I'm finally starting to consider myself an 'experienced NICU nurse,' and I've been reflecting this week on how remarkably different my NICU experience is from all that I learned in nursing school.
Of note, I am specifically not posting this to the NICU forum since NICU nurses already know this stuff (and probably take it for granted). Rather, I think many of the non-NICU nurses might find these quirks surprising, shocking, and amusing. So without further ado....
Ways the NICU is its Own Little World
To bathe our patients, we literally place them in the basin that adult nurses use to wet their washcloths. Many NICU nurses have not done the 'roll the linens under your patient' technique since nursing school, because you can lift your patient with one hand. When our patients are acting out, we can swaddle their arms up next to their bodies like a straightjacket, but we don't have to document on restraints q 2.
A 'big juicy vein' in the NICU resembles a capillary in an adult. It is not uncommon for NICU nurses to use rubber bands as tourniquets. And we especially love starting lines in babies' heads. In fact, you can walk a pale, bald baby around a NICU and hear nurses say, 'Look at those veins-you sure he doesn't need an IV?' Although the veins are tiny we're lucky when we start IV sticks because you can literally hold a light up to your baby's limbs and see all of the vasculatures.
You can also use a flashlight to find a pneumothorax; a pneumo will glow when you hold a bright light up to a neonate's chest. Babies are basically tiny glowworms. We draw almost every lab the same way you a check blood sugar. We poke a capillary bed (in the heel of the foot rather than the finger), and scoop the blood drops into a tube, literally drop by drop. The technique goes squeeze, drip, scoop, repeat.
We use straight-up sugar as a pre-med for lab draws, art sticks, and circumcisions. Babies are so sucrose-nave that a 20% sugar solution (less than the concentration of sugar in soda!) serves as an anesthetic.
A systolic blood pressure of 50 is acceptable, a heart rate of 60 is dangerously low, and we don't become truly concerned about blood sugar until it drops below 25.
It is perfectly acceptable to cuddle your patient in your lap while you sit and chart. It also isn't offensive if your patient grabs your boob. Our tiniest blood pressure cuff will fit around your pinky finger. The concept of IV push doesn't exist. Every bolus is given over a syringe pump, which 'pushes' the syringe for us at a controlled rate.
For an 'advance feedings as tolerated' order, a generous feeding advance would mean the baby gets an additional 8 mL of milk or formula q shift.
A 1 lb baby is small, a 3 lb baby is medium, and a 5 lb baby is large. On the rare occasion that we get a term baby on the unit (i.e. 8 lbs) we practically consider them a toddler. We can, however, have babies up to a year old on the unit if they've stayed with us since birth. We sometimes have kids who can smile, giggle, and get to watch the Wiggles on DVD. It isn't shocking to find two patients sharing a single bed.
Calling our patients "honey," "sweetie," or "darling" is encouraged, and greeting your patient by saying "hey handsome boy" will not result in a lawsuit. It's totally acceptable in rounds or reports to use the phrase "he had a big poop."
It's a whole different world down here, and we wouldn't have it any other way. ?
awesome post. Y'all shoulda been around when I had my first born daughter...12lbs, 24 inches long :) My next two were tiny in ccomparison at 7lbs and 21 inches.
Aaaaah this is too cute!! My hearts desire is to work in L&D when I graduate but I can see myself being persuaded to work in NICU. It's a whole not her world!
NICU nurses are the greatest. The hospital I worked at had an NICU unit staffed by Valley Childen's Hospital. This was a great experience for the babies and the families. Valley children Hospital is 30 miles from Fresno
Excellent thread. Love it. I just had a baby boy who was admitted to NICU at full term for meconium issues. I can relate to a lot of what you mentioned. Thank you for what you do. All of his nurses were awesome to say the least. You all are special nurses to care for these tiny lives.
Thanks to all of your guys for the outpouring of kind words and sentiments! It's especially meaningful to hear from all of you former NICU families--my absolute favorite part of the job is when we get cards, letters and pictures of our babies all growed up. You guys have made my week!
I just can't help but giggle when I imagine if some of these things happened in the adult world, like drawing an adult's AM labs by squeezing tiny drops of blood from the patient's finger, or saying "Ok, Mr. Smith, please hold out your pinky so I can take your blood pressure with my ridiculously tiny blood pressure cuff." If I'm ever admitted to the hospital, I'm tempted to bring my own Preemie X-Small cuff and switch it out when my nurse isn't paying attention, just to see the look on her face.
I was a NICU baby. Weighed 2lb 14oz at birth. Pretty big by today's standard but not so 48 years ago. My mom use to tell me about the nurses that cared for me. She remembered one especially fondly that everyone affectionately called Granny. I'm sure it's part of what influenced me to become a nurse.
I planned on working NICU but when I graduated we lived in a town where they didn't have one and shipped all our babies requiring NICU to a nearby metropolitan area. I ended up taking a position in oncology and fell in love with that specialty.
Wonderful post. Thank you for a look into your side of nursing.
awesome post. Y'all shoulda been around when I had my first born daughter...12lbs, 24 inches long :) My next two were tiny in ccomparison at 7lbs and 21 inches.
Dayum!
May I ask...was gestational diabetes involved? Cuz twelve pounds is massive!
Oedgar
248 Posts
My 33 week son was one of the "big" ones in the NICU at 5 lbs 4oz. We love NICU nurses!