My Preceptorship Experience (NICU)

lisamc1RN, LPN · Apr 11, 2005

Wow! Thank you for sharing the details of your preceptorship! I can't wait to be in your shoes! I hope I get a nurse that is wonderful as yours is! :)

Aneroo, LPN · Apr 11, 2005

Sounds like you've had an awesome experience and an awesome preceptor! You lucky dog! When I did a rotation thru NICU, we were not allowed to do anything invasive, but I am totally with you on the NGT. MY first (and only one so far) was on a 6# baby. I found it incredibly easy, becuase of their sucking reflex. Anyways, good luck- sounds like you got very lucky! -Andrea

Altra, BSN, RN · Apr 11, 2005

This will probably be wordy, but I'm writing this out for myself so I can reflect back on it, but I wanted to share it here with yall, too. I want share my thoughts, feelings and experiences during this incredible and overwhelming time.
.....
I need to get a foundation of what a normal assessment is so I can then learn how to assess these little sick babies. I totally agree with that. She had me watching videos about assessments. Then we went into the well-baby nursery and did Dubowitz scores on a couple of the babies to see if I came up with the same thing as what they put in the chart. I was pretty close on both babies I did! After doing that, we went back to the NICU and took the baby's vitals and she let me insert an NG tube. I had never done it before, not even on an adult, so I was scared to try it my first time on this little fragile baby. But she talked me through it and I did it!! My first NG tube! What a great feeling that was.
.....
Then I had the rest of the week off. I go back tomorrow night. Mon., Tues., and Wed. this week. Again, I'm kinda scared. But I'm excited. I just hope each day gets better and better, last week it did, as the days went on they got better. I just have to keep reminding myself that I'm there to LEARN. I'm not expected to know everything. I ask so many questions and at first I thought they were getting annoyed by me, but my preceptor told me she thinks I'm doing great and that she likes that I ask so many questions. Everyone there is so nice, they all help teach me. I'm so lucky to have such a great preceptor and other great nurses there. It makes this really scary experience not so scary, and more exciting :)
I haven't gotten to do a whole lot in the actual area that I'm precepting in. But I'm glad I'm getting the foundation of working with the well-babies. I'm glad my preceptor is enabling me to do that. She's such a great teacher. She used to be an instructor at an ADN program at a community college here in town. I couldn't have asked for a better preceptor!

Thanks for sharing, RainDreamer. :) My 3-week, 135-hour preceptorship starts next month. I feel like, in baseball terms, I'm "goin' to The Show." :chuckle

During my peds rotation I did my first (and so far only) NG tube on a 5-mo. old. Believe me, I was sweating bullets over that one!

Keep posting ... let us know how it goes!

NoCrumping · Apr 11, 2005

I envy you.... in school.we werent allowed to do NICU rotation... just peds.and I work in NICU now... I wish I had been able to do what you are doing in school....it sounds like you are in a lo acuity lo cencus nicu... but believe me,,, even on those slow nights, you are learning. NICU is so different from any other nursing, just the exposure, to say the least will help you..... do you think you want to go into NICU after this?

krn05 · Apr 12, 2005

I am so glad u wrote this. I have to write a journal for my preceptor experience and this is very helpful. So far I have done two weeks of community preceptor, which was great, but I started my preceptor in the ER 4/4. I don't know about you but I am so overwhelmed sometimes I want to cry. Anyway, I noticed you are a BSN student and I hope to hear from u because I graduate RN this May and start BSN in the fall. I would like to know what u think. thanks for any advice u might give.

RainDreamer, BSN, RN · Apr 18, 2005

I'm glad yall enjoyed reading about my preceptorship experience, I wasn't sure anyone would read it since it was so long, lol. But I wanted to type it out so I'd have it for myself and I love to share it.

I am really enjoying this experience! I wasn't really sure what area of nursing I wanted to get into after graduation. I was interested in NICU, but didn't have any exposure to it, so I thought it'd be a great area to do my preceptorship in, so I could get some exposure and get an idea of what NICU nursing is all about. Well after 2 weeks of preceptorship in the NICU, I have to say I would LOVE to get into this area! I want so bad to get into a new grad NICU program after I graduate next month. I hope I can find a hospital that offers a program for new grads.

