New NICU experience

Gompers, BSN, RN · May 15, 2004

I understand your anxiety! Don't worry though - most NICUs don't just throw you into those situations - they have to think about liability. I'm sure you're NRP certified, but they may want to refresh you before you start going to deliveries. At my hospital, once you have your NRP and are on the unit for six months, you can start going to high risk deliveries with another nurse. After going at least twice with someone else, you can go by yourself (with the docs/NNP and resp therapist, of course) if you feel comfortable. If not, you go a few more times with assistance. Sometimes even seasoned nurses grab a second nurse if she's going to a bad delivery - like if they tell us it's a 23 weeker or a term kid whose heart rate is down so they're sectioning. It's nice to have someone else draw up your epi while you're doing working with the baby. :uhoh21:

For transport, we have a little class that you take after about six months on the unit that teaches you the basics. It's not much different than admitting a kid to the unit from L&D. The only difference is that you're at an unfamiliar hospital, so you need to bring a bag of all your own supplies (our unit has transport bags set up) and get the baby stabilized before you pack him/her up into the isolette and take off. It's a matter of memorizing what's in the bag and how to document what you're doing before you leave the other hospital and while you're in transit. It's just a little scary because you're the only nurse. Yeah, you've got a doc/NNP and a resp therapist (if necessary) but they have their own stuff to deal with. We also send you with a second nurse a few times before you're by yourself.

Other hospitals have different ways of doing things, though. We wait for at least six months for these things, even with experienced nurses, because we want them to be familiar with our policies and procedures first.

Tiki_Torch · May 15, 2004

I agree with Gompers not to stress out about it too much right now.

Some examples of my experiences include:

I worked at a Level III regional perinatal center which was responsible for 22 surrounding counties so we did loads of transports. At that hospital a seasoned NICU nurse had to go through 4 to 6 weeks orientation (new grads got 12 weeks) before being let loose to take regular assignments in the NICU. Not everyone was a transport nurse though because some had health issues and such. However, once a nurse had worked in the unit for at least one year (usually two years) they would be invited by the nurse manager and transport team coordinator to be a member of the transport team. When we became transport team members we received some extra classes on neonatal emergency problems, drugs, procedures, etc. and then began by going on back transports (where we took babies "back" to their home hospital after they had been brought to us sick before) so we could get used to the paperwork and process of back transports. Next we would go on stable transports (like taking a baby to a Level IV hospital for major surgery) and then we'd go on critical transports where you didn't know what you were walking into. We had to ride along on 6 of each before being allowed to go on our own. Some very critical transports included a NNP riding along. All transports (back, stable, critical) had a RT on board to intubate and do gases, etc. I found it exciting and enjoyable and a real growing experience. I bet you might too.

During the first year or two working in the NICU we would go with seasoned nurses to attend deliveries. We were expected to ask, "If you have a delivery tonight may I go with you?" rather than to sit back and wait to be asked/coddled. Most all of our charge nurses were on the transport team automatically, and all charge nurses attended deliveries of high risk babies. A neonatologist was supposed to attend deliveries of babies at 34 weeks or less or other severe high risk deliveries. We usually had one NNP on duty 24 hours which was a godsend. The MDs would be in-house during day hours but had to come from home in a rush at night. Generally charge nurses attended regular c-sections, emergency c-sections, meconium deliveries whether they were lady partsl or c-sections, deliveries for late decels, etc. We also had at least 2 round the clock RTs who were assigned only to the NICU and an RT was to attend all deliveries whether they were with the charge nurse or with a NNP/MD. Our charge nurse always attended deliveries the MD/NNP went to also since the MD/NNP basically led the resuscitation if they were there and we did the grunt work. Our charge nurses did not take patients of their own during a shift. They coordinated transports (incoming and back transports), attended deliveries, covered staffing for the oncoming shift, did charge nurse paperwork of all kinds, checked code carts/supplies/transporters/drugs, etc., and assisted nurses with admits or other patient care and helped when assignments had to be changed during the shift due to new admits, crashing babies, etc. Ours was a 24 bed NICU but usually had 26-28 babies all the time. Before we went to deliveries on our own, we had attended many deliveries with the charge nurse before and were never sent to a delivery without the higher ups trusting our skills and feeling comfortable sending us because it would be a liability for the hospital to send someone unqualified. They wanted all of us, whether we were charge/transport nurses or not to be able to attend deliveries because we often had two deliveries going on at once. Our hospital delivered about 3000 babies each year and had about 350 NICU admits each year.

The small hospital I'm working in now is much different. We usually only have 4 nurses working each shift, sometimes 3. (The larger place had 8-10 nurses each shift.) We have a charge nurse but everyone is expected to attend deliveries whether they are routine c-sections or emergency deliveries of all kinds. We have a RT who comes in and out of the NICU each hour or two and has a beeper so they can be with us at all c-sections and high risk deliveries. We are supposed to have at least 2 nurses in the NICU at all times, so if 3 are working that night then there is only one to go by herself to the delivery. We prefer having 4 nurses so an extra one can go if needed. We recently got NNPs to work the evening and nights with us but this only has happened in the past couple of months because our little hospital is growing pretty fast. We are a Level III with oscillators, 23-24 weekers, the whole nine yards. We don't have a transport team though and believe it or not, I miss that!

I didn't mean to go on and on like this! Sorry!

In a nutshell, don't worry yet. Worry is like paying on a debt you have not yet incurred!! The first part of the nursing process is Assessment, right? They need to assess you before they make a plan for you, then watch you implement that plan, then evaluate how you did with the plan. They'd be nuts to send you on transports or to deliveries without having you be ready yet. Hey, some hospitals might try it but don't you let them do that to you! Just make sure they are aware that deliveries and transports are something you've not been doing. With your 3 years of experience you should do fine. Review your NRP book every day. Memorize the action diagrams by heart backwards and forwards. Practice at home with a doll if you must. Grab some good neonatal nursing books and really bone up on neonatal emergency diagnoses, reading x-rays, understanding fluids and electrolytes as well as emergency and critical drugs very well. A thread at the start of this forum has some good books to check out if you don't already have them.

Maybe you can look at this as an opportunity to stretch and grow. Don't be afraid of change because sometimes is really great in the end. Everything in life happens for a reason, so embrace your new hospital with a big smile and open mind and see where it goes.

Wishing you only the best!!!!!

(Forgive me for not editing this or looking for spelling errors, etc. but I'm tired and it an awful lot to read.... if you read this far, you deserve a prize!).

premern · May 16, 2004

thanks everyone for the kins words!! Iw ill keep ya all posted.