New to NICU

NICURN2013 · May 28, 2013

Thank you SO much for your perspective! :) I do love how specialized it is and I'm so glad that I'm starting off in the NICU as a new grad. One day I hope to be that experience nurse that knows absolutely everything about neonates that can be a preceptor and give someone like me this chance. :)

I have been retired from critical care nursing for four years, but I'll share a bit of my thoughts on my NICU experience. Granted, I regularly moonlighted in the NICU when I was a PICU nurse, so this is not from the perspective of a real neonatal nurse.
NICU nursing is the most highly specialized type of nursing that I ever did, and it may be the most specialized of any kind of nursing out there. There is so little room for error, but as you don't have as much variety as say, an adult ICU nurse or a PICU nurse, I found that most experienced NICU nurses are rock solid in their knowledge of everything neonatal...vs a PICU nurse who may be great with hearts, but shy away from burns or hem/onc. There is everything from super sick micro premie to the late term meconium aspiration to complex chronics....to your everyday premie/rds and you feeder growers. If you are stressed out about taking care of these really sick kiddos, you can take a "break" with a usually quiet shift with three feeder/growers...although one never knows when one will throw you for a loop. I remember I had a kiddo on HFO who I spent a 12 hour shift with...had to mess with the drips every time I turned around...couldn't get his gasses in check....a train wreck...had surfactant...you name it we did it. Thankfully I managed to keep him alive, but I felt like a zombie when I was done. For the next day I asked for an easier assignment, please and thank you. No problem. You're from PICU to help us. We love you. Have you're pick of assignment! So I took three feeder growers who required little teaching and just needed to PO well. Half way into the shift...one started to pulse drop every half hour of so. Soon it was every fifteen minutes. Then every five minutes, then continuously. The kiddo ended up on ECMO with RSV....my first and ONLY time being the nurse when a kid goes on ECMO. So one never knows. Thank goodness, my NICU nurses took good care of me when I came over...and I of them when they got pulled to the PICU. My only advice to you...and this is for new grads in any type of nursing....to find experienced nurses who are good teachers and good people. Doesn't matter if they are a ADN, diploma RN, LPN...even the aides can teach you something. Our best feeder wasn't an RN or an LPN...she was an old fashioned SNA (Sr. nursing assistant) known as "Granny"...she could get a rock to eat!
Best wishes to you on what will be a BEAUTFIUL journey,
Mrs H.

NICURN2013 · May 28, 2013

I will look into STABLE :) I know I'm taking the class soon along with NRP. I believe I'm taking NRP first. Good to know, I will try to focus on home when I'm home. I have a 4 month old, so I love spending time with her when I'm here. :)

Check out the S.T.A.B.L.E. guide. It has a lot of good information for new NICU nurses. Plan for a wild ride, lol, but it's a good one :). When you are off work, be off--your mind will be going a hundred miles an hour and you will need downtime to keep you sane!

carolinapooh, BSN, RN · May 29, 2013

@HazelLPN - I really appreciate your post. I am applying to the USAF's NICU RN program and found all your advice to be timely and very well put.

canucknurse<3 · May 29, 2013

First of all, congratulations on your new job! I am a new grad just finishing my first year working in a level 3 NICU. I appreciate what others have already posted...especially around respecting how vulnerable this population is. My best piece of advice is to ask lots of questions. Run your plan of care by other senior staff or your charge nurse. It is an extremely specialized area and it will take a long time to build your knowledge base. Practice safe and diligently. NICU nurses are very protective of their patients so they can be a little intimidating but if you work hard, study and seek mentorship you will do great! Oh..one last thing. I would recommend making a personal reference guide to refer to.

jes2244 · Jun 7, 2013

@nicurn2013 congratulations, I hope your first few weeks have been wonderful, as I know they probably were. I too recently graduated, and with zero nursing experience I landed a job in a Level III NICU. How intimidating it is to be lowest on the seniority list, in a unit where openings are rare because most nurses stay a very long time. That said, my co-workers are, with very few exceptions, excellent mentors. They all make a point of telling me I am not alone. They are a very tight knit group of nurses, but I don't feel like an outsider. Keep a notebook, ask questions whenever a new case comes along, espeicially if it's something you never saw. Try to get brave and ask to be first to get called to any C-sections, high risk deliveries, admissions...because as scary as it is, the more you jump in, the more confident you become. Unfortunately I am only Part Time Nights, so I am still waiting for my first admission. I took one on after day shift already did most of the immediate care and orders. I was a deer in headlights! I stared at this baby laying on the bed, his hair all messy and unwashed, and here come his dad and grandparents! Somehow I managed to get thru that night, and with a lot of help from my co-worker, I set up his lines, got his fluids running, assisted in a UA/UV line insertion, got him into an isolette, got him off the vent and onto RAM/NC, sent photos up to his Mom...and managed to care for my other baby. Please share your experiences! It's very cathartic to talk about them. Great luck to you! PS...my preceptor lent me a S.T.A.B.L.E book, then lent me a great textbook. I still use this textbook a lot. I also got a cheat sheet of NRP algorithm and some key facts that I keep with me at all times.

Bortaz, MSN, RN · Jun 8, 2013

I have a NICU brain sheet that I frequently send to nurses on this site. If you want it, send me a reminder private message with your email address and I will send them out when I get home in the morning. Can also email me at (bortaz at gmail dot com).