new to NICU nursing and nervous

LisaNICUrn, BSN · Oct 25, 2021

Congratulation. Well your orientation will probably be 12-16 weeks depending on what level NICU you are at. NICU is different from any other unit. What should you expect. Well my "normal" shift (nights) starts with report, then we do our safety checks to make sure our suction and bag/mask is working in case we need it quickly. Then I look over orders to make sure nothing was missed and make myself my hourly sheet, write down times I have meds or labs, BS at a weird time, anything I need to do I put down to keep myself from getting behind.

Our babies generally eat every 3 hours. So we do our cares every 3 hours. Depending on if they are a stable level 2 baby getting ready to go home or a critical level 3 baby will determine how often we do a full assessment. We do a full assessment on every baby during our 1st cares. Then we change them, check their vitals, blood pressure, temp, measure their abdomen, listen to their heart and lungs, determine their work of breathing if any, check pulses. Then we feed the baby via tube or bottle. If they don't finish the ordered amount of feed then we tube the rest if they have a feeding tube. Then we move on to the next infant. Most hospitals have a 3:1 ratio for level 2 stable kiddos, and a 2:1 for the more critical babies, like if they are intubated or unstable. Babies tend to eat on either an 8:00 or 9:00 schedule, every 3 hours. For level 2 stable babies some hospitals require a full assessment each time, but many just require you to get a temp and vitals off the monitor, change their diaper, and feed them. Of course you are monitoring them throughout the evening for any acute changes to their conditions. Level 3 critical babies we generally do our assessment each time we do cares because they are more prone to changing quickly and catching it soon gives the best chance of recovery.

So we do our 3 assessments and feed our kiddos, then chart. Then we do it all over again 3 more times. Now of course that is an uneventful level II assignment. We also have other things like night shift bathing and weighting them, one of the shifts will do line changes. There's also parent teaching, helping parents do skin to skin, breastfeeding, or any other necessary teaching.

You can also have a busy assignment where you infant drops their saturations every hour and you have to go in and stimulate them to breathe, sometimes multiple times an hour, your infant has more to monitor like central lines, they are intubated or on higher respiratory support, chest tubes, infants that are post op, have trachs, g-tubes, ostomy's. You could be doing ABGs or glucoses often, titrating drips frequently, changing respiratory settings (RT does that but you have to be aware and chart it). And on top of your critical busy infant, you probably have another patient to take care of. Hopefully your co workers or charge nurse will help with the other infant though. So you can have a simple night or a night where you barely get to sit down, and that's with just 2 infants.

There's also a chance, depending on your specific unit, you'll have the opportunity to attend deliveries, and you'll get admissions as well. Oh, and discharges as well.

Now please know you'll never get the critical babies until after you feel comfortable. The amazing thing I've found at every NICU I've worked at (Im a travel RN) is there's always someone around to help you. Just ask questions, if you question something, get a co worker to take a look with you. You'll have months of orientation, then you'll start out in the lower acuity patient population. Once you get your feet wet and feel more confident they will no doubt give you more unstable infants.

Welcome to the wonderful world of neonates. Good luck

pinkdoves, BSN · Oct 26, 2021

20 hours ago, LisaNICUrn said:

Congratulation. Well your orientation will probably be 12-16 weeks depending on what level NICU you are at. NICU is different from any other unit. What should you expect. Well my "normal" shift (nights) starts with report, then we do our safety checks to make sure our suction and bag/mask is working in case we need it quickly. Then I look over orders to make sure nothing was missed and make myself my hourly sheet, write down times I have meds or labs, BS at a weird time, anything I need to do I put down to keep myself from getting behind.

