attn: experienced NICU RNs---

NicuGal, MSN, RN · May 3, 2013

I will when I can sit down with my laptop...wouldn't be pretty on my phone lol

babyNP., APRN · May 3, 2013

I did...I spent about 30 minutes typing up my day for that post this morning....but I ended up deleting it. I guess I get nervous about writing about my actual day because of the HIPAA stuff and the fact that my co-workers figured out who I am on AN. Maybe I can write more about a generic day than an actual day.

JustBeachyNurse, LPN · May 4, 2013

I did...I spent about 30 minutes typing up my day for that post this morning....but I ended up deleting it. I guess I get nervous about writing about my actual day because of the HIPAA stuff and the fact that my co-workers figured out who I am on AN. Maybe I can write more about a generic day than an actual day.

You could always PM your thoughts to prmenrs for editing for generalities...sounds like you have a lot to share but need an extra eye to ensure patient/personal privacy. :)

prmenrs, RN · May 4, 2013

@babyRN--that would work for me.

sophie<3 · May 21, 2013

would love to read these stories :) starting in a Level III NICU in 2 weeks!

NICURN2013 · May 26, 2013

I would love love love to hear from experienced NICU RNs!!! :) New grad in the NICU here :)

MegginJ · May 29, 2013

I would love to read them also! I'm just starting nursing school but its never too early to start learning

Bortaz, MSN, RN · May 31, 2013

I've been planning to do this, but life keeps getting in the way.

I don't know that there is a typical day in the NICU. Things can be so completely different from one day to the next, depending on how the babies act (and the nurses, too). But, I'll make an effort to sit down and write something up for you all in a day or two. If I forget, someone feel free to PM me a reminder.

Like BabyRn, I've had a hard time trying to write something without giving away too much. I'll work on it, though.

MegginJ · May 31, 2013

I've been planning to do this, but life keeps getting in the way.
I don't know that there is a typical day in the NICU. Things can be so completely different from one day to the next, depending on how the babies act (and the nurses, too). But, I'll make an effort to sit down and write something up for you all in a day or two. If I forget, someone feel free to PM me a reminder.
Like BabyRn, I've had a hard time trying to write something without giving away too much. I'll work on it, though.

Thank you Bortaz! Let us know about those hectic/ stressful days when you find the time! ?

prmenrs, RN · Jun 1, 2013

How about this scenario:

O650/1850-get assignment from charge nurse; if you're "1st admit", check the Labor Board for imminent incoming (don't forget, L&D loves sneak attacks). If there is something coming, check for a bed that is set-up (warmer on, ekg leads, temp probe attached, O2 and suction stuff, BP cuff, whatever else seems appropriate)

07/19-grab your report paper (print-out, pre-printed form or paper towel), find the nurse you're relieving, and the baby(ies) you're picking up.

Review pts condition, prenatal risk factors, labs, orders, feedings, social issues and anything else w/offgoing nurse, check IV fld against orders (w/the other nurse) and your IV site. What meds do you need to give, when and how. If you're not familiar w/any of them, you need to look it up.

After report, LOOK @ the baby for any obvious problems, do a safety check-make sure the Oxygen, bag and mask are attached and functional, ditto for suction, make sure feeding/IV pumps are working @ the prescribed rates, all tubes are secured.

Some units have nurses checking transporter incubators and kits, bedside glucose testing machines and the like--even temperatures in the freezers and refrigerators.

08/2000-time for your first assessment: look @ baby's color 1st-pale, jaundiced, plethoric, mottled-gives you an idea of stability along w/the #s on the monitor. gently open the incubator, slip your hand in, place it on the baby w/o waking the baby up, count resps for 30 secs. You might be able to do this by observation if you can see the chest. Gently slip your thermometer in place (auxilla); if you are careful, you can get resp/temp w/o disturbing baby too much.

Head to toe assessment: head-fontanelles and sutures, eyes, ears, etc-anomalies? Resp assistance in place and secure? Feeding tube, ditto. Auscultation: lungs, heart, abd. Murmurs, breath sounds. Chest assymetry? Clavicles intact? (can get broken during delivery). Baby moves all extremities (barring IV boards or other impediments) equal and symetrical?

Abd-soft, not distended, not loops of bowel apparent, abd circumference @ umbilicus (check against last assessment recorded, should not be very different); umbilical stump healing or healed, no erythema or purulence, odor, etc. Hygiene to the stump as per hospital policy.

Change the diaper, observe skin condition, any anomalies, clean gently, baby wipes if ok in that unit, but not on real tiny premies-they get sterile water, new diaper applied in such a way as to leave the umbi exposed.

Hips-you will learn how to look for hip "clicks"/dislocation.

If the baby is very unstable, you need to do a limited exam-if you "bother" them too much, they could get worse: drop their oxygenation, heart rate. Avoid this! Watch color all thru the exam as well as the monitor, if the baby shows signs of not tolerating stuff, stop touching.

You need to know how to calm an agitated baby-bring arms and legs into the trunk, turn lights and sound down til the baby gets more stable. Positioning premies is an art. Nesting, swaddling, pacifiers/binkies, all can help the baby tolerate life.

It takes a lot less time to do this then it does to write it down!

1st feeding-what, how much and method: gavage, nipple (what kind of nipple). How is the baby tolerating feedings? Stooling? If s/he has a gavage tube, is there residuals (leftovers) from the previous feeding? Is mom there? How much help does she need breast feeding? This will depend on how sick the baby is. If very sick, she needs to pump-you teach her how, and how to collect and store milk. Parents need support; you need to know the social history. You are caring for the family as well as the pt.

Babies often get fed q3h, so you'll assess and feed 4x on your shift.

