I know the pros, but what are the cons of NICU nursing

**NICU Guy, BSN, RN** · Oct 9, 2015

1. Too many mothers on drugs during pregnancy and having CPS involved, only to have the baby sent home with the mother or giving custody to the grandmother whom the mother is living with.

2. Death of a baby that you have cared for weeks or months.

3. Parents who make no effort to come spend time with their baby.

4. The ever increasing number of NAS (drug ) babies.

xxdiscoxxheaven · Oct 9, 2015

1. Hostile parents who don't understand why the baby can't " "come home. They look fine".

2. Parents who pretty much abandon their child once the mom gets discharged.

3. Parents who refused to be educated by you, especially if you don't have kids

FlyingScot, RN · Oct 9, 2015

In my experience it can be a tough crowd to break into. It takes a long time to prove yourself to your peers and there are many pitfalls along the way. There is a lot of territorialism and sometimes outright jealousy. I have worked with nurses who get in a snit if they aren't always assigned the sickest kid in the unit and woe be it to the nurse who gets that assignment instead. If you can make it through that you'll be fine. It's very different than the ED and similar to any other ICU (I've done all three). For me, the best teamwork I experienced was the ED.

llg, PhD, RN · Oct 9, 2015

Here are some others:

1. The physiology of the premature neonate is so different from the physiology of adults that it complicates your transition into the neonatal field. Also, there is more physiological variability between patients. An old saying is that: "There is more difference in the physiology of a 25-weeker and a full term baby than there is between a 3-year old and an adult." The liver functions differently, the kidneys, the heart, the lungs, the skin, etc.

The "rules of thumb" and "judgment calls" are different -- and an adult nurse transitioning into the NICU can feel as if the rug has been pulled out from under him/her. Some people like that challenging "off balance" feeling of becoming a beginner again, but others hate it and long for the feeling of security they had working with adults.

2. Once you get used to all the neonatal stuff ... If you stay there for several years, it can be hard to switch to adults because you feel so out-of-date with adult care, drugs, procedures, etc.

Coffee Nurse, BSN, RN · Oct 10, 2015

Parents who think they know better than I do what the baby needs because "it's my child"/"Mom/Dad knows best." Someday, yes, you will know this kid inside and out, but right now you're a brand new parent (usually) and I've made my entire career the care of neonates. Your quick Google job does not make you more knowledgeable than a staff with combined centuries' worth of NICU experience. Also, I appreciate that you and the other parents support each other, but please stop trying to advise them on what treatments they should be demanding when your baby is in a completely different situation from theirs.

Fortunately I've never been in a situation like FlyingScot; both units that I've spent most of my career in have been great for teamwork, and it's understood that everyone needs their fair share of time with the "sickies" to build experience. YMMV, but this seems to be more of a specific unit culture thing than something common to all NICUs.

Coffee Nurse, BSN, RN · Oct 10, 2015

Oh, and the questionable ethical places you find yourself. The 23 weeker with bad bilateral IVH and seizures, the 25 weeker with terrible lungs and barely any gut left post NEC, etc. -- and the parents want everything done. Knowing the prognosis and trying not to be angry at the parents for making you put this child through any more pain, because it's their child and their decisions come from being in an unimaginable situation.

Janetnzrn · May 31, 2016

The biggest negative will be the loss of your adult skills. After 12 years as a NICU nurse, there is no way I would be competent to care for adults.

Coffee Nurse, BSN, RN · Jun 1, 2016

The biggest negative will be the loss of your adult skills. After 12 years as a NICU nurse, there is no way I would be competent to care for adults.

That's only a negative if you plan on ever leaving NICU

dawngloves, BSN, RN · Jun 3, 2016

Wrapping a baby in a shroud.

HyperSaurus, RN, BSN · Jun 6, 2016

Hmm. It can be very territorial between nurses, and especially when you're new, you are constantly being watched. However, the flip side to that is that when things go wrong, all hands are on deck very quickly. It's frustrating sending home kidlets to a home life that you know is not good, but due to red tape, ect, the parents get custody (even worse if the child dies at home). I work in a Level III facility that is capable of taking care of some pretty sick kidlets (micropreemies, vents, oscillators, iNO, drips, ect), but we can't do surgery and we can't do ECMO. When we send kids out, we don't often find out how they do or even if the kid survives. I am significantly more sensitive to noise stimulation and alarm fatigue than I ever was on a medical with tele floor, due to frequent crying, ventilator or CPAP alarms, IV pumps, and monitor alarms for bradys or desats. This may be unique to my unit, but we do a significant amount of overtime d/t transports and unexpected admissions.

With all of that said, I couldn't imagine going anywhere else now. I love what I do.