Our babies generally eat every 3 hours. So we do our cares every 3 hours. Depending on if they are a stable level 2 baby getting ready to go home or a critical level 3 baby will determine how often we do a full assessment. We do a full assessment on every baby during our 1st cares. Then we change them, check their vitals, blood pressure, temp, measure their abdomen, listen to their heart and lungs, determine their work of breathing if any, check pulses. Then we feed the baby via tube or bottle. If they don't finish the ordered amount of feed then we tube the rest if they have a feeding tube. Then we move on to the next infant. Most hospitals have a 3:1 ratio for level 2 stable kiddos, and a 2:1 for the more critical babies, like if they are intubated or unstable. Babies tend to eat on either an 8:00 or 9:00 schedule, every 3 hours. For level 2 stable babies some hospitals require a full assessment each time, but many just require you to get a temp and vitals off the monitor, change their diaper, and feed them. Of course you are monitoring them throughout the evening for any acute changes to their conditions. Level 3 critical babies we generally do our assessment each time we do cares because they are more prone to changing quickly and catching it soon gives the best chance of recovery.

So we do our 3 assessments and feed our kiddos, then chart. Then we do it all over again 3 more times. Now of course that is an uneventful level II assignment. We also have other things like night shift bathing and weighting them, one of the shifts will do line changes. There's also parent teaching, helping parents do skin to skin, breastfeeding, or any other necessary teaching.

You can also have a busy assignment where you infant drops their saturations every hour and you have to go in and stimulate them to breathe, sometimes multiple times an hour, your infant has more to monitor like central lines, they are intubated or on higher respiratory support, chest tubes, infants that are post op, have trachs, g-tubes, ostomy's. You could be doing ABGs or glucoses often, titrating drips frequently, changing respiratory settings (RT does that but you have to be aware and chart it). And on top of your critical busy infant, you probably have another patient to take care of. Hopefully your co workers or charge nurse will help with the other infant though. So you can have a simple night or a night where you barely get to sit down, and that's with just 2 infants.

There's also a chance, depending on your specific unit, you'll have the opportunity to attend deliveries, and you'll get admissions as well. Oh, and discharges as well.

Now please know you'll never get the critical babies until after you feel comfortable. The amazing thing I've found at every NICU I've worked at (Im a travel RN) is there's always someone around to help you. Just ask questions, if you question something, get a co worker to take a look with you. You'll have months of orientation, then you'll start out in the lower acuity patient population. Once you get your feet wet and feel more confident they will no doubt give you more unstable infants.

Welcome to the wonderful world of neonates. Good luck

I'm nervous because I'm working at a level IV NICU. I've worked with neonates in general on the floor I'm working at now, though, so luckily I feel like I know the basics. I feel like my assessment skills are sometimes lacking though, so I think that's why I'm nervous. They said my orientation is 8 weeks since I already work for this hospital...I'm nervous it won't be enough bc admittedly I am a slow learner. Your response was tremendously helpful. thanks a bunch!

DevotedRN, BSN · Feb 23, 2022

On 10/24/2021 at 11:45 PM, LisaNICUrn said:

Congratulation. Well your orientation will probably be 12-16 weeks depending on what level NICU you are at. NICU is different from any other unit. What should you expect. Well my "normal" shift (nights) starts with report, then we do our safety checks to make sure our suction and bag/mask is working in case we need it quickly. Then I look over orders to make sure nothing was missed and make myself my hourly sheet, write down times I have meds or labs, BS at a weird time, anything I need to do I put down to keep myself from getting behind.

Our babies generally eat every 3 hours. So we do our cares every 3 hours. Depending on if they are a stable level 2 baby getting ready to go home or a critical level 3 baby will determine how often we do a full assessment. We do a full assessment on every baby during our 1st cares. Then we change them, check their vitals, blood pressure, temp, measure their abdomen, listen to their heart and lungs, determine their work of breathing if any, check pulses. Then we feed the baby via tube or bottle. If they don't finish the ordered amount of feed then we tube the rest if they have a feeding tube. Then we move on to the next infant. Most hospitals have a 3:1 ratio for level 2 stable kiddos, and a 2:1 for the more critical babies, like if they are intubated or unstable. Babies tend to eat on either an 8:00 or 9:00 schedule, every 3 hours. For level 2 stable babies some hospitals require a full assessment each time, but many just require you to get a temp and vitals off the monitor, change their diaper, and feed them. Of course you are monitoring them throughout the evening for any acute changes to their conditions. Level 3 critical babies we generally do our assessment each time we do cares because they are more prone to changing quickly and catching it soon gives the best chance of recovery.

