New Grad NICU

[Guest715801]

Hello,

I'm in need of some advice. I recently graduated in 2019 and obtained my first job at a Level III NICU on night shift rotation. I recently finished orientation. Actually today was my first day alone, the main problem is that while on orientation I wasn't able to experience much let alone any but one admission on my own due to low census. Which led me to ask for an extension, because I didnt feel prepared for an admission on my own. Sadly, I wasn't able to admit during extended orientation. Currently, we are down to one patient a grower feeder and I am the only nurse on the floor with the charge nurse. My concern is getting an admission while on my own without other staff other than the charge nurse and not knowing what to do. This is making me very anxious and although I am aware I have to be on my own, I don't think it is fair that I am left alone with so little experience on admissions.

[caliotter3]

Speak to the charge nurse to elicit their assistance for when the time comes. Forewarned is forearmed. Perhaps they can give you some pointers to write down as prompts for your notebook.

[NICU Guy, BSN, RN]

5 hours ago, NurseRa0804 said:

Which led me to ask for an extension, because I didnt feel prepared for an admission on my own. Sadly, I wasn't able to admit during extended orientation

The sole purpose of the extension was to get experience admitting a baby. Why weren't you proactive and have your preceptor simulate an admission with one of the babies you were assigned to? You could have gone through numerous "admissions" until you felt more comfortable. Why don't you have your charge nurse go through a simulated admission now. You only have one baby and it is a feeder/grower, you obviously have the time?

[Tweety, BSN, RN]

Really it's just time to put on your grown up panties and deal. It was fair of them to give you an extension, but what's unfair now? Should they just keep you on orientation every day until an admission happens to arrive? What would you have them do?

Are you completely clueless as to how to handle an admission? Did you at least not learn in orientation what to do?

Charge nurses are your resource and hopefully if an. admission comes you can get some help.

Hang in there. None of us feel ready out there when we start. It takes a long time.

[Nunya, BSN]

Make sure an admission bed is always set up, cuz sometimes you won't have much or any notice. If the baby hasn't been weighed yet that'll be the first thing you do as docs will need for meds. Don't worry about other measurements yet. When I worked NICU that meant leads/pulse ox/different size BP cuffs on bed, in their package so they don't dry out or get wasted. Bag and mask. Oxygen source. Tape, or carry your own. (Also carry bandage scissors/hemostats if facility allows). Bulb suction, and we would do both sizes. Diaper laid out. Alcohol pads. Tape measure. Since you're new maybe a piece of scratch paper to write notes on and an extra pen. Make sure you have all the cables needed for monitoring on the monitor. Turn on the monitor at start of every shift to make sure it's still plugged in, yes, it happens! If you know a baby is coming put a thermometer near bed, otherwise leave in the charger. Tape measure. Stuff for Vit K shot, eye care. Stuff to draw blood/start IV. Extra blankets/towels for drying/changing bed if baby poops/pees before a diaper is on. Any other equipment your facility mandates. Hopefully there's a checklist of what to put on/near the bed for an admission, follow that. Check this bed at the start of every shift, cuz people steak things off admission bed if it's nearer than the supply cart/room and then forget to replace it. I think this is all but it's been awhile ? Then...once you have a baby...

WEIGHT if not already done

AIRWAY/BREATHING- is the baby intubated, make sure it's secure and connected to vent, if O2 prongs make sure in nose and connected to oxygen. Suction mouth/nares prn.

MONITOR/VITAL SIGNS- put on leads, pulse ox, make sure it's correlating by waveform/doing HR and resp rate. Finish up VS by taking temp (don't forget temp probe as part of monitors) and BP. Leave BP cuff on.

While you're doing monitoring you'll be continuing to dry baby off as needed (hopefully that's already done) and assessing. Think ABC.

Sometime during all this you should have a provider coming in and giving orders/doing their assessment. Tell them it's your first independent admission and ask what they'd like you to do first. If they're snarky just repeat you're new, then worry about it/deal with it later. If they're nice they'll tell you/help you. Write down time things are done/VS/any assessment you think you'll forget on your scratch paper.

1. Bed ready

2. Weight

3. Airway/breathing

4. Monitoring/VS

5. Doctor's orders

Write these 3 things down if you need to. You've got this!!

Anyone else feel free to add stuff, I haven't worked NICU for awhile ?

[adventure_rn, MSN, NP]

On 2/26/2020 at 5:28 AM, Guest715801 said:

My concern is getting an admission while on my own without other staff other than the charge nurse and not knowing what to do.

You've got this. The charge nurse will walk you through it, that's part of her/his job. Just make sure you let them know ahead of time that it will be your first admission, and you need to them to show you what to do. It would be highly unlikely that the charge nurse would just peace out and make you do the admit alone.

Having one other baby on the unit is the perfect time to admit, since you don't have a full house worth of kids vying for your attention.

You've gotten great advice so far. As others have said, a) make sure your bed is set up (preparation is key), and b) make a list of all of the things you'll need to do (weight, apply leads, VS, PIV, cultures, fluids, etc.) If you know in advance that a kid is coming, you can do yourself a favor and string up some fluids as well.

I know it's stressful to do something that you've never done before (especially if you're afraid you'll have to do it alone), but I promise that it isn't as scary as it seems.