Help!

2012rnnewbie · Nov 1, 2013

It's so interesting reading your post...I have been an RN for a year and a half, but always wanted to be in the NICU. When I graduated the opportunity just wasn't there and as of recent I applied and was offered a position with two different hospitals. I was so nervous going into each interview, but gave it my all. They must have seen some kind of potential in me and I in the end I was offered both positions. I accepted the closer/larger level III with a huge children's hospital and am so excited for my new journey. I wish you best of luck with yours and hope that more experienced RN's in the NICU with respond.

jpeters84 · Nov 3, 2013

You ask a very loaded question. Before going into what you could know about the NICU I think it is important for you to first make sure that they have taken new grads before in this particular NICU and that it is a very supportive new grad training program if they have. I think that is fantastic that you are so passionate about the NICU. Just make sure you're going to start in a unit that will carefully foster that passion and gently ease you into the world of the NICU. I would be sure to ask how many new grads have they trained? How long is the training? How many preceptors will you have? Do you start off with low acquity and then move to high acquity? How long with each until you're on your own? Will you have a NICU mentor? etc. etc. The longer the training program the better. The fewwer amount of preceptors the better to a point you should have at least three to get an idea a couple different ways to do things but not so many that no one is taking a vested interest in your development and progress as a nurse.

Now on to what might be helpful for you to know. First off NICU nursing is so unlike any other field that I hesitate to tell you anything. Going in to your interview and just being yourself and letting them know your passion for NICU nursing really should be enough although they're probably going to want to know that you've at least had some exposure to the NICU to know that you're not going to get freaked out and leave early on after they hire you. So if you have had any exposure at all I would definitely mention it. It would probably be helpful to know some broad basics like the different types of infants you will find in the NICU. The preemies-there's micropreemies (Extremely Low Birth Weight or ELBW and Very Low Birth Weight or VLBW) they're genererally the 24-29 weekers. Then there's the later termers which is 34ish/35 weeks-37 weeks gestation. They can be deceiving because they act like they're term but they're not term and can be the sickest. Then there's the term babies generally 37 weeks on. Preemies are generally in the NICU for respiratory issues and well because they're premature but there can be a whole lot of other reasons. Term kiddos can be there for congenital heart conditions, meconium aspiration, congenital defects, delayed transition, infants of diabetic mothers or IDM babies, and many other reasons. Respiratory modes used in the NICU: there are those kiddos on a ventilator- high frequency (usually an oscillator) or conventional ventilaors, there's CPAP, RAM, and high flow cannula or nasal cannula. Different cardiac conditions are PDA or Patent Ductus Arteriosus, Coartaction, ASD, VSD, and many many others. Bread and butter NICU issues are hyperbilirubinemia or bili-babies (those under the lights), kiddos working on feeding and growing, and kiddos with minor respiratory distress needing CPAP and high flow nasal cannula. Everyday nicu nursing issues are worrying about respiraoty issues such as "spells" when a baby drops their oxygen saturation you want to check their positioning, their color, and are they breathing too slow (babies respiratory rate is usually 20-60, heart rate 120-180), are they taking pauses in their breathing, do they need to be stimulated to breathe during the spell? Low blood sugar can often be an issue especially on admissions or babies just born and especially with infants of diabetic mothers. Every unit is different but usually a blood sugar under 50 some units under 40 is considered too low and you will be asked to give a bolus of D10 IV fluids. Gut or belly issues are also huge. There is something called NEC or necrotizing enterocolitis (which its complicated but really condensed down) the issue is that their bowel tissue dies and it is an emergency surgical issue usually and infants can often die and die quickly from it so frequent assessment of bowel sounds, belly color, shape, belly girth, are they toelrating their feeds? When did they last poop, emesis, color of emesis etc. Honestly I could go on and on but...

This is a ton of info and I basically mention it so you can go off and research further on these topics at your discretion. I wouldn't really expect a new grad to know any of this and its really hard to put any of this information into the correct perspective until you've seen it at the bedside so I hesitate to even tell you all this. Not to mention I am telling you all this at 3am on a night shift and I may not even be giving you that great of information. But I want to give you some things in case it is at all helpful. But as someone who entered the NICU as a new grad three years ago-I cannot emphasize this next part enough- it is not at all what you know going in that's going to make the difference- it's how good of a new grad NICU training program they have and how supportive of you as a new grad they're going to be.

I wish you all the luck in the world. Go into your interview just bursting with passion, humble enough to know you have a lot to learn but driven enough to want to do whatever it takes to learn it. Don't be afraid to say you don't know but you aren't afraid to ask, and I'm sure you'll do great!

2012rnnewbie · Nov 4, 2013

WOW jppeters84, thank you for all of that information. As stated previously I will be starting new to service in the NICU(I have gyn/gi surgical and ER background). I have been scrolling this forum for information as I am so excited to start. I found the description/summation you gave to be one of the best! So thank you for taking the time to no only write it, but to also get me even more excited for this new adventure.

tincan · Nov 4, 2013

Just wanted to leave a thanks for jpeters84's thorough post!

rnblack4 · Nov 19, 2013

jpeters84: Thank you so much for taking the time to send your very informative reply. I just shadowed in the NICU today and loved it. Loved the RNs and the environment. Everyone is so nice and patient answering all of my questions. There orientation program seems to be very good. Hopefully it all ends up working out for the best!!!

HyperSaurus, RN, BSN · Nov 19, 2013

Rnblack4, you were offered a position? Or are you currently in the interview process?

2012rnnewbie, when do you start?

2012rnnewbie · Nov 21, 2013

I start Dec6th, its a month of shadow then a month of NICU simulation school then back the floor for hands on orientation

HyperSaurus, RN, BSN · Nov 21, 2013

Holy crap, that would be wonderful. But is that just for new grads or does anyone new to NICU do that?

Pedinurse_mia · Nov 22, 2013

Hi ! Great post jpeters84! I will be starting NICU also, transitioning from Tele. I am nervous but so excited. I also start dec 6! I have been trying to read up on material before starting, Any suggestions on books? Thank you.

2012rnnewbie · Nov 23, 2013

HyperSaurus, RN, Thats anyone new to the Level3 Nicu.

rnblack4 · Nov 23, 2013

Rnblack4, you were offered a position? Or are you currently in the interview process?

I was starting the interview process. I applied for the position and I had met with the manager and she "fast-tracked" my application to start the interview process ASAP. However, when HR looked at my application it showed that I had received a written corrective action back in March of this year when I was still going through my residency (a time that I wish didn't come back to haunt me -- due to a "lack of communication"). Anyways, new policy at my hospital says that after receiving a written corrective action, an employee cannot transfer units until a year later (previously was 6 months). I met with my HR rep and she said it's really non-negotiable (the not being a resident anymore and now I am permanently on my floor) part. I was hoping being in the residency it may not still be applicable.

However, I shadowed in the NICU for 4 hours and loved it. The nurses were so patient and helpful answering 100's of questions for me. When mid-March comes around, I hope that there will be a NICU position available because I will definitely reapply!