Neonatal Nursing is the specialty of caring for the tiniest of patients and their families. Leading patients and families down an often long and circuitous route to a successful homecoming is the ultimate goal of all NICU nurses.
Neonatal nursing covers nursing of the neonate - infants from birth to age 30 days as well as neonatal intensive care nursing and the neonatal step-down unit. Usually when one thinks of neonatal nursing, it is focused on the Neonatal Intensive Care Unit (NICU). As the age of viability has decreased over the years, there are more and more low birth weight and premature infants being born and requiring intensive care.
There can be many reasons that an infant would be admitted to the NICU:
- Congenital cardiac abnormalities
- Cerebral palsy
- Diaphragmatic hernia
- Fetal alcohol syndrome
- Drug addicted babies
- Low birthweight infants
- Meconium aspiration
- Respiratory distress
- Chromosomal abnormalities
As in other pediatric specialties, you are caring for the infant as well as the parents and family unit. Nurses who work in the NICU must enjoy the education aspect of nursing care since rarely do parents know what happens in a NICU prior to their child's birth. It is imperative that the nurse can easily relate and gear the education to the parent's education, socieoeconomic status as well what information they can process at this time. Infants being cared for in the NICU can have a very stormy course with many highs and lows. It is often necessary for the nurse to understand palliative care as well as the usual course of the more common diagnoses.
There is much disparity in the levels of care that NICUs provide ranging from Level 1 to Level IV;
"Level I facilities (well newborn nurseries) provide a basic level of care to neonates who are low risk.
Care in a specialty-level facility (level II) should be reserved for stable or moderately ill newborn infants who are born at ≥32 weeks' gestation or who weigh ≥1500 g at birth with problems that are expected to resolve rapidly and who would not be anticipated to need subspecialty-level services on an urgent basis.
Evidence suggests that infants who are born at <32 weeks' gestation, weigh <1500 g at birth, or have medical or surgical conditions, regardless of gestational age, should be cared for at a level III facility.
Level IV units include the capabilities of level III with additional capabilities and considerable experience in the care of the most complex and critically ill newborn infants and should have pediatric medical and pediatric surgical specialty consultants continuously available 24 hours a day. Level IV facilities would also include the capability for surgical repair of complex conditions (eg, congenital cardiac malformations that require cardiopulmonary bypass with or without extracorporeal membrane oxygenation)" (American Academy of Pediatrics, 2013).
Care in the NICU is extremely specialized and runs the gamut from the stable neonate to the extremely ill infant. NICU nurses are intensive care nurses of the smallest patients. Their work environment usually consists of high intensity care coupled with technical details associated with the most critically ill patients.
The allnurses NICU Nursing / Neonatal forum is very popular. Some recent topics include:
- Complete list of NNP graduate programs
- Poll: What do you love about the NICU?
- "Never trust a 35 weeker"
- Funny/happy NICU moments needed
- Pediatric A&P website for parents
- Neonatal HUS website
Certification for Adult, Pediatric and Neonatal Critical Care Nurses (CCRN) - Critical care exams offered for adult, pediatric and neonatal specialties
American Academy of Pediatrics - Information about the levels of care in the NICULast edit by Joe V on Nov 28, '13
traumaRUs has '20+' year(s) of experience and specializes in 'Nephrology, ER, ICU'. From 'Midwest'; Joined Apr '00; Posts: 46,085; Likes: 20,058.3Nov 28, '13 by ThePrincessBride, BSN, RNGreat post!
NICU is the end-goal for me. I am fortunate in that I am in the NICU often for postpartum mothers. It is a very extreme specialty, and most of the nurses that get a job stay in the NICU for the long haul.
My heart is with the babies. <32Nov 29, '13 by NYbabyRN, BSN, RNThank you for this informative article and NICU resources! I am helping out a bit in our Level IV NICU and want to transfer and become a NICU nurse.5Nov 29, '13 by babyNP., MSN, APRNLooks great!
I (in my humble opinion) would add the following:
-Cerebral palsy is usually an acquired condition as a consequence of extreme prematurity, not an admitting diagnosis by itself and I would dare say that prematurity is the #1 cause of being admitted to a NICU. Full-term is 37 weeks and above (although ACOG has recently changed so that 37-38 weeks is early term, 39-40 weeks full term, and 41 weeks post-term), but many FT infants still get admitted for problems related to birth.
-The RNC-NIC exam by the NCC corporation is more recognized in the neonatal world and is by far more popular for NICU RNs. You need 2 years of NICU experience in order to take it.
-The different levels have recently changed by the AAP and as a consequence, you may still see a lot of hospitals refer to things like, "Level IIIB" or "Level IIIC." There was no such thing as a "Level IV," although many tertiary academic centers called themselves that because they truly did offer many more services than other level III units. I do like that they've clarified it and traumaRUS has the correct "levelling."
-The NNP program thread hasn't been updated in awhile and many programs have shut down. I wouldn't go off of that list alone, but it can serve as a good starting point. I also created a thread that you can search for that lists the schools and how much they cost in-state/out-of-state (a few years ago), whether or not they require a GRE, etc etc.
-Academic centers are an excellent way to get started in a NICU career and they generally overwhelming take new grad nurses. They like them because they are "fresh" and have no "bad habits" that they pick up from the adult world in regards to getting used to adult medicine norms. If you apply for a job, make sure they have a decently long orientation (at least 12 weeks, better to have longer; I had 20 weeks). You will feel like you're in school again because you are learning entirely new norms. It's okay to feel dumb; we all do at times, but especially as a new grad.
-STABLE and NRP are good certifications that you can get while trying to make yourself competitive for job applications, although they are challenging as a student nurse. I took NRP as a senior nursing student and then took STABLE as a new grad while in orientation.
Hmm...didn't mean to go that far. Hope you're okay with it traumaRUS, once I got going, couldn't help myself! What we really need is a FAQ page in the NICU forum because we get the same questions all the time...
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