I have seen so many things that are just amazing to me. I forgot to mention something about the first night I was there. There were 2 babies in the nursery, but 1 of the babies was getting ready to be discharged the next day. So they had that baby stay in the well-baby nursery for the night. Early the next morning one of the NICU nurses went and got the baby from the well-baby nursery so she could get her all bathed, dressed and ready to go home. She did all that, got the baby all ready, then took her out to the mother. The nurse came back in crying and crying. This baby had been there for 3 1/2 months. They were telling me she had been really sick, had coded a few times and they were real worried she wouldn't make it at times. She finally went home! This nurse was so thrilled this baby was finally able to go home, but after taking care of her for over 3 months, I could see it was heartbreaking for her to let her go, it was bittersweet. That was amazing to see.

Mon. 4/11:

My first day back after having 6 days off. I was dreading it for some reason. Even though I had great experiences the week before, I still cried the night before I went in. I was worried I'd be so bored again and the night would just drag on. *Deep breath*, I'll be fine! I get up to the unit and am surprised to see all these baby beds filled .... with babies! I start counting ...... 1 ... 2.... 3 .... 4 ......... 7 babies! Wow! That's a huge change from the 1 baby we had last week. I go sit with my preceptor to get report from the day-shift nurses. We have 2 patients. 1 is a 33-weeker. She's 6.5 lbs, born to a mother with diabetes. But apparently there's problems with her parents. The dad is extremely upset because he wants to know exactly WHEN his baby will be coming home. The doctor and nurses can't give him an exact date and so that upsets him. My preceptor told me she thinks more than likely he doesn't understand that just because his baby is a good size (6.5 pounds ..... not exactly a "preemie") doesn't mean she's a full term baby, she's 7 weeks early and it's too soon to tell when she'll be able to go home. Our 2nd patient is a 34-weeker, born at 4 pounds 4 ounces. She was born the night I was in well-baby nursery last week, I remember them saying they had a 34-weeker in labor. My whole shift I just helped my preceptor with these 2 babies. I took vital signs every 3 hours for each of them. I didn't know how to do the feedings yet. She thought I was doing a great job just with the vital signs. Doesn't sound like a whole lot to do, but it sure kept me pretty busy. About 3 am I had some downtime so I did some reading. I got a little bored, but felt like the night was going by faster than the nights the week before. Then I helped with bathing them, changing their beds, and weighing them. Before I knew it, it was time to go home! I thought this week won't be so bad, not with all these babies .... not as boring as last week with just the 1 baby.

4/12:

We have 3 patients today. The 2 babies we had yesterday, plus another one. This additional 1 is a 10+ lb baby. These 3 babies kept us pretty busy. I helped her with all the vital signs again. She also showed me how to do the gavage feedings. We were to start feedings on the 34-weeker, so I got to put in another NG tube. We did the feedings every 3 hours, VS every 3 hours. The parents of the 33-weeker came in to visit their baby, the dad was still a little upset about wanting to know exactly when his baby would be able to come home. My preceptor sure had a way with him .... she was able to talk to him in a way that kept him calm and happy. Every time they came to visit I'd wrap the baby up and hand her to the mom or dad. That doesn't sound like much, but it was a little tricky for me to get all those cords, the baby, the blanket, etc and hand her to the parents. WHEW! Then I sat and chatted with them a bit. Even though the dad had been upset and he was the talk all around the unit, the nurses bickering about him and all .... I could see these parents really cared for this baby and were just concerned about when she'd be able to come home. Their little 8 year old daughter was there too. It was nice to see all that. Then I had a bit of a scare when I was taking the vital signs of the 34-weeker. I was taking her temp and the thing just kept going up and up. 99, 100 ..... 101! I got a little nervous. But just retook the temp. Still, the same thing. It was over 101. I freaked out, not knowing what to do. I called my preceptor over and she looked in the isolette, and found that the temp probe came off the baby, the isolette was saying "baby temp too low" because it had come off and it was cooking her! Scared me so much. I just got another temp probe to put on her and we cooled her off. That morning I bathed the 33-weeker, changed her bed and weighed her all by myself. I just took my time and got it done. I was a little scared to be doing all that by myself, but I just took my time and knew the other 2 nurses were right there if I needed anything. Doesn't seem like a whole lot, but I felt great that I was able to do that! The night just flew by, even faster tonight because I was helping with the feedings too.

