How sad is the NICU? Is there a personality type best suited to it?

NICU_babyRN, BSN, RN · Nov 25, 2011

If you don't have tough skin, you may have a hard time in the NICU. Some NICUs, specially those that are Level III with surgical cases and ECMO are sometimes very sad. So you may be better off in a level II nursery where infants are a little bigger and healthier.

Getting attached is often hard in the NICU and sometimes it's devastating.

Once you get to apply for jobs, you can think about doing a shadow day!

Bortaz, MSN, RN · Nov 25, 2011

Babies die. Sometimes often, sometimes tragically and messily. It's hard. It's sad. Some of the hardest and saddest times I've ever encountered.

But on the other hand, I've also seen some of the most beautiful, happy times of my life.

NicuGal, MSN, RN · Nov 25, 2011

If you get sad/depressed easily, a level 3 NICU may not be for you. We see some pretty devastating things Some things happen quickly, others last for months and months.

Also, their body functions can be pretty bad too....trach, kids with mulitple ostomies, intestine hanging in a bag from a warmer, other organs on the outside that should be in. It isn't all pretty babies with nothing gross thrown in.

Maybe try for a level 2, they see less of what we see.

chunkiesundae · Nov 26, 2011

I find myself sometimes thinking I am tougher and stronger than I really am. Its not so much the "icky" stuff that I'm worried about- I've been working at a veterinary clinic for 6 years and the intestinal surgeries, mucus, infections, impacted anal glands....well, I don't love them, but I tolerate them...to be honest I'm a little intrigued by some of the medical interventions in the NICU. I hope that doesn't make me sound bad or sick.

But really what is more tragic than a baby dying...I hate to see puppies and kittens suffer and die, and it happens all the time and we all go on with our lives. Yes we are sad, but in general the staff finds a way to get through it. However, puppies and kittens, cute as they are, are not baby humans and we would never do the extreme type of interventions that happen in the level III NICU.

How do you cope? How do you not hate God every day? I want to take care of these special, special little humans but I don't know if I have it in me.

umcRN, BSN, RN · Nov 26, 2011

I worked a level III NICU for 2 years and now work in a peds cardiac icu...its not much different, lots of babies bit some older kids too. Many make it many do not. I've gotten very attached to babies in the past, its hard not too and when they die its tough. On those days however I think pf one little guy I fell in love win. He left the hospital with a trach, vent, gtube and a death sentence...but no diagnosis. His mom still sends me pictures of him 20 months later- no trach, no gtube, walking, eating, completely normal. He remains undiagnosed but when he had left he had been pretty sick and had zero muscle tone. Now he is a completely different kid and makes me happy on those tough days. I will also say, as sad as it is, MOST of the babies who doe, in the long tun, are probably better off that way because their quality of life was bound yo be poor or all we were doing was torturing them and prolonging suffering.

It is definitely interesting all the different diagnosis. And working in a large children hospital I've been able to see all those "extremely rare" diagnosis nursing school books don't even touch. You should def try shadowing somewhere before making your decision and may've a level 2 would be a better fit for you

Sorry for typos, writing from phone at 2 am is not easy for me!

dixRN · Nov 26, 2011

You asked what type personality works the level III NICU. Level III NICU nurses are usually very OCD. You have to be very exact with dosages & when dealing with a 750gm infant there is no room for error. It is a very stressful work enviroment. You need to be able to destress when you leave work.

As far as the higher mortality/morbidity rate you have to keep in mind that a lot of the kids eventually do OK & that those little ones need you. The ones who die, need you to make them as comfortable as possible & their families definitely need your support in dealing with the death. The flip side of the coin is seeing a two year old walk down the hall & say Hi when you never thought that child would make it out of the unit. The joys make up for the tragedies & you will always feel that you have a meaningful career & that what you do does make a difference!

chunkiesundae · Nov 28, 2011

It's funny that you mention an "ocd" personality type because that is so me. I've always been really careful, detail oriented and conscientious.

