new in the nicu...i feel behind, help me!

EricJRN, MSN, RN · Aug 2, 2006

Do you use a cheat sheet where you put all of your meds, feedings, treatments, etc on a schedule and cross each thing off as you do it? That's the only way I ever keep my head above water.

I don't know if anyone ever feels comfortable 100% of the time in the NICU. I work with veterans who still get overwhelmed and stressed at times. I can tell you, though, that it gets better over those first few weeks and months. Hang in there!

RainDreamer, BSN, RN · Aug 2, 2006

Hi Jackie! Well first off, what you're feeling (overwhelmed, drowning, not improving) is TOTALLY normal! Heck, you haven't even been there a week yet, it's ok! Just know that you won't feel organized and on top of things for a long time to come.

I just got off orientation a couple of weeks ago, so I'm still brand new at this. But you'll be so amazed at how much you learn each week ..... even each day. I made mistakes at first, you'll make mistakes. It's impossible not to. I didn't make mistakes that endangered my patients, but I made mistakes that I learned from. My preceptor let me make mistakes, she knew it wouldn't cause harm, but she knew I'd learn better from it if I made those mistakes myself.

I said all that just to get to the point that it took me a while to get organized and find my own way to do things. After I was on the unit for a couple of weeks, I missed a bunch of meds one night. It was kinda hectic when I first got there and I just started doing things that needed to be done. Then a few hours later my preceptor pointed out that I missed some meds (just vitamins and such, but still). It was then that I realized I needed to become more organized.

So every time I start my shift I do the same things to get going. After I get report I do all my safety checks (bag/mask, code sheet, vent settings, TPN/lipids, IV checks, alarm settings, etc.) Then I take my cheat sheet (like Eric mentioned) .... I already have part of it filled out with stuff that I got in report. But I take that and fill it out more in depth. It'll depend on your style or what type of sheet you have, but I have a block for each hour and I write in each block what needs to be done that hour. So I first start with the rounds ..... I just circle those hours the rounds are due. Then I go through the med sheets and see what time each med is due. Then I fill those in in the correct time block.

For example: I have a baby that's q3, due at 2100, and gets ampicillin at 2300. So I'll have 2100, 0000, 0300, and 0600 circled .... those are the times my rounds are due. Then I have AMP written in red in the 2300 block. If I have feedings I write those in the blocks too.

I write EVERYTHING down! Even in my round blocks I still write everything down that I need to do so I don't forget. I used to forget so many things. I'd get done with a round, get the baby all tucked in, isolette closed up and covered, lights turned off and then OOOPS, I forgot to take the temp! So I write everything down in those blocks. Under 2100 I'll make a list ..... temp, diaper, abd girth, BP (I used to always forget to take a BP too, so I write it down now), weight, chem strip, and whatever else I need to do during that round.

This has helped me so much, just to write it all down. I even made a list of things to help me when I did my safety checks (bag/mask, alarm settings, etc). I just listed everything so I wouldn't forget. I don't need that sheet anymore because I can remember everything now, but it helped me so much at first.

The best advice I can give you is to start your shift by getting organized and writing all your stuff down. Get all your ducks in a row, so to speak. Get your sheets all filled out and all your times filled in. Know what you need to do and at what time.

I'm not sure how it is on your unit, but for us we get report at 1900. Report is usually finished by 1920-1930. Our rounds are either at 2000 or 2100 usually. So I usually have a good 30 minutes before I have to get in to do a round. I take that time to do all my safety checks and get my sheets filled out. It really doesn't even take that long and by doing it at the beginning of the shift it'll help to keep you organized.

