Suggestions for New NICU RN

NICU_Nurse, BSN, RN · Aug 9, 2003

Hi, Cathy! Welcome to the forums! :)

I can completely relate to what you said: I thought for sure, when I started nursing school, that I was either going into L&D (to eventually become a CNM) or Oncology (to eventually work in hospice)! It wasn't until I was actually offered a job in the NICU that I thought, hey, maybe...and then I just fell in love with the whole shebang.

I was scared also- I had no children, had had virtually no contact with babies (none of my friends really had children, aside from one, none of my family lived close enough for me to be near children, never really worked with kids, etc.). I had no idea what I was getting into, really, and felt like I was taking a big chance. I knew I wanted to work in Maternal/Child, but I kept hearing that Peds was better/more interesting/more suited to me/etc. I mean, people I talked to said things like, "But the babies don't DO anything...how boring!" and "What are you going to be doing all night? Changing diapers? Ick!". LOL!

In fact, if you search back, one of the first posts I made after starting in the NICU was because I couldn't burp the babies successfully! I was terrified of touching the babies, especially the extreme preemies; I'd never in my life seen a baby so small or fragile. The only exposure I got in nursing school was in the well baby nursery- big, healthy 9 pounders.

During my first few months on the unit, it definitely took some patience with myself and some perspective reminders to get me feeling comfortable. I would walk into the Level III nursery and feel like crying when I saw what I'd been assigned: A 23 weeker on a ventilator (had no experience with those!) with central umbilical lines and a PICC line and an IV tree with what seemed like four hundred drips hanging from it. All I saw (which actually will lend you some perspective when you're dealing with parents!) was equipment. TONS of it. NO baby, really, just a tiny figure dwarfed by tubes and machines. I literally had to stand at the bedside and break it all down, piece by piece. Okay, this is the umbilical line. Here it is, trailing off the bed, hooked up to this tube, hooked up to this pump. Okay, here's the ventilator tubing. Here it is, there it goes, there's the ventilator. One at a time until I was familiar with everything and the tubes and machines stopped being so intimidating. Really, only then do you get to actually SEE the baby, if you know what I mean. And eventually (and don't worry- I don't think this took THAT much time!) I would walk into the room and see the baby first.

I can't speak for anyone else, but I immediately fell in love with these babies. I mean, HARD. What I was doing felt important! These babies wouldn't stand a CHANCE at life if not for the nurses who literally nurse him/her to optimal health. Mother Nature did not intend for pregnancy to last five and a half months! I remember the first few weeks, being sort of afraid to touch a baby, and noticing that his mouth was completely crusty with built up saliva and he just looked so pathetic! It broke my heart. The linen was wrinkled, his skin was chapped and peeling, and I just thought, wow. If I were a parent I'd flip out if I saw this- I wonder if I can do anything here. I felt so little and inconsequential- I mean, how can I make a difference here when I know so little and there's so much to learn? One by one, I addressed the things that I knew how. I changed the linen so that it was fresh and soft for the baby. I changed the diaper and slathered A+D ointment on his chapped little cheeks. I gently rubbed Aquaphor all over his scaly skin, and couldn't help notice his tiny hands, the slender little fingers wrapped around mine. I did one arm, then it almost seemed as if he *offered* me the other one. I remember thinking how funny it was, and thinking, hey, I should let his mom know that! I took damp gauze and gently cleaned away the crud around the ventilator tubing. You could actually see the lips now! I remember him darting his tongue out and thinking, I wonder if the babies get cotton mouth from their mouths being open so much. So I got another damp gauze and placed it on his lip and let him taste it with his tongue. He sucked on it like he was a thirsty man in the desert. When I stood back, for the first time, I actually saw the baby! A baby, not a patient, not a preemie, not a body hooked up to machines, but a BABY, one who might go home, who might laugh and play someday, or fall asleep on his mother's shoulder as she rocked him. I mean, I know it sounds kind of corny and sentimental to some people, but I get tears in my eyes just thinking about it NOW!

