Attention NICU Nurses! What advice do you have for a new Grad RN?

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Hi everyone!!!!!! :cheeky:

I interviewed at my local children's hospital and was offered an RN position in the NICU! I am a little bit nervous because it is the largest NICU in town and we get transfers from other hospitals to our NICU.We have level I-III babies ranging from premies, to congenital heart defects, and other rare complex diagnoses. We get the sickest newborns in town. I will be having a 13 week orientation to the NICU and after that I will work on my own!!! Do you guys think 13 weeks is enough to be trained in the NICU?

My start date is in February In the meantime I plan to do a lot of studying on critically sick newborns.

What advice do you NICU nurses have for me as a new grad nurse in the NICU? Any pearls of wisdom? And how long have you been a NICU nurse for? Also, what books do you recommend? Sorry for all the questions, I just want to have a head start because other than nursing school clinicals I have little to none experience in the NICU but I am so excited to start :D

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journey2success....congratulations!!! I too was offered a position on a level 3 NICU as a new grad!! Starts in February. I am so nervous. Best of luck to you!!

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Specializes in OR, Nursing Professional Development.

AN is a very diverse site- it even has a forum dedicated to NICU nurses where you may find some answers to your questions.

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Specializes in Nephrology, Cardiology, ER, ICU.

Moved to the NICU forum.

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Specializes in Pediatrics, NICU.

I didn't start as a new grad in the NICU (I worked a year in pediatric medsurg and then came to the NICU 3+ years ago) so I can't quite relate to where you are now. However, I do precept new grads now, so here's my advice:

1) Make sure you grasp concepts about basic equipment and procedures (IVs, central lines, ventilators, art lines, heelsticks). Having a good grasp on the fundamentals will help with putting everything together when you are on your own.

2) Learn your gestational ages! A 24-weeker is different than a 28-weeker who is different from a 33-weeker.

3) Never trust a 34 or 35-weeker! They're big enough usually to appear trustworthy but they are still premature.

4) Watch your baby's bellies! Necrotizing enterocolitis (NEC) is a nasty infection so the sooner you can catch it and treat it, the better.

5) Never pass up a learning opportunity, even when it isn't your patient. Watch intubations (volunteer to pull up RSI meds if you can), help with chest tube insertions, go to deliveries, help secure umbilical lines, etc. See if you can follow the doctor's rounds or the charge nurse(s) for part of a day on orientation.

6) If you don't feel that you are ready to come off of orientation when your original time ends, ask for a short extension. They just invested thousands of dollars in training you so they won't fire you for asking for a couple extra days and they would prefer you to be safe to work on your own.

As for books, I highly recommend Core Curriculum for Neonatal Intensive Care Nursing. I found a copy used on Amazon for about $20. Good luck! The NICU is an amazing place to work. It can be sad on occasion but there are many great outcomes that you get to be a part of. I hope you love it! :)

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congratulations on the position, I know nothing of NICU nursing but I wish you the best! My advice would be dont be afraid to ask questions :yes:

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Congratulations! That's probably a coveted position & you are going to get amazing experience!

I totally agree with above post by "NICUNurseEliz." 13 wks is a typical length, and given that it's your local Children's hospital they will have a well organized plan for their new grads. Most big places are very thorough with what they cover, and will often extend your orientation if necessary. You're very expensive to train so they are very motivated for you to learn what you need to in order to be successful. Plus you'll have really sick kids to learn from so that will be good - no waiting for the census to change or for higher acuity patients - you always have them.

Expect to feel totally overwhelmed, excited, scared and humbled all at the same time. It's a good idea to get one book now - like the "Core Curriculum for NICU" book - and then wait to buy more - they may have books there, they may have other suggestions. I also have a book by Merenstain & Gardner, also good.....and the "S.T.A.B.L.E" book.

I love to read but know I learn best by hearing and doing....and then reading about it. I find that watching stuff on "Khan academy" helps too....and I tell my preceptors (am at a new job) that I need them to do it and talk about what they are doing the first time, then walk me through it the second them....then it sticks in my brain. Figure out how you learn best. I'd suggest spending @ 20-30 min at home after work studying about the baby I just took care of - their dx/gest age and then read on that....because once I put a face/circumstance on a diagnosis, it also really helps me to learn.

