Challenges of working in the NICU?

[MamaMagic]

Hello,

I'm a nursing student interested in NICU nursing. There are so many things about it that I feel like sound like a dream job, but I'm also trying to think critically about the challenges as well. One thing that has stood out to me is the stress of dealing with fussy babies who may cry for the entire 12 hour shift, like what I've heard many NAS babies do. I know from dealing with my own children how stressful it can be to handle a crying baby for hours on end and mine were relatively easy. Is that a significant issue that NICU nurses face, or is just something you get used to? Are there other components of the job of a NICU nurse that are particularly difficult compared to other areas in nursing? Thanks so much for your input! 

[NICU Guy, BSN, RN]

NAS babies are only one component of the NICU population. NAS babies can be challenging, they do not cry the entire shift. There are things you can do to assist them through the withdrawal period.

NICU nursing is very specialized, so there are many things that apply to us or don't apply to us compared to the rest of the hospital. Depending on the level of NICU, you may care for babies with feeding issues or needing nasal cannula O2 (Lvl II) or you may care for patients with congenital defects/ heart defects/ genetic issues (Lvl III/IV). 

Keep in mind that in some areas of the country it may be difficult to get a NICU position as a new grad. I was fortunate to get a new grad position at a Lvl IV NICU as a new grad, but you may not lucky enough to apply to the right place at the right time.

[ss21]

Following this post as I’ll be starting in nicu soon!

[Melina Haas, BSN]

Crying, fussy babies are part of the job. I don't feel like it is a terribly troublesome part of the job though. When I have a fussy baby I just remember it is only 12 hours I am here for and also you learn some pretty good techniques for soothing NAS babies that help somewhat. I always feel bad for these babies because it just means they are not feeling so good and need some extra TLC, which I try to give if I can. If you are passionate about neonates and families the NICU can be a wonderful place.

[vintage_RN, BSN, RN]

My challenge may just be the place where I work and the culture. I came from adults where I did everything...IVs, venous draws, central line dressings, complex wound care etc. In the NICU I work in, you have to be selected to get trained to do IVs, or attend deliveries. So there is only a small core group of nurses who can do venous draws, IVs, attend deliveries and an even smaller group who does central line dressings. The rationale behind this is that if a smaller group knows how to do these things really well, then there will be less adverse outcomes, rather than everyone knowing how to do it moderately well. So I've been in my NICU for 4 years and still cannot start an IV. Part of the culture is they pick their favourite nurses and "groom" them to be part of the group. 

Another thing is I know in adults and especially adult ICU there is a lot of atonomy and medical directives. I find in the NICU I need an order for everything. I do miss the atonomy.

[Dmg84]

Also following to stay in the loop! Hoping to join the NICU nurse ranks later this year ?

[moongoddess9301, BSN]

Hearing your own child cry and hearing a NICU baby cry are very different. Yes, there are days when crying babies at work can be very frustrating. But you have the benefit of coworkers who can help and an objective view of the baby crying you probably don't have with your own children. 

[MamaMagic]

I'm going to update here! I just finished my preceptorship in a level IV NICU and it was absolutely wonderful. I loved all the aspects of the job and everyone I worked with. I am now just trying to figure out a way to get a job!

[NeoNurse23]

4 hours ago, MamaMagic said:

I'm going to update here! I just finished my preceptorship in a level IV NICU and it was absolutely wonderful. I loved all the aspects of the job and everyone I worked with. I am now just trying to figure out a way to get a job!

Awww that’s awesome!! I also precepted in the NICU (level III though) and equally fell in love. I’m applying to several new grad residencies in hopes of securing NICU locally, otherwise I may have to relocate. I’m In CA where it’s difficult for new grads to start in specialties, how about you? 

[RhandaH, ADN, RN]

Hello! I know this thread is a few months old but I think you still might be in need of advice for getting into the NICU. I was in a similar situation as you, I had my preceptorship at a Level 3 nicu near my home and had no idea what to expect but thought I liked the idea of nicu nursing. My 3 months on the unit made me FALL IN LOVE. Many people on the unit told me to say something if I wanted a job so I did. I prepared my resume, added a little confidence in my step and walked into the managers office. You may be done with your preceptorship but you still have the resources. If you feel like someone liked you or can vouch for how hardworking and prepared you are, use them! It works. Networking is huge in the nicu world because there are soooo many people who have worked as rns for years that are fighting to get into nicu, so some hospitals don’t use nicu new grad residencies as well. I understand since these babies are so fragile and precious! Hope all goes well!!

[NICUmiiki, DNP, NP]

I never thought fussy babies to be that big of a challenge. There are swings, pacifiers, etc. Plus, between feeds you can usually hold them. They also tend to find friends (other RNs, techs, cuddlers, hopefully family, etc.), so they don't usually cry the WHOLE shift. If you compare them to sleepy pre-term babies, they are a bit more work. But they are just being a baby who doesn't feel well, and I keep that in mind.

[VRS82, BSN]

How many patients does a nurse typically care for on your Level 2 units? We have many NAS babies and sometimes I feel so overwhelmed and incapable of caring for all of them adequately… ? Thank you!