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This is a discussion on Is this normal? in NICU Nursing / Neonatal, part of Critical Care Nursing ... I am in my 4th month (just finished 3rd week being independent) of working in a level III NICU and...by Make.it.workRN Apr 7, '07I am in my 4th month (just finished 3rd week being independent) of working in a level III NICU and I am not sure I am a good fit. I work in an awesome unit, the other nurses are nice and it is a team atmosphere. The NM and other 'suits' are superb as well. I got great reviews from my preceptors and I think I am doing a good job.
Here is the problem, I can't distance myself from the sadness. Babies shouldn't be this sick. I am also concerned with the acuity of the babies and if I will catch the subtle hints that a baby is taking a bad turn. When I am off of work I worry that I missed something or that I said something wrong to a family.
I am having symptoms of anxiety and depression. I also think part of my problem is that I am not adjusting to night shift well (I get nausea and headaches when I work), I have been on nights 5 weeks. I guess I was wondering if this is a normal part of the overwhelming first year of nursing in combination with starting off in the NICU.
I would hate to leave the unit I am on, but then again I am not sure I can handle working there. My NM is great, but I don't want her to think I am a whiner. I also don't want to quit without talking to her to see if it could be worked out, I know they have spent a lot of time and money on orienting me.
I guess I just want to hear if others have gone through this and if it is a phase of the first year. Thanks in advance!Last edit by Make.it.workRN on Apr 7, '07
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- Apr 8, '07 by anniesongWell, I strongly believe that each nurse, while able to share many common experiences with others in the same place, is different and handles his or her experiences differently. Opportunities that are open to each person will be different as well. What you are feeling is important, and you need to do what feels right to you, and is a decision that you can feel good about.
I can, however, offer my experiences thus far...
As of tomorrow, I will have been in my level III NICU for 10 months (including my preceptorship). I'm still so new and green that I practically glow in the dark I, too, have had feelings similar to the ones that you are describing, and I'm told by my coworkers (who I find wonderfully supportive) that this is common and experienced by most, if not all, nurses new to NICU.
In the past, I've gone home and tortured myself on the drive home about things that have happened that day. My sleep schedule (8-hour nights at the time) was incredibly hard to deal with and keep on a proper schedule that I desperately needed. I'd wake up mid-sleep, I'd dream about work and hearing bed alarms in my dreams, and I'd even wake up with the feeling of "Oh no, I'm late to do a hands-on assessment of my baby!). There were times when I thought I was the only goof who had these experiences. I did wonder at times if I was experiencing depression or that "adjustment" difficulty that I've heard so much about that many new grads experience.
Well, turns out I'm not alone, thank goodness There were several things that have helped me out so far:
1) TIME! This is hokey and cliche, but also key. My life is far more settled now, I've gotten a handle on scheduling myself and my life to fit the way my life works right now. I gain more experiences and practice every day. I've had the time to experience and try the things on the rest of my list.
2) Taking care of myself. I made myself sit down and figure out what I needed to do to help myself feel better physically, so that I'd be in the best shape to handle this "whole new world". I tried different sleeping times and schedules until I found one that allowed me to get 7+ hours of sleep on the average night (Yup. I know some of my coworkers talk about getting about 4 hours between shifts. That is not for me. I simply can't do it, and know that I can't. I do not "beat" myself up about it, just work my life to accomodate what I know I need.). I do not routinely "switch over" to a day schedule, as I find that incredibly hard on my body. I also have been very limited on picking up extra time. When specifically asked to come in or stay, I've definitely done it if I've felt able to do so, but I haven't specifically signed up for many extra shifts. I value my time away from work just as much as my time in work, and tried to make a point to have a separation between them, especially this early on when burnout and being overwhelmed is so risky.
I did what I could to prepare meals ahead of time and freeze them, or portion out salad materials, fruit, snacks, etc. I had an "emergency" pair of scrubs on hand in case I realized at the last minute I hadn't done the laundry recently. Little things that made me feel more "in-control" of my life.