My heart just leaped for these babies, and hopefully you will too. Seeing the look on the face of someone when they come into the unit to see their child and ALL YOU'VE DONE is clean him up, and they start to cry because they see him for the first time, too...Man. It's unbelievable and I cannot really accurately describe what you feel.

No matter what baby I see, big or small, sick or not, no matter what physical condition, I now see a baby first. A tiny personality, someone who means the world to his or her mother. Each one is different, but they're all beautiful to me. Again, I can't speak for anyone else...but when a baby starts to get sicker, or if something happens when I'm at home and not working, or if a baby dies, I grieve for that baby in some way. I have gone home and cried in my husband's arms for an entire weekend because I was so upset that I couldn't do anything more than I had been doing. Working in the NICU has taught me so much about the cycle of life, and the adversity, and the loss process, and I am a changed person because of this, literally. I will never be the same, and that's okay. It's altered my perception of faith and hope and life and death and I'm fine with that because I feel LUCKY to work with these parents and their children.

No one ever said it was easy. But it's worth the emotional price you pay, IMO. Hopefully you'll feel the same way!

Good luck in your last semester. We'll be waiting for you. :)

neonatalRN · Aug 9, 2003

Kristi, that was so beautiful. I am crying after reading it! Those sweet babies are very blessed to have a nurse like you! I hope I can be like that, too.

Heidi

NICU_Nurse, BSN, RN · Aug 9, 2003

Heidi,

I have absolutely no doubt that you will be. Each one of us brings something different but equally valuable to our units. You, in particular, will be able to offer these parents compassion like I could never offer. I don't know what life is all about, I don't know where we're all headed, I don't know what happens when we die, I don't know if any of it means anything at all, but I *believe* that it does. Each of us may seem to be working all alone, but we're actually working together, each of us supplying a little of what other people need to cope and learn. I know that working in the NICU might be painful for you in a different way that it was painful for me, but in the end, the babies will be lucky to have you advocating for them because you will do so in a way that no one else could.

I've always been a bit conflicted about nursing- I mean, when I sit there and think, wow, no matter what we all did, this baby didn't make it...or hey, look at that baby who *did*...why did *that* happen, and HOW? I've visited babies who were discharged only to end up in another hospital for Failure to Thrive and my heart has wept for them because I'm no longer their nurse and their care is in the hands of people I've never met. Ultimately what it comes down to for me is this: I have absolutely no control whatsoever after those babies leave my unit. Of course, we can do our best to contact social services or try to provide resources for the families. Even when a baby doesn't make it, we can make a difference, though, because as long as they are in *my* care, they will hopefully have a better evening because I will try my ASS off to make sure that they do. Whether it's ensuring that they have enough sedation to rest comfortably, or suctioning them to make sure they can breathe properly, or massaging them so that they can learn that not all touch is bad touch, or repositioning them so that they are comfortable, or whatever it is- I am going to try until I walk out the door to do my best with them. When they leave the unit, in whatever way or form, it is completely out of my hands. But I don't feel helpless anymore, because I know that I did *my* part to the best of my ability, and I hope that those parents that I meet remember that, even in some small, unconscious way. I hope that somewhere, deep down, those babies have that soft, gentle touching filed away in their brains, and maybe, just *maybe* when it happens again, they'll think, "Ah, yes, THIS is what love feels like!".

What nurses do in the NICU is not inconsequential. Just remember that, because it can be easy to overlook, easy to feel small and powerless. Nurses and parents and doctors and babies are all working together, and while none of us can predict the outcome, we can all make the experience better in our own unique ways.

I just want to say, again, good luck to both of you. I hope to hear a lot from you on this board! I have no doubt that one day you'll be on here "preaching" and sounding overly emotional to someone else just like I am.

Mimi2RN, ASN, RN · Aug 9, 2003

Kristi-that came from your heart.

:kiss

StacyC417 · Aug 9, 2003

Kristi,

Thank you for posting this. The compassion you have for your patients just leaps off the page and totally revives my motivation to plug through the next (LONG..lol) 4 years of school. I can't wait until I am able to get out on the floor and do what I can to give these little guys a chance!

