How common is all this support?

If you are in a level 3-4, that is all pretty common.

Very common

Ok good.

I was worried I'd be in for a shock if I ever worked in another NICU!

Standardization like that by having one group of well-trained people doing their task well results in fewer medical errors. Level IV NICUs usually have the resources to do this unlike most community NICUs. Back in the day, apparently RNs in the NICU used to mix their own TPNs. Scary...

Our NNPs do our dressings, we have RT and a lab in our unit, fellows in house 24/7, pharmacy on the floor but no milk bank. Not all NICUs have all this. Count ourselves lucky.

I work in a small level 3a NICU. Our PICC nurses insert PICCs and do dressing changes (but they often have their own assignment as well). RT does vent adjustments (we can titrate FiO2, and depending on the ordering physician, we're the ones telling RT what adjustments we want). We do our own milk mixing, our own labs, often no physician/NNP on the floor overnight (but usually 5-10 minutes away)

I work in a fairly large level III NICU (60 beds) and while we do have RTs that take care of our vents, CPAP, HFNC, etc. some of the other stuff you mentioned are things the bedside RN does. I do sterile dressing changes for all central lines (except PICCs which our neonatal nurse practitioners do) and we handle all of the breast milk ourselves whether it's maternal or donor. We draw our own labs on admission and if we have an inline draw system (like on a UAC) we draw our own daily labs as well. We have our own pharmacist and dieticians as well.

That sounds awesome. I work in a pretty large NICU. Largest in the area. Great hospital. But we don't quite have all that support. We have our own RTs and pharmacy. But no PICC team or breast milk bank.

Level 4, absolutely. I work on a small level 3 and our RTS are not NICU dedicated so we have to know what they are supposed to know because they don't always know it. I learned everything I know about vents and oscillators from the RTs at a level 4 I worked at. They loved teaching and I'm so glad I took them up on it.

We mix our own milk.

We don't mix our TPN or Lipids or specialty meds but we double check everything that comes from pharmacy because we don't have a dedicated pharmacists. Heck, we double and triple check all meds but I did that on a level 4 too.

Our NNPs do PICC placement and line dressings as well as UA and UV lines. We assist. I have no desire to do my own UA or UV lines, but I would love to get trained and be able to place PICCs. I placed PICCs in adults in another life. And when a given NNP doesn't place PICCs, we end up dealing with peripherals that, as you know, go out so easily. Because of those two things, I am an expert at placing peripherals but I hate putting the kids through that.

I work in a large Level IV and we have a PICC team who changes the PICC dressings, and we also have NICU RTs who do all of our vent adjustments, and also re-tape our ETTs (although we can and do help with that when needed.) We have a nutrition team who mixes all of our fortified formula and donor milk, but we mix/fortify breast milk on our own. The nutrition department provides the liquid fortifiers, and the providers write out the mixing orders, and then we take it from there. That way it's up to us how much we mix up, and hopefully we can cut back on wasted breast milk.