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.
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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. ?
