Bumped from NICU?

**NICU Guy, BSN, RN** · May 13, 2017

When a situation arose that revealed exactly how much I didn't know

New employees don't know much. That is why we place them near experienced nurses to be used as a resource person

just needed more practice admitting critical infants (which is where the problem started)

New employees should not be admitting critical babies for awhile

The other 3 all said I needed teaching on communicating with patient families because I was "awkward"

What new person is not going to be awkward talking to families until they get comfortable in their job. I am an introvert and it took me a long time to get comfortable answering parents' questions.

Evidently I'm "excellent with level 2 patients" but "some of the charge nurses don't feel comfortable with giving [me] the more critical babies"

Then they shouldn't give you critical babies until you are comfortable.

I was completely blindsided; no one had said anything about this to me before then.

You were railroaded. You were not part of their clique and made you look incompetent.

I'm currently biding my time on Postpartum/Newborn until my re-evaluation in 6 to 12 months.

I hope it works, but the complaints they had were all normal new employee problems that work themselves out with more experience. If we transferred every new employee because they were awkward with parents and couldn't handle critical babies soon after orientation ended, we would have no employees.

meanmaryjean, DNP, RN · May 13, 2017

Eight weeks in and they're giving you critical admits?

Wow- they need to re-examine how they assign patients.

poppycat, ADN, BSN · May 13, 2017

It sounds like they set you up to fail. I had almost 30 years of Peds & PICU experience before going to NICU and they gave me the same amount of orientation as the new grads. What they gave you was not enough time. I don't think I would want to return to a unit that operates that way.

Lady_Leijing, BSN · May 14, 2017

To clarify, I had been on my own for about 8 months when they gave me a critical admit that the charge nurse claimed was "one of the easy ones". I had only admitted one micro-preemie before and that was while I was still on orientation and had a preceptor to walk me through it. I had not taken care of a critical infant since orientation, and the charge nurse berated me for not taking charge of the situation or bringing my concerns to her first. I did tell her I was uncomfortable with it, and I did tell her that I had never seen lines put in before--let alone assisted with them--but none of that registered with her, evidently.

Semper_Gumby · May 14, 2017

To clarify, I had been on my own for about 8 months when they gave me a critical admit that the charge nurse claimed was "one of the easy ones". I had only admitted one micro-preemie before and that was while I was still on orientation and had a preceptor to walk me through it. I had not taken care of a critical infant since orientation, and the charge nurse berated me for not taking charge of the situation or bringing my concerns to her first. I did tell her I was uncomfortable with it, and I did tell her that I had never seen lines put in before--let alone assisted with them--but none of that registered with her, evidently.

Holy cow, OP, it definitely sounds like they set you up to fail! And 8 weeks seems a pretty short orientation for a NICU. If you really want NICU, I would look for a different hospital that will support you as you transition to your new position. The unit I just got an offer for gives 12 wks orientation and assigns you a resource person after that so you have someone to go to with questions, etc. They also pitch in and work as a team on any admission, but especially a critical baby. I think it's silly they let you go 8 months without caring for a critical baby and then expected you to ace admitting one. Totally unrealistic expectations.

I recently had the experience of going through orientation being told I was doing well and then at the end they said the complete opposite and fired me; I felt like you, blindsided by it, but now I am thankful it happened. Mother-baby is nice enough and a good place to get some experience with healthy newborns while you figure out your next move. And hopefully the next place won't just hang you out to dry.

bgxyrnf, MSN, RN · May 14, 2017

This wasn't your failure; nor was it even a failure of the charge nurse. It was, however, a complete failure of the educator who should have been following up with you to be sure that you were transitioning well and getting the support that you needed.

It is absurd to think that you'd been there 8 months without a critical patient and then expected to take one for the first time without support and oversight. It wasn't fair to you and certainly not to that little baby and its parents.

It sounds like a crappy unit and not one where I'd have wanted my 27-weeker.

itsybitsy · May 15, 2017

I agree with the general consensus that the unit wasn't doing you much justice by first, giving only 8 weeks orientation, in which who knows how much experience you really got during those weeks.

Second, sheltering you from exposure for 8 months. Once off orientation, in what I hope was the case, where you got experience with caring for critical micro-premies, the information and skills are fresh in your mind. To keep that rolling, it's common to give you those level 3 babies once on your own. Maybe not the sickest on the unit, but still level 3 with respiratory support to get you accustomed to providing care and learning more to feel more comfortable on speaking about.

And third, using you being "awkward" as an excuse to push you to another unit is laughable. I don't believe this was really a legitimate reason for the move, but just another "justifiable" reason that you were not working out.

My advise, stay on the postpartum & newborn floor for a year, regardless of what NICU says on your re-evaluation. And at that year mark, apply for a NICU position at a different hospital. If that is the nature of this NICU, I'd rather work somewhere else. For the reasons above, if they let you have the NICU jobs back, who is to say you still won't get the level 3 babies, and if that goes on long enough, you have level 3 experience on paper and real-world level 2 experience. That is dangerous because if you change hospitals, they will expect level 3 real-world experience and you will be just as new to level 3 as you are now, which may even make the new hospital look poorly on you.