So we do our 3 assessments and feed our kiddos, then chart. Then we do it all over again 3 more times. Now of course that is an uneventful level II assignment. We also have other things like night shift bathing and weighting them, one of the shifts will do line changes. There's also parent teaching, helping parents do skin to skin, breastfeeding, or any other necessary teaching.

You can also have a busy assignment where you infant drops their saturations every hour and you have to go in and stimulate them to breathe, sometimes multiple times an hour, your infant has more to monitor like central lines, they are intubated or on higher respiratory support, chest tubes, infants that are post op, have trachs, g-tubes, ostomy's. You could be doing ABGs or glucoses often, titrating drips frequently, changing respiratory settings (RT does that but you have to be aware and chart it). And on top of your critical busy infant, you probably have another patient to take care of. Hopefully your co workers or charge nurse will help with the other infant though. So you can have a simple night or a night where you barely get to sit down, and that's with just 2 infants.

There's also a chance, depending on your specific unit, you'll have the opportunity to attend deliveries, and you'll get admissions as well. Oh, and discharges as well.

Now please know you'll never get the critical babies until after you feel comfortable. The amazing thing I've found at every NICU I've worked at (Im a travel RN) is there's always someone around to help you. Just ask questions, if you question something, get a co worker to take a look with you. You'll have months of orientation, then you'll start out in the lower acuity patient population. Once you get your feet wet and feel more confident they will no doubt give you more unstable infants.

Welcome to the wonderful world of neonates. Good luck

WOW ! As an aspiring and possibly soon to be NICU nurse I love how detailed this response was ! I felt like I could really picture everything taking place that you mentioned. I myself have been offered a position in a level IV NICU and I want to take the position but fear of failure is what currently lingers over me. I hope to be a competent NICU RN one day, thanks !

AlyshaAdele · May 19, 2022

Hi, OP ? May I ask for an update as to how you’re feeling in the NICU thus far (assuming you’re still there) please? I just read your original post & all the informative replies and am very curious to know…

I am seriously considering applying for an accelerated MN program (Master’s of Nursing) very soon, in order to work as a NICU nurse. I am just feeling extremely nervous of my potential/competency, similarly to what you expressed in post.

I had already completed all of the nursing science pre-reqs prior to starting a Master’s program to be a therapist, actually. Then I became pregnant, my baby was born early, and needed 3 open heart surgeries during his first week of life... That aspect of how/why my attention/interests turned back towards nursing, especially the NICU, probably speaks for itself! I also happened to be an open heart surgery kid (x2) myself.

Anyways, I would really love to hear from you, if you’ve gained any additional insight, experience, and/or confidence thus far, please?

I am especially prone to “Imposter Syndrome” (essentially doubting your abilities despite proving them, if you’re not familiar) so hearing from someone who went into the NICU with reservations but has had time to build experience would be very informative, and possibly encouraging, for me, I think.

I’m also open to hearing from anyone else who may be able to chime in.

Please & Thank you :)

Leader25, ASN, BSN, RN · Sep 7, 2022

On 10/1/2021 at 8:44 PM, pinkdoves said:

I always hear the people who go into the NICU never really leave. Maybe this will be my niche but I don't want to get my hopes up. Any advice from current or experienced NICU RNs would be appreciated!

!.Never let anyone bully you.Plan on lifetime learning,if you like working with the latest technology you will love,study read,attend conf etc.Purchase books like the Core ,Farnoff ,download the Neonatology medication manual,you need to know respiratory issues inside out, Gomella manual on on call situations,proceedures, Ask if you are not sure but don't ask the obvious or if you have a floor proceedure book,learn how to prepare to assist in different proceedures including the morgue.Good luck.