Charting: Record your VS and assessments, intake and output, observations and interventions as needed.

Be aware of what's going on in the rest of the unit: admissions, babies going to surgery, babies not doing well so that you can help your colleagues. It takes 2 people to start an IV; admissions go faster if there is help.

Drs rounds. In a teaching hospital, the doctor responsible for the baby examines him/her, checks the chart/computer for labs, intake/output, and any other reports from the previous day. In rounds, all that gets reviewed w/the "attending", i.e. the faculty doc in charge of all of them, the plan of the day is made and orders written. You need to keep an ear out when they are rounding on your pt(s) so you can get a head start on anything that needs to get done, like labs, X-Rays; if you need an order for something (feeding changes, topicals for sore bottoms, whatever, now's the time to ask for it.

You do get breaks for lunch, etc. Someone must cover your pts, and you have to "hand-off" to that person-a brief recap of pt status and possible needs. You will be paying them back--watching their pts for their breaks. Some places have "break nurses"--that's all they do all shift.

@the end of your shift, you'll be giving the oncoming nurse the info on what happened on your time and how the baby did.

Additions, corrections? Anyone?

MegginJ · Jun 1, 2013

How about this scenario:
O650/1850-get assignment from charge nurse; if you're "1st admit", check the Labor Board for imminent incoming (don't forget, L&D loves sneak attacks). If there is something coming, check for a bed that is set-up (warmer on, ekg leads, temp probe attached, O2 and suction stuff, BP cuff, whatever else seems appropriate)
07/19-grab your report paper (print-out, pre-printed form or paper towel), find the nurse you're relieving, and the baby(ies) you're picking up.
Review pts condition, prenatal risk factors, labs, orders, feedings, social issues and anything else w/offgoing nurse, check IV fld against orders (w/the other nurse) and your IV site. What meds do you need to give, when and how. If you're not familiar w/any of them, you need to look it up.
After report, LOOK @ the baby for any obvious problems, do a safety check-make sure the Oxygen, bag and mask are attached and functional, ditto for suction, make sure feeding/IV pumps are working @ the prescribed rates, all tubes are secured.
Some units have nurses checking transporter incubators and kits, bedside glucose testing machines and the like--even temperatures in the freezers and refrigerators.
08/2000-time for your first assessment: look @ baby's color 1st-pale, jaundiced, plethoric, mottled-gives you an idea of stability along w/the #s on the monitor. gently open the incubator, slip your hand in, place it on the baby w/o waking the baby up, count resps for 30 secs. You might be able to do this by observation if you can see the chest. Gently slip your thermometer in place (auxilla); if you are careful, you can get resp/temp w/o disturbing baby too much.
Head to toe assessment: head-fontanelles and sutures, eyes, ears, etc-anomalies? Resp assistance in place and secure? Feeding tube, ditto. Auscultation: lungs, heart, abd. Murmurs, breath sounds. Chest assymetry? Clavicles intact? (can get broken during delivery). Baby moves all extremities (barring IV boards or other impediments) equal and symetrical?
Abd-soft, not distended, not loops of bowel apparent, abd circumference @ umbilicus (check against last assessment recorded, should not be very different); umbilical stump healing or healed, no erythema or purulence, odor, etc. Hygiene to the stump as per hospital policy.
Change the diaper, observe skin condition, any anomalies, clean gently, baby wipes if ok in that unit, but not on real tiny premies-they get sterile water, new diaper applied in such a way as to leave the umbi exposed.
Hips-you will learn how to look for hip "clicks"/dislocation.
If the baby is very unstable, you need to do a limited exam-if you "bother" them too much, they could get worse: drop their oxygenation, heart rate. Avoid this! Watch color all thru the exam as well as the monitor, if the baby shows signs of not tolerating stuff, stop touching.
You need to know how to calm an agitated baby-bring arms and legs into the trunk, turn lights and sound down til the baby gets more stable. Positioning premies is an art. Nesting, swaddling, pacifiers/binkies, all can help the baby tolerate life.
It takes a lot less time to do this then it does to write it down!
1st feeding-what, how much and method: gavage, nipple (what kind of nipple). How is the baby tolerating feedings? Stooling? If s/he has a gavage tube, is there residuals (leftovers) from the previous feeding? Is mom there? How much help does she need breast feeding? This will depend on how sick the baby is. If very sick, she needs to pump-you teach her how, and how to collect and store milk. Parents need support; you need to know the social history. You are caring for the family as well as the pt.
Babies often get fed q3h, so you'll assess and feed 4x on your shift.
Charting: Record your VS and assessments, intake and output, observations and interventions as needed.
Be aware of what's going on in the rest of the unit: admissions, babies going to surgery, babies not doing well so that you can help your colleagues. It takes 2 people to start an IV; admissions go faster if there is help.
Drs rounds. In a teaching hospital, the doctor responsible for the baby examines him/her, checks the chart/computer for labs, intake/output, and any other reports from the previous day. In rounds, all that gets reviewed w/the "attending", i.e. the faculty doc in charge of all of them, the plan of the day is made and orders written. You need to keep an ear out when they are rounding on your pt(s) so you can get a head start on anything that needs to get done, like labs, X-Rays; if you need an order for something (feeding changes, topicals for sore bottoms, whatever, now's the time to ask for it.
You do get breaks for lunch, etc. Someone must cover your pts, and you have to "hand-off" to that person-a brief recap of pt status and possible needs. You will be paying them back--watching their pts for their breaks. Some places have "break nurses"--that's all they do all shift.
@the end of your shift, you'll be giving the oncoming nurse the info on what happened on your time and how the baby did.
Additions, corrections? Anyone?

Thank you for posting prmenrs! I really enjoyed reading this, thanks for the insight!