3) Having people to talk to. Just knowing that I wasn't alone in my feelings and experiences was wonderful. Talking to both fellow new grads and experieneced nurses that I've worked with has been invaluable. Having someone who will understand my feelings of frustration with certain situations, having someone to bounce concerns and ideas off of, etc. Having someone to double check something in an assessment that I was worried about (For example, I still sometimes ask someone to listen to a murmur and talk me through what I'm hearing and seeing about a baby with one). The glory of my NICU environment is that although I have my own assignment, I'm never really alone. I've got fellow nurses, the charge nurse, practitioners, etc there to help out.
4) Take advantage of opportunities. Our CNSs are wonderful. They make time to talk to us, answer questions, find out information, teach... When I had concerns about my charting, the CNS went though some of my charting with me, gave me pointers, gave me a "rough outline" she'd made up a few years ago for "typical" charting as well as "atypical" charting, etc. I've taken classes that were offered, picked up assignments that allowed me to learn and practice areas of care (all with resources nearby, of course), and gone to inservices and a conference to help gain experience and learn new information. These opportunities can be hard to find if you don't have much available at night, but that depends on your unit.
I'm also finding myself very willing to "float" to our well-newborn and special-care nurseries. Again, I feel better the more experiences I have and the more opportunities to learn that I have. The more I work in the other areas, the better and more comfortable I feel about floating, instead of seeing it as a "bad" experience, the way I know some people do (some really dread floating because of being a "fish out of water" in the other area).
5) Learn, learn, learn. If you feel concerned about assessment skills, and your charge nurse or fellow nurses are responsive, you can mention "I need experience in ____" and if they run across such an experience and have time, they can offer it to you. I've had nurses say, "Hey, want more experience changing lines?" or "Wanna hear a great murmur?" or "Want to observe a post-op assessment?" I bought the nursing handbook of neonatal care book and bring it in to work with me. It's always great to refresh myself in something or look deeper into what going on with a baby I have questions about.
6) When all else fails, make a plan or look for ways to adjust things in the future. I had a very rough time working 5 8-hour nights each week and every other weekend, I felt like I was either always at work, or always getting ready for work, and the only time I had two days off in a row was my weekend. After a few months a 2 12-hour shifts and 2 8-hours shifts each week and every 3rd weekend position opened up (still nights) and I jumped at it. Since then I've had much more flexibility (that extra day off really does make a difference) with my schedule and am finding time to do "stuff" that I'd missed, like seeing friends, making needed appointments, and am considering taking a "fun" class during the summer or fall (bellydancing maybe? Or photography). So I'm beginning to find a nice balance between work, required "life stuff", and fun.
I still have a looooooooooong way to go, and am reminded of that frequently, but I've found a "path" that works for me so far, and it's made me a much different person now than I was 4 or 6 months ago. I feel more confidant in my own skills, fledgling though they may be, as well as my ability to discern when something extends beyond my skills and I need to ask for help. One preceptor once said to me that asking for help is not a sign of weakness or poor nursing skill. Not asking for help when needed is. Took me a little while to find my voice and confidance in speaking up, but now after realizing that most of my coworkers are very open to teaching and helping and won't act negatively towards my questions... well, it's a good feeling
I know our situations are different. We likely have different responsibilities, different demands on our time and attentions, and different needs. Things that work for me may not work for you, and things that make a huge difference for you, I may never have thought of. But basically, what I wanted to say when I set out on this incredibly long-winded and likely boring (sorry!) post, is this:
You are not alone in your feelings. Your feelings are IMPORTANT, and nothing to be ashamed about - I would definitely NOT call you a whiner. It's far better to recognize challenges and feelings, as you obviously have done, than try to ignore and let them grow and grow. You are important - your health, your emotions, and your value as a nurse. And so I hope that you can have the support you need to succeed - however you need to
If I haven't scared you off with my ridiculously long post, do feel free to PM me if you have any questions or want an ear to talk toLast edit by anniesong on Apr 8, '07 : Reason: My mind works far faster than my fingers type!