I hope this helps some. I know how it feels to be overwhelmed and not organized, but it really does get better. Good luck to you!

rnpilot · Aug 2, 2006

Excellent advise, RainDreamer. I wish I'd done that my early years in NICU. It would have made things so much easier. I have over 13 years experience now and just recently started using a cheat sheet because I was out for some years. I've also started using sticky notes. I take a sticky to the bedside, jot "T-, HR-, RR," etc. that I need to do, then when I'm done I can attach it to my report sheet or take it to the computer to chart. That keeps my cheat sheet uncluttered so the important stuff stands out, since they're sticky, I don't loose them, and I can stack each baby's together on top of their block on my report sheet. I may go through a lot of stickies, but I think it's worth it. It helps me be much more organized. Also, it took me about 2 years when I started to begin to feel like I knew what I was doing and kind of organized, but it wasn't until about 4 years before I really felt truly comfortable. Every day, it will get a little easier, even the really bad days will make the next day a little better. Another thing to keep in mind which I wish I'd learned sooner, there's 100 ways of doing just about anything, so go with the flow depending who you're working with. I was actually laughed at recently when I asked about how the level 1 nursery does first baths. They were incredulous I didn't know how to bathe a baby. I pointed out the discussion on this forum of how many different ways there was to do it and I just wanted to know their preference so I wouldn't be told "we don't do it that way."

lccougar02 · Aug 3, 2006

Wow thank you everyone! I am going to do that tomorrow on my day off. I am going to make a sheet of what I need to do in order while I am in the infants isolette. I do that same thing...forget to take the temp or bp or feel the liver. Whatever it is. I just hope it all gets together soon! :) Thank you again!

prmenrs, RN · Aug 3, 2006

This is a description of a worksheet--I hope it makes enough sense for you to try it:

Make your self a worksheet for each pt. Should be ~ 5x8. Draw a vertical line down the middle, more or less, then divide one side of that into 8 or 12 little boxes (8 or 12 hour shifts). Number the boxes w/the hours. Write feedings, meds, anything that needs to be done on time in that hour's box, and cross them off as completed.

The rest of the sheet can be divided up: Put historical stuff on the back for both baby and mom; put CURRENT stuff on the front. Top of the sheet should have name, today's date, today's wt (loss or gain from yest), today's "conceptual age".

Another section should be respiratory: current support, latest blood gas and/or X-Ray info.

Next: IV's.

Next: lab data, current results, pending labs, labs to be drawn (put them in the timed boxes, too).

Then feedings: what, when, how. When was the last stool?

Leave a box for anything else. Put d/c plans, teaching plans, social stuff on the back.

Needless to say, keep these papers in your pockets or under your charts. Shred them @ the end of the shift, or tear off/black out the names. (I prefer the shred method.)

Humbled_Nurse · Aug 3, 2006

Jackie:

First and foremost you need to be patient and not so hard on yourself. It's only the first week. I do want to warn you though things are likely to get worse before they get better. It really doesn't matter what unit you are on that first year is rough. I remember my first year in the NICU as a new nurse and I was also very overwhelmed. It was hard for me to see that one day I would be like all those other experienced nurses. There were times that I thought maybe NICU was too much for me and maybe I should go work newborn nursery, but I hung in there and it eventually passed.

Just take one day at a time and hang in there. It will take at least a good year to get comfortable, but even after a year there will still be situations/patients that make you tremble, but a little fear is a beneficial thing.

Also enjoy your days off and do something fun for yourself to take your mind off of the stress. Nothing like a good movie to get your mind of things.

Everyone else has already given you good advice on how to organize your shift.

Good luck and keep us updated.

justjenny · Aug 4, 2006

I am going to make a sheet of what I need to do in order while I am in the infants isolette. I do that same thing...forget to take the temp or bp or feel the liver.

Don't use that type of a cheat sheet for too long...use it at first to develop a "rhythm" for your work but the goal is a SYSTEMATIC approach to each hands on with each baby. Whether it is a micro preemie or a feeder-grower you should "get in" do your full assessment and "get out" (ideally in 5 min. or less) make it a part of your practice and you won't constantly worry "did I forget something...??" If your hands on are the same each time you won't miss anything.

Ex: Have all supplies at bedside (thermometer, bp cuff, etc.) Get vitals, bp (before you touch them and get them upset) then temp, then diaper (while changing diaper assess belly, pulses, etc.) you get the idea...some people take a "head to toe" approach after the temp..fontanels, heart/lung sounds/bowel sounds, palpating, diaper pulses. Whatever you do make it the same each time.

The best type of cheat sheet is what was previously mentioned...managing time effectively. Coordinating feedings, meds, etc. with multiple babies.

HTH

Jenny