Wed. 4/13:

More of the same tonight. We had the same 3 babies. Again, I did all the vital signs and feedings on those 2 babies, while my preceptor did the care for the other baby. I helped the parents again. Then did the bathing, bed changing, weighing. This night flew by too. At the end of the night my preceptor gave me a hug and told me "I don't know how I would have made it without you these last few nights, thank you so much". WOW! How good did that make me feel!! I felt like I was actually accomplishing something .... I was helping out and learning so much! I left that night, and that week feeling so good about all of this. I can see myself doing this. And actually getting paid to do it?! I've always wanted a job that I'd love going to each day ... not just for the money, but actually enjoying it while I'm there .... and I think this is it. Just those 3 days that I took care of those 2 babies .... I can see how nurses get attached to them. I went in the next night wondering how they'd been doing. When I heard the 34-weeker was being weaned to room air I was just so excited! I love being able to give all my time and attention to just 2 or 3 babies and their parents ... and taking care of the same ones each day, I really liked that.

I'm really enjoying this preceptorship. I really didn't care for clinicals at all. I dreaded clinicals each week. This is completely different. At clinicals, a lot of the time, I felt like I was in the way. During this preceptorship I NEVER feel like that. I feel like I'm actually helping, but I'm learning a lot while doing so. It helps me to do things over and over and over .... it helps me learn that way. So I've been doing the vital signs, the feedings, etc OVER and OVER again. It helps the nurses out, and it helps me learn.

This week I go back Tues., Wed., and Thurs. Even though I really love it, I still dread it some ..... sounds crazy! I'll probably cry the night before. But once I'm there and working, I'm fine! I think I just get a little nervous, excited and anxious because I don't always know what to expect each week. I hope it continues to go well :)

grinnurse, RN · Apr 18, 2005

I have enjoyed reading your posts this morning. I start my preceptorship tomorrow and am very nervous. Hope mine goes as well as yours. Can't wait to see the last of your experience posted.

Tweety, BSN, RN · Apr 18, 2005

Nice to hear from you Rain. I lost count as to how many are left, but good luck to you!

GWENLYN18 · Apr 20, 2005

Wow. I Am Excited For You. Thanks For Sharing Your Experience Because I Plan On Becoming A Nicu Nurse. Good Luck!

Adene Balzer · Apr 20, 2005

Hi, I wanted to tell U that I really loved reading your journal of learning in the NICU. I have been an NICU RN all of my career & have been away for the last 9 years raising my own miracle son. Now that I must return to work, I am a bit more enthusiastic since reading your post. Very best of luck to U in your journey through neonatal medicine. It is full of rewarding and proud moments, that will give great meaning to your career and life.

Sometimes, there are sad moments, that can be a challenging, but even in those times, you can be able to give something from down deep in your soul, to someone who needed what you just gave to them-your caring self.

Watching a sick micro-premie grow from barely a pound, on through the steps of maturity, towards becoming healthy enough to place in the Mom's arms for the first time, may be one of the most touching moments of your career. It still is to me and I spent 23 years in this field.