- Apr 8, '07 by RainDreamerGreat post from the previous poster! Lots of great advice there.
It's totally normal to feel the way you're feeling!
I've been in the NICU for exactly a year now. When I was first on my own I felt just the way you described. I would go home and try to sleep, but constantly think about the night before, think about the babies I had taken care of, wondering if I had missed something or forgotten to do something important, or did something wrong. The day before I'd go back to work to start the next week I would totally dread it that whole day!! I felt like I was wasting a whole day off (and sometimes I would dread/worry about it the whole stretch of days off) by worrying about it so much. I was incredibly depressed and stressed out.
That was about 8-9 months ago. I can honestly say that it's A LOT better now. I don't stress about work nearly as much as I used to. I work tomorrow night but I haven't spent a single minute dreading or worrying about it today. Sure I get a little anxious that first night that I go back ..... wondering what kind of assignment I'll have, if it's something I'll be able to handle, etc. But it's not like the constant dread/worry/sick feeling I had months ago.
You mentioned the acuity of the babies. Are they giving you higher acuities than you feel comfortable with? You've only been on your own for 3 weeks now ..... you shouldn't be getting very high acuity patients. I know all units are different in how they assign patients to their new grads when they come off orientation and it really depends on their staffing, but don't let them give you something you don't feel comfortable with. When I first got off orientation they were giving me some heavy patients just because our acuity was extremely high .... our census was so high and all our babies were so sick. I said something to one of the supervisors though, after I was in tears from being so stressed, and she was wonderful and completely understanding! Please go to one of the supervisors, clinical leads, or whoever you feel comfortable with talking to and express these concerns and feelings you're having ...... tell them what you've told us.
I hope it turns around for you like it did for me. I know everyone says it'll get better and it's hard to believe that. I remember all too well what it felt like. Like I said I don't dread and worry about work as much as I did .... I don't get all anxious and sick to my stomach and worry about it all weekend like I used to. I can't tell you when exactly that changed, but it's been a few months now that I feel a lot more comfortable and confident. I hope that happens for you soon ..... I hope you get the same joy from work that I do now. I hope one day soon you'll actually look forward to going to work and be able to say "I LOVE MY JOB!" I NEVER thought that would happen to me, I seriously didn't ..... I thought something was wrong with me because I dreaded and hated my job and what I did. But a couple of months ago at work I was able to say "I love this! I can't believe I get paid to do this, I love it!"
(((((HUGS))))) Good luck to you. Please let us know what happens. I hope you feel better soon!Last edit by RainDreamer on Apr 8, '07
- Apr 8, '07 by Make.it.workRNThanks you both for your responses. I am going to stick it out because the unit is awesome and I thought about it a little more today and I do think it is the newness. I am going to give it a full 6-8 months, then revisit how I feel. In the meantime I plan on getting on track with taking care of myself by eating right and exercising and enjoying my family.
- Apr 14, '07 by RN4BABESI am in my 18th year of NICU nursing (same unit) The memories of that first year are still pretty clear. I was petrified when I started....scared I would miss something, I hated answering the phone, I would shy away from the admission area in case I was asked to do something....
I would do silly things when I was off work such as dream crazy stuff at night, smack my husband and say "You were not allowed to bottle-feed that baby!" or jump up when my alarm clock rang and say "It's mine, I got it...everything's okay here...baby's fine..." Needless to say my husband thought I'd lost my mind. Same thing when the microwave beeped. I'd call the beep as if it was my baby's heart monitor. My husband would say "I know it's the microwave, it's okay". Eventually these dreams of missing a baby's feed or forgetting to come to work went away. For the first year of shift work, I was either constipated or extremely gassy. Now I have worked for so long, my body knows what to do when.
Every day in the NICU is a learning experience. If I were you, I'd write all these feelings down and surely in a few years, you'll be able to laugh at them and share them with other new new grads. I really liked reading what the other people had to say about getting control of your life. I thought the advice was great. I never thought I would make it through that first year but I did and there's no other job I would do other than this! Give yourself a chance...