I only say stay at your job now to get that newborn experience for your resume for future NICU jobs, which is, I believe, to be looked upon highly. You will still have to say you were on NICU for 8 or so months, which is half the battle, but you can explain in the interview you were very comfortable with level 2 babies but did not get a lot of level 3 kids at the old facility.

vintage_RN, BSN, RN · May 15, 2017

Totally sounds like they set you up to fail. So sorry you've had to go through this. In my NICU we have 5 "pods" and then a level 2 around the corner. Eventually all nurses work all areas...one day you may have 2 critical. Babies and the next day you're in level 2. But there are 2 pods that are intermediate which are basically more stable babies but on CPAP and the like. New nurses to the unit always start out for at least 6-8 months working in level 2 and the intermediate pods only until they feel ready and comfortable to take the more critical babies. At that time the Educator sits down with you and you do another month of orientation in the critical pods. I don't think anyone should be given critical babies if they don't feel ready.

llg, PhD, RN · May 15, 2017

I'm interested in what happened in that 8 months after your orientation. If sounds like you didn't use that time to grow very much. Granted, they should have helped you to grow by giving you increasingly more complex patients ...

... but if you had 8 months in that NICU and were still uncomfortable talking to parents ... and had not sought learning experiences to help you get ready for sicker infants ... then you have to take some responsibility for that.

That 8 months is worrisome. I think there is more to this story than the OP has shared.

xObabytiggerr · May 21, 2017

I don't think you should assume. I work in the NICU right now (about 10 months in on my own) and it can be super intimidating to ask for more complex patients. I think charge/clinical educators or whomever deems the appropriate assignments to whom, should know every nurse that works in a specific shift's experience and give each the appropriate assignment. i.e. a NICU nurse with 3 years experience a 24 weeker on an oscillator with plenty of IV drips whom is a 1:1 vs. a NICU nurse fresh off of orientation a 2-3 baby "feeder grower" assignment.

Recently, I've been slowly getting babies with a little bit more acuity, which I like because they know how long I've been there and what is appropriate for me. So I think it's more so whoever makes the assignment is the one to blame and the administration for not making her FEEL comfortable to talk to them about what kind of assignments she wants. I wish I knew who OP was. I'd definitely recommend filling out an application at my hospital. There's so many helpful resources on my unit. They'd make you feel comfortable asking for help and progress to where you need to be.

Lady_Leijing, BSN · May 28, 2017

... but if you had 8 months in that NICU and were still uncomfortable talking to parents ... and had not sought learning experiences to help you get ready for sicker infants ... then you have to take some responsibility for that.
That 8 months is worrisome. I think there is more to this story than the OP has shared.

I thought I was doing well, especially since I did not get the official orientation classes until I had been there for 3 months. I had been taking 3 level-2 patients a shift and had just been certified to use the iStat meter, which oddly enough many of the nurses don't bother with. I had signed up to take STABLE in the spring, even though it wasn't required, and had been pouring through the CEUs that were offered for NICU. I though they would advance me when they thought I was ready, but instead they advanced the new grads that they hired 3 months after me instead. I normally can explain things fairly well to my patient's parents, but I do not excel at small talk; I never have. The other instance where I had difficulty teaching a patient's family was regarding a critically ill infant during my re-orientation period with a very abrasive preceptor standing over my shoulder correcting me. I have suffered some mild social anxiety in the past and having someone judging and correcting me while I explain something is really stressful.

As for more to the story, there was quite a lot more from the initial instance, but I'm not sure I've distanced myself far enough from it to look at it rationally. The "situation" in my original post involved me having a panic attack at work after admitting a 28-weeker. I told the charge nurse that I was uncomfortable, though she said afterwards that she had no memory of it. While I was doing as much of the admission as I knew how to do. She was showing a new nurse how to set up a line tray. I had to assess and record everything myself because the nurse she was teaching was supposed to be the scribe. When it came time to put in the umbilical lines, I told her that I had never helped with lines before. She did not acknowledge me. She let me fumble through it with the doctor giving me instructions on how to do it. When she sent me to get sterile water to clean off the betadine, I got out there and realized that we have 2 different sizes (there are actually 3, but I'll get to that in a moment). Brought back one, she told me that it wasn't what she wanted. Brought back the other, and she rolled her eyes and said "that's not what we need." I replied "then which one do you want? Tell me clearly so I don't have to keep running back and forth." She wanted the sterile water bullets that we use for oral care and added "M knew which ones I was talking about". When I went out to get those, I ran into a nurse mentor of mine and she asked how the admission was going, and I broke down. She told me that she would take the sterile water back to her and give me a chance to regroup. I took longer than the charge nurse felt was acceptable to regroup, and when I came back she accused me of abandoning my patient, reassigned me to take over a different patient, and wrote a letter to the manager of our cluster that morning before she left. She pulled me aside to "counsel" me on my mistake of not letting her know I was struggling, and several times through out the night interjected herself into conversations with other nurses to tell me that "we all get stressed sometimes, but we can't just run away from our problems." She told our manager that I only had 1 patient the rest of the evening (not true) and that I did not offer to help anyone else after the incident (also not true; I just didn't offer to help HER).

I wish I knew who OP was. I'd definitely recommend filling out an application at my hospital. There's so many helpful resources on my unit. They'd make you feel comfortable asking for help and progress to where you need to be.

Thanks! :) I'm not sure that my husband would be up for moving for my job though. (I peeked at your profile, and I live several states away) I am thinking about going across town though. At least we have 2 hospitals with NICUs in this city.