Doctor's role vs. nurse's in the NICU

prmenrs, RN · Aug 28, 2011

Find a University teaching hospital w/a Level III nicu and see if you can't "shadow" a nurse. This will give you some exposure to both his/her role, and that of the Nurse Practitioners and MDs. Nurse Practioners do proceedures, manage patient care and other stuff like that. But you can't be a NNP w/o being an RN and staff nurse first. Also, in your last semester, you might be able to do a practicum on a neonatal nursing.

Staff nurses take total responsibility for 1-3 babies (and their parents); they do vitals, assess their patient, review labs, maintain IV lines and respiratory support (w/the Resp Therapists). They need to think of everything going on w/the baby and put it all together to make sense for the docs and the family. IMHO, they have the most fun of anybody in the unit.

What a doc "does" in a NICU varies depending on the acuity level of the unit, where that particular doc is in the educational hierarchy. Younger MDs are learning, the more senior MDs are teaching. In addition to supervising the junior docs, teaching in the clinical settings, the Attendings may also lecture med students, have research projects ongoing, working on publishing (very imp't in the view of the University honchos cuz it brings in $$).

A regular pediatrician might have one or 2 intermediate level pts in a community hospital Special Care Nursery, but they make rounds 2x/day, and then go to their office.

umcRN, BSN, RN · Aug 28, 2011

I had two years experience in the NICU and currently work in a peds Cardiac ICU.

If you want to be with the patient you want to be a nurse, IMHO

As a nurse I could do any of the following or all in a day: vitals, assessments, feeds, insert iv's, administer meds, complete spetic work-ups, assist with xrays, assist with the intubation/extubation of my patient, obtain frequent blood gasses, discuss said blood gasses with the doctor or respiratory, suggest options for improving blood gasses, give fluid boluses or albumin boluses for low blood pressures, start and titrate pressors, give blood products, hold a grumpy baby, hold an upset mothers hand, care for a dying baby, or a baby and family that has passed, complete discharge teaching with a family, could be anything from how to change a diaper to how to change your childs trach. There are more things, too many to list. Note that many but not all of these things are done on doctors orders, but thats mainly what the doctor does, orders things based on the nurses assessment, labs, xrays etc but it is the nurses role to carry those things out and it is the nurses role to keep the doctor informed of the patients condition. I worked in a large level 3c unit of a teaching hospital, the doctors had 10-20 patients, I had 1-2. The doctors spend the day getting phones calls, text pages and knocks on their door from multiple nurses who have issues with their patients. They also do procedures such as intubation, insertion of central lines and lumbar punctures. They tell the parents the bad news, and take calls from outside hospitals who wish to transfer a patient to the unit. They talk with doctors of other specialties if they need a consult on a patient.

Nurses and doctors do very different things and both are equally important, but it is the nurse at the bedside 99.9% of the time carrying out the life saving orders written by the doctor.

dawnebeth · Aug 28, 2011

Remember that you are at the bedside with the patient your entire shift while the doctor is there a minimum of a few minutes a day. As others have said, you do so much more than be the doctor's assistant and pass bedpans. You are the patient's advocate and first line of defense.

I cannot tell you how many times I have told the doctor--this patient is not right, and listed my reasons why. A good doctor will listen to you, especially at a teaching hospital. If you have valid concerns and maybe even suggest getting a blood gas or a CBC to check out the reasons for your concerns, you may have just saved that patient's life. The doctor isn't standing there watching the patient improve or get worse, you are.

Where I work, we have new doctors fresh out of medical school. Many times, they don't even know the right orders to write or what tests to try. A gentle suggestion or a smile and a "maybe the patient needs this...?" goes a long way to helping the patient and teaching the doctor the value of listening to the patient And the nurse. lol