How to become a neonatal nurse/your experiences?

**NICU Guy, BSN, RN** · Feb 10, 2016

Get your BSN. If your school offers an externship/Capstone placement, try to get placed in a NICU (higher the level, the better). If you are able to relocate after graduation, apply to NICU positions at the larger NICUs (children's hospitals). Many of the larger NICUs have established training programs (including classroom time) to train new grads and experienced nurses without NICU experience. Otherwise, take any nursing job you can get, to gain experience and apply to NICUs as positions become available.

I graduated with my BSN in Aug. 2014, passed NCLEX in Sept, applied to 50-100 openings (mostly NICU positions) in 12 states, had two interviews in Nov. (a Level III in NC and a Level IV in KY). I accepted the job in KY 4 days later and started in Jan. 2015. Many of our new hires are new grads, so it is possible to get a NICU job as a new grad. We hire 6-7 new nurses every 3-4 months (very large NICU).

bpaster12 · Feb 10, 2016

What NICU do you work at in KY?

ThePrincessBride, MSN, RN, NP · Feb 10, 2016

Get your bsn. Apply. Then cross your fingers and hope you get a NICU position.

TheCommuter, BSN, RN · Feb 10, 2016

Get your bsn. Apply. Then cross your fingers and hope you get a NICU position.

Yep, NICU is a coveted specialty because many new nurses want to work with the preemies and micropreemies. You'll notice that the first respondent had to cross state lines and relocate to secure employment in a NICU.

**NICU Guy, BSN, RN** · Feb 10, 2016

Yep, NICU is a coveted specialty because many new nurses want to work with the preemies and micropreemies. You'll notice that the first respondent had to cross state lines and relocate to secure employment in a NICU.

OP,

Like I said, I applied to 50-100 openings in 12 states and only had 2 interviews. I am one of the few non-local hires. Most come from local colleges and had received a grant from the hospital that has a contract of service depending on the amount of your grant (more money, more years obligation). I also had a 135 hr Externship at another Level IV NICU while in school. While it is possible to get a NICU job as a new grad, it is very competitive and you need to stand out from the crowd. I realize that I am very fortunate to have a NICU job as a new grad. As the NICU chaplain said to me when I started, "You are an anomaly in the unit". I am the only male staff nurse out of 300 nurses.

I work at Kosair Children's Hospital in Louisville. 101 bed Level IV NICU.

RN_jess · Feb 11, 2016

I just recently made the transition from adult to neonatal nursing. I graduated with my BSN in 2014 and started on a cardiac stepdown unit fall of 2014. I had no previous experience with peds but during my interview the manager said that having the acute care experience is a bonus. Many of the nurses I now work with in a level IV NICU have been on the unit for 20+ years and/or have never worked in an area other than NICU. It is possible to get hired to a NICU straight out of school, especially if you do your senior capstone/practicum in the specific NICU where y ou want to be hired. However, don't be surprised if you are turned down straight out of school due to lack of experience. Stay persistent and keep in touch with the nurse manager. As a previous poster stated, many large hospitals offer NICU residency programs for new grads that give you a longer orientation including class time. Maybe there are also volunteer opportunities in the NICU near you. Getting your foot in the door that way would work in your favor. Good luck!! I have never been happier with my job.

NICUmiiki, DNP, NP · Feb 17, 2016

My nicu hires in groups since we take classes. Everyone in my group was an ER Tech or had a NICU preceptorship. I was an ER Tech for 2.5 years while in nursing school. Get involved in projects and quality improvement wherever you work so you have some good stuff to talk about that will set you apart from their many, many applicants.

LPNTOBE2017 · Feb 27, 2016

Hello

I was reading the thread and it sounded interesting. I would like to know what is the day and life of a neonatal nurse like?

carmen

**NICU Guy, BSN, RN** · Feb 28, 2016

Hello
I was reading the thread and it sounded interesting. I would like to know what is the day and life of a neonatal nurse like?
carmen

