Getting a feel for the field

Gompers, BSN, RN · Apr 10, 2004

Welcome!

1. What are your average daily duties?

It all depends on your assignment. The nurse is responsible for all the bedside care - vital signs, physical assessments, diaper changes, blood draws, baths, feedings, medications, IVs, suctioning breating tubes, etc. We are at these babies' bedsides constantly.

You could have 3-4 growing/feeding preemies that get bottles or NG tube feedings every 3 hours or so. That's kind of like being on a hamster wheel - you run from baby to baby in circles all shift long. When it's time for each baby to eat, you do their vital signs and assessment, then you often have to "teach" them to eat as preemies aren't programmed to have this skill until they're almost full term. This is when you do a lot of family teaching because these kids are going home soon, and you do a lot of bathing and rocking and it's actually kinda fun if you're not TOO busy.

Or else you could have 1-2 very sick babies that need constant care. With these kids, you're dealing with multiple IVs, medications, ventilators, lab draws, off the wall vital signs, terrified parents, etc. There may be a constant flow of new orders for that baby's care so that just when you thought you had things under control, suddenly you have 10 more things to do. Here you'll give a lot of blood product transfusions, cardiac meds, antibiotics, narcotics, steroids, paralysing agents, etc. Sometimes you might have 8 or 9 different IV bags/medications going at once, and the baby might have IVs in each extremity to accommodate it all. You have to deal with breathing tubes, feeding tubes, chest tubes, IV catheters, etc. It's very scary sometimes, as these babies can be sicker than sick.

Also, in some units, you might be trained to run to high risk deliveries (any delivery where something is not normal, i.e. prematurity, emergency c-section, baby not breathing) to help recussitate newborns. You also might be trained to do ambulance or helicoptor transports, bringing babies to or from your unit. You take babies through the hospital for different tests like MRI or CT scans. When a new baby is admitted, you have to stabilize him or her and help the doctors get IV lines and breathing tubes in, things like that.

2. Are most days hectic and busy or calm and controlled?

Depends on where you work and what kind of staffing they usually have. MOST NICU nurses are pretty happy, as far as I can see. Of course you're going to have busy days and quiet days, but at least for me it's more quiet than crazy. Even when it gets crazy, people pull together and things are pretty controlled. The thing about NICUs is that they are usually pretty open layout-wise, so you are always working next to other nurses, and that helps to foster wonderful teamwork in times of crisis. Also, NICUs don't tend to have as high a turnover (quitting) rate as other units, so staffing is usually pretty good and you usually have some very experienced nurses on each shift.

3. Is working with the tiny babies so rewarding or does your heart break all the time?

Of course it's rewarding! I'd say about 10% of babies don't survive, or if they do it's with horrific problems. The other 90% do pretty well and go home. (Of course, these kids might show up with physical and intellectual handicaps down the road.) It's the best feeling to see a baby get better and go home after being so critically ill. Of course your heart breaks when a baby doesn't do well, but most of them time when that happens you know it was just nature and that the baby wasn't meant to survive. We have great medicine and technology but Mother Nature really calls the shots! The vast majority of the time you're going to feel great rewards in this field.

4. If you don't mind, what sort of salary can be expected? New grad? and experienced RN? (I'm in the midwest)

I think most hospitals in the midwest start between $20-25/hr right now. If you stay at one place long enough - meaning 20-ish years - you can reach the "ceiling" pay for RNs in that hospital - usually around $35/hr or so. Of course, nights and weekends will get you a little more money on top of your base pay.

5. What types of advacement are available (charge nurse, extra certification, masters for NNP) and how does those effect a nurse's desirablilty and income?

You can be a charge nurse or a preceptor for new nurses, but in most units not for at least a year or so because NICU is such a specialized area that you really need at least that much time to get it all under your belt. Charge nurses usually only make a buck or two per hour above their regular pay. You could always go for head nurse or assistant head nurse, but again that takes time and dedication. After a couple of years you can take the RNC exam to get certified in NICU, though some hospitals don't pay you more for this. NNP is always a possibility, but again, you'd need at least a couple of years as a staff RN to do well in that vein. Of course getting any advancement makes you a more desirable nurse.

This is only MY experience though, so other nurses might have different takes on these questions! Good luck!

rainbows4me · Apr 12, 2004

I didn't post the original question, but as a new grad who's going to be starting this summer in NICU, I really enjoyed your answers. Thanks for taking the time to share!:)

Gompers, BSN, RN · Apr 12, 2004

I didn't post the original question, but as a new grad who's going to be starting this summer in NICU, I really enjoyed your answers. Thanks for taking the time to share!:)

You're welcome! Just ask if you have any questions - this NICU board is great! Good luck in your new job.

