tmjwe3
    Thank you so much. I actually went into clinical today with a note of what you said! I mean my shift today was still really anxiety provoking. When you change the baby, feed, burp get so confused on what to do next. I took on the responsibility of one patient fully. I did TOA and everything. It was scary but I survived. I don't know how I'm going to handle the 4. You guys have given me motivation though, thank you so much for taking the time to write all these tips I will always appreciate it. Im just going to hang in there, I don't want to give up because this is my passion. I too want to pursue my career as an NNP. I am going to try and bust my butt off!
  6. by   Lyfling83
    Oh my gosh, no! I started in the NICU right out of school. 4 shifts? Hell, our training for working in the NICU was 4 months long. Classes and preceptor shifts. And even then I didn't feel comfortable doing everything! That's when you ask, ask, ask for help. Ask a nurse who has been there forever, ask your admission nurse, or your charge nurse. You couldn't possibly know everything right away! But with time you will start to feel comfortable. Hang in there!
  7. by   vintage_RN
    I came from the adult world with no baby experience. For the first little while I felt pretty dumb too. I'd been successfully taking care of critically ill adults, mentoring students and being a "go-to" person on my unit for 4 years and now I was the clueless newbie again. I can relate. I assure you, it gets better. I felt completely comfortable with intermediate level assignments after 3 months of being on my own. I had a month preceptored before I was on my own. My advice is don't be afraid to ask questions, it's better to ask than to be afraid of looking dumb and not asking. If it helps, this is my routine:

    I come in and get report on my babies and then scrub in. Then I go to each bedside and wipe everything down with a virox wipe, all surfaces, the monitor, the outside of the isolette, the counter etc. Then I do my safety checks and make sure that the bag mask is hooked up and working, suction is hooked up and working and that I have the correct baby mapped to my monitor. I check my fluids and rates, and calculate my TFI's to make sure they're correct. The above poster is correct in that we do clustered care. Meaning that if a baby is due for a feed at 9 but they are asleep, I'm not touching them. I just hook up their feed. I only handle babies when they are cueing and awake. Now I am in a level III (highest in Canada) which means I have mostly sicker or preemie babies...but we do have a level 2 around the corner which we all work in also. Level 2 is hard if you have 3-4 bottlers, in this case I start approx. 45-30min early and I wake these babies up to feed...they are term or ex preemies so I'm not too concerned about disturbing them as I am with the preemies. Try to cluster as much as possible when you touch that baby...meds, assessments etc. and if that baby is sleeping next handle time than don't touch them (unless your hospital policy states otherwise).

    Hang in there, you will get this! NICU is a whole other world
  8. by   babyNP.
    Totally normal what you're feeling. Hang in there. I cried a few times on orientation too- even spent an extra couple of weeks on orientation when I didn't pass one of the tests we took.

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