NICU duties

RNin2007 · Dec 21, 2005

This is packed with such great info. Should be a sticky for all those wondering about NICU.

~J (student nurse, hopeful NICU RN!)

CyndieRN2007 · Dec 21, 2005

I would love to end up working in the NICU. How much experience is usually required befored being hired on a NICU floor? I'm a PN graduate/RN student assessing all the possibilities after graduation. NICU sparks my interest the most.

Gompers, BSN, RN · Dec 21, 2005

I would love to end up working in the NICU. How much experience is usually required befored being hired on a NICU floor? I'm a PN graduate/RN student assessing all the possibilities after graduation. NICU sparks my interest the most.

It seems 50/50 - half of the NICUs out there hire new grads, the other half want experience. The reason some don't mind having new grads is that you don't learn NICU in school and you don't get experienced at it working in another unit or on another floor - so a new grad is just as good as an experienced nurse from, say, adult med-surg. You actually have to un-learn some things, especially if you worked with adults.

If the hospitals around you don't hire new grads into the NICU, try for post-partum/newborn nursery (mother/baby units) or pediatrics. Med-surg will help you use your nursing school education and teach you how to organize yourself, and lots of nurses choose to do this to get a good background.

I started in the NICU as a new grad, and 75% of our new hires are new grads.

Bailarina · Dec 28, 2005

Being on a ventilator is uncomfortable for anyone, even babies. I've never been awake and intubated myself, but I can't imagine it's comfortable at all. You can't move any which way you want because of the tube, and it's pretty large in proportion to your throat. So yeah, probably irritating and a little painful too. There is also suctioning, where you pass a suction catheter down the tube and suck the secretions out of the lungs. That is VERY irritating. There is also the issue of sedation - it's natural to want to pull that tube out - it's like a basic reflex, I think. So if you sedate the patient, adult or baby, they're less likely to be trying to pul the tube out.

Hi Gompers, I was just wondering if you have seen a decrease in the incidence of head bleeds with the regular sedation?

Gompers, BSN, RN · Dec 28, 2005

Hi Gompers, I was just wondering if you have seen a decrease in the incidence of head bleeds with the regular sedation?

You know, it's kind of hard to tell. Over the past few years, our pain/sedation protocols have gotten better, but we've also had smaller and sicker babies surviving. So we still seem to have about the same amount of IVH - however we are seeing less grade IV bleeds than before, and fewer bleeds severe enough to require shunting.

Two things that we are doing to decrease incidence of IVH involve preventing cold stress at delivery and keeping the head midline as much as possible. We're placing micropreemies right into plastic bags in the delivery room, leaving only their heads out (with hats on) for intubation, and they've been staying much much warmer than ever before with this method. Then, instead of turning the baby's head every few hours, we try to keep the head midline as much as possible, because there is talk that there is compression on the vessels in the neck/head if the head is turned too far to one side.

Mimi2RN, ASN, RN · Dec 28, 2005

I work in a level 2, and I have learned so much from all these NICU threads. It is fascinating to me, to see how much variety there is in the way we care for our babies.

I read about Vapotherm a year before we got them, and we really have had good success. The babies are much happier than on regular CPAP. I'm hoping that the recall doesn't last long!

We average 2-3 babies per shift in my unit, our stepdown ratio is usually 3-4.

We don't keep micropremies or surgical cases. Our limits are usually 27-28 weeks and a kilo in weight.

Gompers, the info about keeping babies with their heads midline-is that just from your unit, or do you know of other research?

bethin · Dec 28, 2005

On average, how much pain medicine (in mg) do you give to a preemie? I know it depends on weight but it seems like it would be an itty bitty amount.

As for being intubated -- I woke up after surgery still intubated. I felt like I was suffocating so I could see why these little babies need medication. Just because they don't have the strength to scream or the ability to speak doesn't mean they aren't in pain.

Gompers, BSN, RN · Dec 28, 2005

On average, how much pain medicine (in mg) do you give to a preemie? I know it depends on weight but it seems like it would be an itty bitty amount.

Basic starting bolus doses - morphine can be up to 0.1mg/kg, fentanyl is 1-2mcg/kg. For drips, we usually start morphine drips at 0.05mg/kg/hr and fentanyl at 1 mcg/kg/hr.

If the baby's pain scores are increasing or the baby isn't tolerating handling, we'll either increase the drip or give an additional bolus before handling. If the baby is on the same dose for several days and is still critical or post-op, we'll increase the drip because they develop a tolerance to the narcotics. If the baby is getting better and may be extubating soon, we'll leave the drip where it is and then start weaning it 1-2 times a day.

Gompers, BSN, RN · Dec 28, 2005

I read about Vapotherm a year before we got them, and we really have had good success. The babies are much happier than on regular CPAP. I'm hoping that the recall doesn't last long!

Tell me about it! We're using the Fisher Prikel (sp?) version of it at the moment instead. We trailed both and decided on Vapotherm because the tubing is more flexible and there is a back-up alarm in case something gets disconnected. The babies don't seem to be doing as well on this brand as they were on the Vapotherm though (more apnea, needing to increase pressure, etc.) so I hope we get it back soon, before we have to resort to CPAP. Our CPAP is soooo old - we use the Sechrist vents and do either CPAP or cycled CPAP, and use the 4cm prongs that go to the back of the throat and need suctioning Q4-6H. YUCK!

Bailarina · Dec 28, 2005

Gompers, the info about keeping babies with their heads midline-is that just from your unit, or do you know of other research?

We also keep head mid-line for 96 hours and initiate a minimal stimulation protocol for babies less than 32 weeks.

Mimi2RN, ASN, RN · Dec 29, 2005

We also keep head mid-line for 96 hours and initiate a minimal stimulation protocol for babies less than 32 weeks.

Thanks, we recently had a little 27-28 weeker with a grade 4 bleed. I'm wondering if this would have helped prevent that. We do minimal stim on these babies, keep them in a quiet room, but I don't think that we sedate as much as we could. Usually we only give Versed, sometimes Fentanyl, but that's on the bigger ones.

EvaLuna · Aug 31, 2008

Hi all,

I'm new to this thread and new to specialties as well. I've been struggling with the decision of where I'd like to focus my nursing. So far I've really enjoyed NICU and O.R. The university I'm graduating from gives us 220 contact hours on a specialty of our choice and my time to decide is coming soon. This is a top-notch university and they offer this option to nursing students so that they can hopefully have an edge towards entering the specialties. My question is, is it easier to begin O.R nursing and then transfer to NICU? Or is it simpler to begin in NICU and transfer to O.R? I really enjoy both but I don't want to pigeonhole myself into one or the other. As an LVN I worked at San Diego's Children's Hospital in the O.R/ PACU and loved working Peds. But I always found the NICU a rewarding challenge I would not mind undertaking. Also, is there a difference in amount of employment and transferability of one specialty over the other? A O.R. nurse friend of mine once told me that O.R. specialization is more transferable (i.e. from state to state) and that there are more positions to be found than NICU. Is this because there's less attrition in NICU :wink2: ? This aspect is important because my husband is military and we move often. Sorry for the long question...I admire the work that you perform on a daily basis :bow: perhaps I may be able to join your ranks soon. Any reply is appreciated...Thanks in advance...