https://allnurses.com/nicu-nursing-neonatal/nicu-nursing-890418.html

A day in the life of a NICU nurse definitely differs...there's really no way to give you a good feel of what it's like because it can differ from minute to minute depending on the stability of your patients.
Taking care of babies in a NICU is a very scheduled job though - on other nursing units usually night shift doesn't bother them much throughout the night and it's just giving them meds every few hours, but in the NICU we do a full head to toe assessment every 3 to 4 hours depending on what's going on with the patient.
In my unit we admit any gestational age from 22 weeks (if viable and parents want to resuscitate) to sick term kids (the only thing my unit doesn't do is cardiac defects), but we do cooling, PPHN, ECMO, etc.
So my shift goes like this...get report from day shift, scrub up (washing hands is VERY important), start my cares. "Care times" or "touch times" is when we go into each baby's bed and do their assessments, change diapers, feed them, etc. It's very important for premature and sick babies to sleep (aka their way of healing) so we cluster our cares. Either every three hours or every four hours depending on the needs of the patient.
When we do our care times, I start by taking a blood pressure (with the teeniest blood pressure cuff you've ever seen), then I take an axillary temperature. Our goal temp is 36.5 to 37.5 degrees celsius. After temp I always listen to lung sounds, heart sounds, and bowel sounds. Then I feel the baby's head to see how their fontanels and sutures feel - we don't want the fontanels to be bulging (could mean increased ICP) or sunken (could mean dehydration) - we want them to be soft and flat. Sutures can be normal line, overriding, or separated - all of these can be normal at first but should go to normal line relatively quickly. After feeling the head I check pupillary response for PERRLA (especially if it's a baby with neuro issues). Then I go to the belly and make sure that looks and feels good. Premature babies are at a high risk for NEC (necrotizing enterocolitis - where part of the bowel basically dies - it can be fatal for babies). You need to watch the abdomen for loops - which are bowel loops visible from the outside - they feel like little lumps on your baby's belly. You also want to make sure the belly is very soft and the abdominal girth is stable. Measure abdominal girth around the entire abdomen near the umbilicus. Then I'll check residual via the baby's nasogastric or orogastric tube - we don't want more than 30% of the baby's feed to be left in the belly - this means the baby has not digested their food and maybe cannot tolerate the volume. Last (always last) change diaper. Makes sense why you would do this last - INFECTION RISK - but some people don't do that... make sure you monitor closely for any breakdown on the bottom. Take off gloves, wash hands, new gloves, feed the baby.
That's basically a set of cares for a typical baby. Of course each baby is very different - if you have an intubated baby you'll have to do oral care and suction out the mouth and ETT, and ensure the ETT is in the proper place. You'll also want to check your ventilation settings to make sure the baby is getting the proper amount of pressure and support. You also want to wean the FiO2 (oxygen) per protocol. Premature babies less than 36 weeks gestation have oxygen saturation parameters of 85%-93% and babies over 36 weeks have parameters 88%-95% (but those can also change per baby). You do not want your baby to self-extubate on your shift so you need to make sure you monitor the tube positioning VERY closely and make sure it is safely secure on the baby's face.
Feeding the baby can differ too - we never try to PO feed babies who are less that 33 weeks gestation as they physically do not have the suck/swallow/breathe reflex - which means they'll aspirate when they try to suck on a bottle. For these babies we feed them via an NG or OG tube (which is something I mentioned previously). Always check the placement of your NG/OG tube! If the tube is even a few centimeters out - it can be in the trachea rather than the stomach - and you would be pouring food into your baby's lungs!! This happens more often than you would think And this then causes aspiration pneumonia, which can also be fatal.
IV's are another thing you'll have to check if your baby has one. Little baby veins can blow and become infiltrated VERY easily. If your IV has continuous fluids running through them you need to be putting your eyes on that IV every hour. IV's, if infiltrated, can burn babies depending on the fluids going through.
Those are some of the basic things I can think of right now - The NICU is a great place to work! If you have any more questions feel free to ask :) I'd be happy to try to answer/help!!

MNNICU, RN · Feb 29, 2016

Hello! I started in the NICU fresh off my BSN but I did have a 120 hour capstone in that NICU and knew I wanted to work there. I made sure to sit down and speak with the manager on a few occasions during my capstone and got to know everyone. According to the manager the employees grew to really like me and thought I was doing very well. They asked on a few occasions if she would consider hiring me. The day of a NICU nurse varies widely. Part of it depends on the type of NICU you work in. Mine is a level three and only accommodates less than 30 patients but we also go to all high risk deliveries and do our own transports so you can have a very easy day with 3 stable or "feeder/grower" patients or you can be going on a flight transport 2 hours away to a 24 week micro preemie that's coding and you have to manage with a nurse practitioner until you get back. It can be intense, hard, frustrating, terrifying and absolutely beautiful. You don't always know what you are walking in to so you HAVE to be able to be flexible, think on your feet and deal with an ever changing environment. But it also serves "type A" people well as you are trying to keep on a strict schedule for your babies for proper developmental care and it's a intensive care unit so attention to detail is paramount. These tiny people can (and will) often quit breathing on you multiple times during a shift- not many other specialties can claim that. You also have to be able to deal with families as a whole- it's not just sick babies but their terrified parents and well. You comfort, empower, explain, reinforce, and teach a lot. You have to be a voice for you patients- even if that means standing up to their parents and kicking them out of a room of they are being loud and obnoxious which is bad for their baby. It entails more than I could ever tell you in a thousand pages. But I would never do anything else. It's my passion and where my heart belongs. I have wanted to be a NICU nurse since I was 7 years old and still to this day I want to be one until I'm 70. If this is really the field you chose, you probably won't regret it :) good luck!

kiwiRN22 · Mar 9, 2016

What an awesome post! @guy in babyland Thanks for taking the time to post this :)