I feel really good about this, actually...I think I could do it.

aerorunner80, ADN, BSN, MSN, APRN · Nov 30, 2011

No matter where you go in nursing, you're going to run into sad cases. It's part of the job. The NICU is no exception.

I work in a level III with lots of surgeries, ECMO, whole body cooling, etc. We are the hospital where everyone else sends their sickest kids to.

As you can imagine, we see the worst of the worst but we also see the best. Since you are asking about the sadness, it all depends on you and how you handle it and are able to seperate yourself from the situation and look at is as a nurse/trained medical professional. The majority of the deaths we see, everyone expects. It's actually a relief when the parent(s)/family decide to stop and pull support. The hardest/saddest part for me and a lot of the nurses I work with is when we are trying to keep a baby alive who is clearly suffering and wants to not suffer anymore.

On the flip side, I've seen so many amazing things that FAR outweigh the sad parts. I took care of this one baby who was born early. This baby was very sick and the day I had him, he really started to go down and we had to start pressors, were giving boluses of NS and D10 like crazy. The blood sugars were down in the 20's. This kid had me running nonstop all 12 hours. I thought for sure he was going to die on me. It was very scary. The parents were so wonderful and involved with everything. The mom really liked to talk to her baby and read to him. I started to notice as he was dropping his blood pressure/means, that he really responded to some mild stimulation such as being talked to or having a hand placed on his back.

The mom had to step away for a few hours which is when he started to do his downturn and tank. Mom came back and started reading to him through the isolette portholes. She was reading a baby's first bible stories book to him. All this time, we were going up on our dopamine and talking about starting dobutamine. As soon as mom came in and started reading to him, his pressures stabilized. He was still on pressors but he was more stable. Normally we ask parents to leave at 1830 so we can get ready for shift change and everything but seeing the response of this baby, I asked the mom to stay and she stayed an extra hour and then came back at 8 when the unit reopens to visitation.

Now we don't know how this baby will do develomentally. There will be some delays for sure just for prematurity, but about 2 months after this happened, mom and dad took home a well and thriving baby boy.

If that wasn't a miracle, I don't know what is then. I will never ever forget this case.

So as you can see, the good FAR outweighs the bad. I LOVE my job.

ETA: I don't know if I'd say we are OCD but we are definately strong minded and have no problems standing up for what is right. There's a joke in our unit that is so true.

What is the difference between a pitbull and a NICU nurse? A pitbull will eventually release.

CeilingCat, ASN, RN · Dec 1, 2011

All types of nursing can be sad, if you choose to see the negative. You can look at the positive in NICU: in some countries there really isn't a NICU and most of the babies would not make it. By working there you're helping to give the newborns the best chance possible.

I don't work NICU but I was there for volunteer work & part of my clinical rotation. The upsetting part for me were the withdrawal babies who were suffering terribly because of their mother's choices. It infuriated me that in my state not only is there no penalty, the infant is turned over to [drug-addicted] mom as soon as he is stable. There is not much in the way of a support system in my county for the women who do want help getting off drugs/alcohol, so it just keeps happening over and over. But if your state has better laws or your hospital serves a different demographic, perhaps it's not as big a problem elsewhere.

MegNeoNurse · Dec 1, 2011

I've worked in NICU for over 7 years, and PICU for over a year now. PICU (at least the one I work in... Level I trauma center, transplants..) is by far MUCH sadder than the NICU.

chunkiesundae · Dec 1, 2011

MegNeo- I suppose that it being less sad than PICU is a good thing, but I've never experienced either, so it doesn't give me a point of reference lol! I can see how that would be true, however, based upon the fact that in PICU the children are older and there are probably auto tramas and things like that.

Ceiling-cat- I agree that the drug addiction stuff is just plan nasty and depressing. I wish there was more we could do...or more the hospital system could do. Obviously nurses do their best to make these babies are comfortable as possible, but what could the hospital do to help the mothers?

aerorunner- that does sound amazing and miraculous, and is so inspiring!! Makes me want to do this for sure.