Your preceptor can give you examples of the most common NICU dx - although nothing is really "common" at a Children's Hospital since your kids often come from everywhere else & you do surgeries, etc other hospitals dont.

You will not learn it all but you will learn "how" to learn and figure out what and who your resources are when you need help. Best wishes!!!

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More things I just thought of:

NICUniversity.org (but this site tends to be better for somebody more experienced - but keep it in mind for later)

pted.org (for cardiac stuff - check out the awesome pictures and how they change to show defects vs normal anatomy)

Go on youtube for "Khan Academy" "medical" and search "Fetal" There's cool videos to watch about circulation. Learn about PDAs.

You'll see a lot of Respiratory stuff like all the NICU books talk about - RDS, Pneumos, PPHN. You'll get comfy looking at chest and abd xrays. Common drugs are caffeine (for apnea) gentamicin, ampicillin & meds for pain/comfort (morphine, fentanyl, ativan). You'll use INO. Practice a few NICU calculations - like a generic one for figuring out how much ampicillin you'll be giving. You'll use a lot of TPN and Lipids and work with UVCs, UACs and PICC lines. You'll concern yourself a lot with keeping a NTE - keeping them warm. Supporting them developmentally is so important - ie keeping them flexed in a similar position to what they'd be in utero. NEC is a really big deal in the premie population. There's too many things to name.

The dx like "myelomeningocele" and congenital stuff is great to learn about but more rare - although you will see it there.

When you're a new grad you have to start at the basics like learning what a normal blood pressure is for a baby at their gestational age, how to use the IV pumps, how is a 24 weeker different than a 28 weeker, etc. Start your learning with the more basic stuff.

I'm rambling and now I probably overwhelmed you :-) Sorry. Am excited for you.

You will understand this later:

You wont feel so dumb in a couple of years. When I did adult ICU, I still felt pretty dumb after a year becasue there were SO many dx that adults could have.....yes, they came in for heart surgery, but they're also an alcoholic, or a smoker, or a diabetic, or all 3, etc....there were so many comorbidities. With NICU, in general, there's less to learn than with adults because it's not like this micropremie was a smoker all of their life. Eventually you'll start seeing patterns and having an idea of what may be coming next....but this takes at least a year, usually more. Having said that, your job will be harder than other NICUs because you are the place other places send their hard cases to. It's a bit like entering politics by running for President. It'll be OK!!! It will take time. Bond with the other new grads that are starting with you - they usually hire/train in groups. Find someone in your same position who you can talk to without fear of judgement.

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Specializes in NICU.

Congrats! I am also a new grad in the NICU and I have three weeks left in orientation and then I am on my own! It's definitely overwhelming and there's a lot to learn, but no one expects you to come off orientation as an expert in everything. Like others have said, take any opportunity you can! I come home from work loving my job more and more every day! It's awesome and I hope you love it as much as I do! Good luck!

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Congrats!

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Get the books. Study up on your STABLE, NRP, and basic complications for neonates. GET Neofax on your phone, you will need it. Also be aware that it is not all cute and cuddly (although there is plenty of it).....BUT, sometimes NICU is a rough place. Try to think about how you will cope with death and interacting with parents during difficult times. Now put on your grown-nurse undies and go in with your best go-getter attitude. You will be fine.

None of us knew what to expect as new grads. If you start at a good facility with the proper support in place, you will be fine. Trust me, they will teach you everything you need to know. BUT, you also have to do your part and go into work prepared. If you know what your assignment for the next day will be, find out what the baby's main diagnosis is and go home and read up on it. Find out how to be an asset to your unit. Don't wait to be told to do obvious things (stocking, helping out coworkers, making beds during downtime). Your coworkers will appreciate it and it's so much nicer (and easier) when you go in with a team player mindset. Enjoy!

***Oh, and watch out, NICU is a serious addiction. Once you're in, it's hard to leave the tiny patients!

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Specializes in General Surgery, NICU.

Thanks to all the allnurses members for the info; I'm new to NICU and this is helpful!!

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