Advice for a New NICU Nurse?

KKEGS, MSN, RN · Jan 31, 2017

I also started my career in the NICU! I did a 2 year New Grad Training Program. My biggest pieces of advice are: 1) Ask questions! Seek out new things to observe! Hopefully you get great preceptors who will help seek out interesting things going on in the unit. 2) Be patient and kind to yourself. It took me 2 years to really feel that I knew what I was doing. After 2 years I felt that I had the experience, skills and confidence to care for any baby on that unit, no matter how sick they were. And 2 years is about the time I was told it takes a novice nurse to feel really comfortable in NICU. You will have hard times but, if you are passionate about NICU, don't give up! Give yourself time to get there! We were told by our training program that at some point we would want to quit and to not give in to that feeling without talking to someone first!

Also join the Academy of Neonatal Nurses ASAP! You'll get a journal (with CEU opportunities) and there are some wonderful articles in it!

Elizabeth777, BSN, RN · Feb 2, 2017

Congrats! I just got hired for a new grad position in the NICU too. As much as I've been looking up info and reading the recommended books, as well, remember that most everything we have to know will be taught during training. They know that you're a new grad, so they won't expect that you would know everything.

So, continue reading up info, if you'd like, but don't panic too much about it. It'll be an exciting time for both of us when we get to jump right into it.

isthisreal · Feb 16, 2017

Congrats!! I also just got hired as a new grad in the NICU as well! :cat: I start this weekend and I'm very nervous, but also excited! I've worked as a nursing assistant in a NICU and I definitely second what both commenters have said. I've been told that the best way to learn is to be proactive during your orientation time, seeking out as many opportunities as possible and that no question is ever stupid (even if it's asking where the bathroom is!). Most nursing programs do not go in to detail about our speciality so the learning truly begins on the job.

I'm happy to know I'm not alone in my anxiousness and pure excitement to start this career in this speciality! Hope everything goes well with you! Good luck!

jennylee321 · Feb 16, 2017

This piece of advice applies to any new grad but seek frequent feedback on how your progressing so that there are no surprises when it comes to formal evaluation when your ready for independent practice. We had to set goals for our orientation and then our first year, but also set some smaller daily or weekly goals as well. For example, this week I want to complete all my feeds independently. Let your preceptor know these goals so they can help you seek out opportunities to achieve them.

if you aren't immediately paired with a preceptor, try to share with the educator your learning style and what you look for in a preceptor. They may take it into an account, they may not but its worth a try. It's also good if you run into preceptor problems down the road, you will be able to articulate why it's not working and relate it back to what you expressed at the beginning. Rather than you complaining about the preceptor and it coming off as petty or a personal attack.

Try to reposition intubated babies as much as possible (when it's time to turn them, I don't mean just start turning them all the time lol) while you are still with your preceptor. I found this was an intimidating thing for me that took me a long time to feel comfortable with. It takes a lot of practice to get used to the pull of the tubing and turning the baby and tube as a single unit.

you might not be in any code situations/critical events during your orientation so get your preceptor to give you scenarios to work through in your downtime.

While on orientation, once you've been shown how to do line changes, volunteer to do them for other nurses. You will need the practice and the other nurses will appreciate you taking on this time consuming task for them particularly if they have a very busy assignment. In my opinion offering to do another nurses lines is one of the greatest gifts a coworker can give you.

Try to get as good as you can at capillary bloodwork since you will be doing it a lot. I find many new grads including myself are slow with it in the beginning and it can really put you behind when you have labs due for your kids first thing in the morning.

Ask if you can shadow an RT for half a shift or even a few hours. They are the experts at ventilation and will teach you so much. They will also probably have some tips and tricks about how to keep those pesky CPAP masks in position and not ringing off as much. Ask them what the different alarms mean, a lot of nurses don't know the specific alarms and page the RT whenever the vent rings. By knowing the alarms you will be able to troubleshoot and maybe not be paging them as much. It's really good to shadow any member of your team who you will regularly interact with because it helps you understand what their challenges are and how you can best work with them. For example shadowing an NP or doc will help you understand what their day looks like and what other things they are dealing with when you are waiting for them to return a page.

At a minimum every NICU nurse should know how to show a mom how to hand express milk and how to use a double electric pump. If they don't get off to a good start with pumping they will be playing catch up and facing problems down the road. Know when they need to be referred to the LC. Examples: low milk volumes, sore nipples.

Learn how to make a beautiful bed. I know it sounds silly but in my experience NICU nurses are very particular about their beds. I've had mine taken apart for poor colour coordination. (Don't make this your first priority for learning though )

Good luck with your new position, the NICU is an incredibly challenging place to work but it's also amazing and I wouldn't want to work anywhere else.

Missie Hannie · Feb 17, 2017

Congratulations on your dream nursing job! I started my NICU residency in May 2016, and have been on my own for about 6 months now. Everything the previous commenters have said is absolutely true - best way to learn is to ask questions! One thing I wished I had paid more attention to / overheard more often during residency was the teaching that the other nurses did with the parents; I often stumble over my explanations, but after hearing another nurse explain it, I remember it better. Plus, you learn so much by listening to more experienced nurses! Oh, and reviewing what to do when a baby desats/bradys (NRP) is a good idea if you have any anxiety (like me).

The kiddos are so precious, and even though the job will drive you insane sometimes, it is totally worth it!

P.S. - I hope this post makes sense. I just got home from a night shift in the NICU, and should really get some sleep :)