New to the NICU... What Should I Know?

[tanaynicole]

I'm a New Grad, and will starting in a Level II NICU in a few weeks, and I'm both excited and scared (a normal reaction I think?).

I'm interested in what you girls/guys think I should do to help better prepare myself.

What advice would you give a new grad?

What do you wish some one had told you?

Any information/advice would be very VERY helpful.

Thanks in advance for your time

[EricJRN, MSN, RN]

Thank you for the books and sites, prmenrs. I've bookmarked them and I'll look through them later on.

Does anyone happen to know if anything like the book above comes in a format available for PDA's? That would be very handy to have. I've love to hear of any PDA software strictly for the NICU.

Thanks!

Kat

Not sure about the Merenstein-Gardner book, but I know you can get a version of the Neofax (NICU drug guide) for your PDA from the Neofax website.

[2curlygirls]

What I've gleaned in my 5+ years:

ANYTHING CAN HAPPEN AT ANY TIME-keep up with your charting!

And, it usually ALL happens at the same time.

Good Luck. I have definitely found my home in NICU, I hope you will love it.

[2curlygirls]

Oh, and never assume anything about anything. Double check everything!

[kate1114]

First of all, you've had some great advice, and I second everything said so far

Secondly, observe your fellow nurses carefully while on orientation. Look at their attention to detail and to patient care. See how they respond when you ask questions. By doing this, you will be building your own personal database of who you can trust. As one poster mentioned with the dopamine spilling story (:angryfire) not everyone pays as close attention as they should, and this can lead to dire consequences.

I would just make sure to spend as much time learning as possible. Orientations and internships seem to fly by quickly, and before you know it, you're on your own. If you have a solid base and good resource people, you'll be fine.

Always know when to go for help. When I'm precepting, I always let my interns know that that's one of the most important things to learn during orientation. If something "doesn't look right", go find someone who might know what's going on.

At a former workplace, I had a pod partner who basically ignored a high potassium level. I didn't know about it, but the NNPs did. When she was on break, I called and mentioned that the EKG was looking funny. I didn't know exactly what was wrong, but I knew it wasn't right. Fortunately, they had just seen the lab, and came running into the room to intervene. Always trust that little voice that says something ain't right!

Good luck and make the most of your orientation. You are willing to actively learn (or you wouldn't have asked for advice). That's one of the most important steps to a successful, safe career!

Welcome to the NICU!

[2curlygirls]

Another thing...Don't worry about "bugging" the MD's (or NNP's) It's better to tell them too much than too little especially when you're new.

[elizabells, BSN, RN]

It's okay to take your time! I'm about to start a job in the NICU where I did my senior capstone, and the only negative thing my preceptor said about me in my eval was that I was a little slow. But you know, when I had to do a treatment/procedure, I feel like it took less time for me to carefully double-check that I had all my supplies ready than have to stop, re-swaddle, bring up the crib rail, go get what I needed, and start all over, all the while feeling stupid for not being prepared. Keep in mind that NICU has very low turnover, so many of the nurses have been there for YEARS, and will have their routines down. You are learning. Speed will come with time and experience.

ALSO, and this is something else I learned from experience, if you have a sub preceptor, it is almost certain that s/he will do some things differently than your regular preceptor. Use that nursing judgement, and if it's not something you think will actually harm the pt, just do it the way the person you're with wants it, rather than saying "But nurse so-and-so does it this way..." Then when you're back with your regular person (with whom you presumably have a closer relationship) you can say "Nurse so-and-so had me do it this way, what would be the rationale for that?" That's the key. Not "waaaah, you do things differently and I'm confused," but showing that you're interested in the reasons behind things. Nine times out of ten there isn't a rationale, and it's just a preference thing, but you never know.

Aaaand one more thing: I read things in Gardener that directly contradicted what we did on the unit. As in Gardener says NEVER turn a baby's head back and forth while suctioning an ETT, but hey, that's what they did on my unit. Honestly, I never did get the courage to ask about it, but if anyone has any ideas for those situations . . .