Mithrah · Apr 14, 2004

Wow, Gompers, thank you so much for your detailed answers.

I will be graduating in one month and I have a job waiting for me in the NICU. I begin the training program this July and the training will last longer than my nursing school! Can you beleive it, my NICU training will be 18 months. I am very excited and nervous at the same time.

HarleyDivaRN · Apr 15, 2004

Gompers You really broke down the answers and questions I really like how you organized your reply.......We can tell you are a nurse by your ability to organize your words and answer questions in an understandable way.....I like that ......just thought I would share that with everyone...................(smile)

Gompers, BSN, RN · Apr 15, 2004

Gompers You really broke down the answers and questions I really like how you organized your reply.......We can tell you are a nurse by your ability to organize your words and answer questions in an understandable way.....I like that ......just thought I would share that with everyone...................(smile)

That's sweet, thank you. :)

vemiliob · Apr 16, 2004

:rotfl: Hi! Tara,

I don't think I could add some technical or specific detail over the pretty Gompers' explanation, however, in relation to your 3rd question

(3. Is working with the tiny babies so rewarding or does your heart break all the time?)

I guess I can feedback you with my story.

One of the most remarkable things is that health care might be completely different in different sites. It changes from one institution to another, from one city to another, from one country to another, nevertheless Neonatology seems to be Universal. One can deal with better o worse instruments, but the essence of one's job will remain the same in Bs.As., Peking or Iowa.

I am a BSN with much experience in Emergency and Med-Surge area, alternating peds/adults since 8 years but I always wanted to be in the NICU.

Life sometimes gives us the possibility of revenge and mine was to get in the NICU at my 47s. Right now studying at the Garraham Hospital (our main pediatric) and working at small hospital closed to my home.

I came back to life when I started working with neonates.

They depend completely on you, I mean all their basic needs will be met through you, so that you'll become a life support of little-tiny-defenseless babies. If you are sensitive enough you'll found in yourself an unexpected source of responsibility that will transform you in a better human being.

I agree, there is more reward than pain, more calm than hectic days although always busy.

Sometimes a profound peace, holding in your arms a baby ready to go home, that do not want other thing than being hold by you...

as a way of saying you Good by and thank you for all your human warm!

:crying2:

couchdogs · Apr 18, 2004

Thank you all for the helpful information. It is great to hear what nurses already working in the field have to say. I love this forum for exactly that reason

Couchdogs

LauraLou · Apr 23, 2004

I am a nursing student and have planned to become a NICU nurse. I was observing in the OR this week and the circulating nurse was a former NICU nurse. She told me it was horrible. She said the parents yell at you and think everything you do to their baby is wrong. You are sent off to attend high risk deliveries, meanwhile you have tests due on your patients in the NICU and the doctors yell at you when the tests aren't completed on time. She said it was a rat race and she was so glad to be out of there.

I have to say what she said worried me a little. I know it is only one person's opinion, but she was a NICU nurse for 7 years. Is it really that stressful? I don't mind some stress but she made it sound like every day is an ulcer waiting to happen. Any feedback is appreciated.

Thank you!

Gompers, BSN, RN · Apr 23, 2004

I have to say what she said worried me a little. I know it is only one person's opinion, but she was a NICU nurse for 7 years. Is it really that stressful? I don't mind some stress but she made it sound like every day is an ulcer waiting to happen. Any feedback is appreciated!

Well, there is no nursing job without stress, so of course you have to expect a little bit. No job is perfect. I think the reason most NICU nurses are happy with their jobs is because they love taking care of those little babies, and that makes putting up with the stress worth it.

That particular nurse might have worked in a very busy unit with little nursing support, who knows. In our unit, yes sometimes you are assigned the high risk delivery pager, and yes while you are at a delivery your babies' care has to wait a little bit. But if there is good support on the unit, usually one of the other nurses or the charge nurse will pitch in and help while you are gone. They'll give the feeding or draw the lab or give the med so that everything isn't late. Besides, most of the time when you are assigned to high risk, you don't have the kind of baby that has tons of labs or meds that can't wait. At least that's the routine on my unit. And you'll run into the same problem in adult areas too - those nurses are sometimes assigned "code" pagers so they, too, have to run off and leave their patients.

As far as family and docs yelling at you...welcome to nursing. Sometimes it happens, in any unit, not just NICU. So please don't let that stop you from going into neonatal. Honestly, you're going to put up with the same B.S. all over the hospital, you might as well do it while caring for the population that interests you most.

Good luck!