Stacy

BlueYYsRN · Aug 9, 2003

Congratulations on being near the end of a long road! I am not sure from your post what level NICU you are going into and what kind of orientaion they will provide. Will you be given theory and a preceptor? My suggestion is to begin learning theory even before you begin your job. There are many continuing education opportunities for NICU if you know where to look. One of the best basic courses is the Perinatal Continuing Education Program. It is kind of expensive but well worth it if only for the added confidence of going into the unit with some sort of a knowledge base. You can find it at http://www.pcep.org. I would also suggest investing in some good current neonatal books such as the Handbook of Neonatal Intensive Care by Merenstein and Workbook in Practical Neonatology.

These are very good resources to have for a quick look-up when on the floor and for more thorough research later. I found that to study the different disease processes or conditions of my babies was the best way to help make the theory more concrete.

Remember that noone was born knowing any of this and that everyone who will be teaching you was taught by someone else. Learn from your mistakes, learn from others mistakes. When you get off duty take time to think over the shift and pick out things you could have done differently or better but only to help yourself improve not to kick yourself over.

Start what I call a "cheat notebook" put easy to forget things in there like lab values, formulas, and little pieces of info that could elude you if trying to come up with them on the spot. In short time you won't need your notebook that much! Part of what you need to learn is not in any book. You must learn to relax even in the most trying circumstance. Panic will make every speck of theory you have learned temporarily fly out the window. Even the best, most capable nurse cannot function when panicking.

The last suggestion is pretty obvious. Pick out the nurses that are like what you want to be and use them as role models. Ask questions and learn from them. Then take all you know and apply it with the love, caring and compassion that these babies and their families deserve being careful to see them as the blessings they are and not just examples of theory. Remember that you will have a precious role in the lives of your patients. For the sickest you will be the eyes, ears and provider that mom cant be yet and that family is also your patient. You can't learn that part from any book. Good luck and let us know how it is going. You are leaving one long hard road for another but the reward is worth it!

fergus51 · Aug 9, 2003

I am still pretty new to NICU and my advice is to breathe. There are days when I wonder what I was thinking taking a job in the NICU, but I just muddle through and hope the next shift is better. And you know what? Sometimes it actually is better:)

I would ditto the importance of finding a role model. Take all suggestions with graciousness and try to improve everyday. Also try to remember to keep things in perspective. I have noticed that NICU nurses can be a bit picky about things that may not seem hugely important at the time (like the color of the linen the baby is on). The attention to detail they need to function in this area can sometimes cause a little bit of friction between team members. Also remember that there is more than one way to skin a cat as I am finding out. Everyone has their own w.ay of doing things and their way is always the "best" way. Find what works for you.

New2NICU · Aug 10, 2003

Wow!! where do I start. Thank you all for the great advice and stories of inspiration. Kristi...you make me cry and I hope and pray I can be as good and passionate nurse as you seem to me to be!! I will be in a Level 4 nursery, they have it all there, and I am very anxious, but so looking forward to getting started in there and helping those sweet babies, and their parents to deal with situation, to grow and to move ahead to a healthier time. I think picking out a role model is a great idea...I have done that now where I work. As I am finishing school, I am working as a nurse extern in OB, mainly postpartum, and well baby nursery. There is one particular nurse who just blows me away, and I pray I can be like her one day!! Thanks again for welcoming me to the boards, giving me great advice, praying for me while I finish school, and giving me words of encouragement. I hope you will all be there for me when I rough days in the NICU, and when I have happy stories to share!!:) Thanks so much!!

Anna57 · Aug 11, 2003

New2NICU, there is no doubt in my mind that you can and will be the BEST NICU nurse that hospital has seen.... you will do wonderful. I can't wait to be right there with you! Love you!

BTW everyone, I too am a nursing student and New2NICU happens to be my sister! :)

NICU_Nurse, BSN, RN · Aug 11, 2003

OMG, I'm going to stop talking now! I don't want people to CRY after reading my posts! LOL!

I'll be in my corner.

New2NICU · Aug 11, 2003

No, No, do share....it was just very touching!! :wink2:

Thanks again!