I hope that NICU is a wonderful home for you & wish you the best.......Adene

This will probably be wordy, but I'm writing this out for myself so I can reflect back on it, but I wanted to share it here with yall, too. I want share my thoughts, feelings and experiences during this incredible and overwhelming time.
Our preceptorship is required, 144 hours. Basically I have to do 12 - 12 hour shifts. I'm scared. I'm excited. I'm anxious.
Thurs. 3/31:
I went to the hospital and met my preceptor. We had to go over the syllabus and the contract, get all that stuff signed and in order so I could turn it into my instructor. My first impression of her is that she's a very sweet lady. That put some of my fears to rest and I feel more at ease about this. I think it'll be a good experience, I hope. I got her schedule so I know when I'll have to work. I start tomorrow. I work 7pm-7am, 12 hours/day, 3 days/week for the next 4 weeks.
Fri. 4/1:
My first night! I am so scared. I'm really excited too. But I'm scared because I have no idea what this is going to be like, I don't know what to expect. I just keep tellling myself I'm there to learn! I'm at a fairly small hospital (187 beds) with 8 Level 3 bassinets and 14 Level II bassinets. They currently only have 1 baby in the NICU. She told me all about him, he was born at 26 weeks, born at the end of Feb. I was just amazed. He's so tiny, but he's doing so well. All the equipment that is helping him, it's just incredible to me. He's a Q3h baby, so they just do his vitals and anything else every 3 hours, in between that time we don't bother him. So during those "in-between" hours she had me busy with reading about "normal" baby assessments. I need to get a foundation of what a normal assessment is so I can then learn how to assess these little sick babies. I totally agree with that. She had me watching videos about assessments. Then we went into the well-baby nursery and did Dubowitz scores on a couple of the babies to see if I came up with the same thing as what they put in the chart. I was pretty close on both babies I did! After doing that, we went back to the NICU and took the baby's vitals and she let me insert an NG tube. I had never done it before, not even on an adult, so I was scared to try it my first time on this little fragile baby. But she talked me through it and I did it!! My first NG tube! What a great feeling that was. But then after that, the night just kinda dragged on. With just one baby, that's Q3h, the night can really go by slow. By 1 am I was so tired. I was surprised at how tired I was already. I normally stay up really late, I'm a nightowl. But I was ready to find a corner and curl up to take a nap! The boredom was getting the best of me. Finally by 7 am it was time to go. I went home and went straight to bed. Later that day I just felt frustrated. I mean yeah I learned some, I got do things I hadn't before, but for the most part the night dragged on and I didn't know how I would be able to make it through another night like that. I had Sat. off, then went back Sunday. Sat. night I just cried and cried. Not really sure why, the first night wasn't bad, but it was really overwhelming. I'd never worked 12 hours before. 12 hours is a long time! I hated that I was crying about it on my day off though.
Sun. 4/3:
I spent most of this night just reading. There's still only 1 patient. And 2 nurses, plus me. One nurse takes the patient and the other nurse helps out if needed. Me and my nurse didn't have the baby that night, we just went over more of the assessment things that I had read about. She asked me a ton of questions and if I didn't know the answer she had me write it down so I could look it up. I had a list of things I needed to look up, so I spent most the night just reading and writing down stuff. I was actually glad to have stuff to look up though, it gave me something to do. The night went by a little faster than the night before. I was still a little frustrated by the end of the night. But at least I felt like I had learned some, even if all I did was read all night. I was really just dreading the following nights because of how slow these last 2 nights had gone.
Mon. 4/4:
Tonight was going to be a little different. My preceptor wasn't there. Since the census is so low, she had volunteered to be off for the night. She told me about this beforehand and told me she wanted me to hang out in the well-baby nursery since there would only be one nurse in there for the night, and they had 4 inductions scheduled, so we'd have at least the 4 admissions. So after I got there, I went into the well-baby nursery, met the nurse, very nice lady, only 22-years old, just graduated last May and she was all by herself in the nursery, charge nurse! She was glad to have my help. I fed a couple babies while she was bathing one that was just admitted. Then she had to do 3 assessments. After the first 2, they called saying they needed her to go to L&D to be the baby nurse for this lady that was about to deliver. So we headed over there. I got to help her clean the baby off, weigh her, make sure all was ok, do her footprints, wrap her all up and give her to mom. That was incredible. Then back off to the nursery, finished the assessments. Then a couple hours later, they brought that baby in and we assessed her. I got to do the bath. Right after I would get done with something, something else would come up. It was time to feed this baby. Time to change this one. Time to check this one's sugar before he eats. Time to do vitals on all the GBS+ babies. A mom called for me to test her baby's sugar because she wanted to feed him. I went and got him, we checked his sugar. I took him back to mom and she asked me if I could show her how to swaddle him. I'm still learning myself, but told her I would show her the best I could, that it just takes a ton of practice. I did the best I could and she thanked me. That little thing, just showing her how to swaddle him .... I loved it!! That was just a great experience. I loved teaching her how to do it. Her and her hubby were just so excited, I loved being able to help them out with that. Incredible. The rest the night I spent feeding, changing, bathing, etc. Then when the nurse was finally feeling like she was caught up, at about 4 am, they called us saying an induction that was scheduled for tomorrow, just walked in, in labor. So we got another admission about 5 am! That took about the rest of the shift. Already, 7 am!! Wow! It just flew by. I couldn't believe it! What an amazing night. I left that night just high as a kite. I felt like I had actually accomplished something. I learned SO MUCH that night! And the nurse just kept thanking me for my help, saying she didn't know what she woulda done without me there. What a great feeling :)
Then I had the rest of the week off. I go back tomorrow night. Mon., Tues., and Wed. this week. Again, I'm kinda scared. But I'm excited. I just hope each day gets better and better, last week it did, as the days went on they got better. I just have to keep reminding myself that I'm there to LEARN. I'm not expected to know everything. I ask so many questions and at first I thought they were getting annoyed by me, but my preceptor told me she thinks I'm doing great and that she likes that I ask so many questions. Everyone there is so nice, they all help teach me. I'm so lucky to have such a great preceptor and other great nurses there. It makes this really scary experience not so scary, and more exciting :)
I haven't gotten to do a whole lot in the actual area that I'm precepting in. But I'm glad I'm getting the foundation of working with the well-babies. I'm glad my preceptor is enabling me to do that. She's such a great teacher. She used to be an instructor at an ADN program at a community college here in town. I couldn't have asked for a better preceptor!