I just started four weeks ago and have had the WORST orientation I have ever had in my 20 years of nursing! I have a preceptor that values her free time as social time instead of teaching me and has been irritable with me from day two when I started doing hands on. They were well aware that I was coming in as an experienced nurse, but one that has not done bedside nursing in 13 years and no prior NICU/Pedi experience. She showed her frustration with me right away, without any explanation as to why, or additional teaching. Instead of teaching me during cares and charting , she was off socializing with her bestie in another room and audibly laughing at some questions I had asked, like not knowing what a CMV swab was for. During cares, when she was actually there, all I got was eye roles and sighs instead of explaining what I am doing incorrectly or letting me know what she would have done or how she would have handled time management. If I was late with something it was more sighs and "now you're late, you need to hurry" which just got me even more flustered and anxious. It would have been more effective if she told me after the fact how she would handle the constantly screaming baby in one room that was due for cares at 8, cares were done but he would take FOREVER (full 30 minutes and still need some tubed) and not settle and she wouldn't help me by holding him while I did cares for the other two who were due at 8 and 830. That would have been MUCH more beneficial than the constant eye rolling and condescending verbiage. She tells me to start cares as early as I need so that I can get feeds on time (within reason) so I wanted to start unhappy baby's cares at least 20 minutes early so I could do my assessment, just like she said, but then she says no that's too early to start them and then I am late with my other cares because of waiting for meds. That's after I ask her how soon I should ask for a certain medication we need for 8 o'clock cares that will need to come from pharmacy, I asked her should I ask for the meds now (25 minutes prior to cares) she says "no, it only takes them 5-10 minutes to bring them up". I go to the floor pharmacist when she says to and ask her, she is mad because she said she would have appreciated at least a 20 minutes warning so she could plan ahead. The constant snapping at me during cares for every little thing just got me more flustered and anxious making it hard to focus. I am honestly getting teary eyed writing this because I am so traumatized by the last few weeks! Keep in mind I am new to NICU and have never had children, so the baby stuff is all new. I asked her early on if I could take a day to learn the unit and where stuff is and focus on one baby just so I could really focus in on doing a solid head to toe exam, learning feeding techniques, tube feeds and most of all the relentless charting so I would have time to process what I was doing, she of course said no to that. Then when I would try to focus and look at the chart and process everything she would pull me away to do something else, same if I was in the midst of planning things and grabbing milk she would interrupt me and tell me I needed to start cares when I was already doing so! I have ADHD so every freaking interruption means I have to think and figure out my thought process all over again! She would also tell me to do one thing and then I would do it next shift and she would tell me it's wrong! On top of it when I was following her around to get certain things she would make faces at co workers who would make faces back, as if I am not even there and interpreting them! The other team members don't even smile at me or acknowledge my Meer existence, it's so childish, except for maybe a couple that are grownups! She was great at teaching me "tasks" to do when she felt like it, but not explaining the why and how part! I asked the nurse educator ahead of time if she had any recommendations for learning ahead of time since I had two months before starting.... her answer was no. So they are getting frustrated with me caring for these babies right from the get go without ANY knowledge. I don't start the actual NICU didactic stuff or modules for another two months!

The babies are adorable, but I cannot even imagine having to work this job long term! Between the toxic work culture, the irritable parents, and the screaming babies (which I understand are telling u they are uncomfortable and need something, and I love to hold and comfort them, but I feel like this job does not allow time for that). I just honestly hate the NICU and I am glad I tried it, and I thought I would love it, but it's nothing that I want in a job and I look forward to finding a new job. I solidly regret giving up my previous job, thinking the grass was greener... It's not, it's brown and covered in baby poo!

Just a message to you NICU nurse dreamers out there.... If you go to your interview and they let you in and don't even say hi or crack a smile or anything, take that as a red flag on the culture of the unit (I wish I had backed out then)! It's NOT less stressful then adult care, if anything its far more stressful between the personalities and the strict care times and the over tired parents and babies that cannot tell you what they need except for crying. Make sure you shadow for at least two hours minimum, and make sure it's with feed/growers and during the day so you get an idea of how busy the day will be! I shadowed a nurse at night and she had two CPAP babies so I got the idea that the NICU was going to be much less overstimulating then working elsewhere in the hospital, IT'S NOT, it's worse in my opinion!

Anyway, just mainly a vent and a word of caution for others considering a move...

So I started a week ago in a NICU which is what I thought was my "dream job". Anyway after this week I am like meh... it's not that great, but I am also experiencing a lot of stress related to all the information overload I am receiving. I am tryin to differentiate between deciding it's not for me vs. I am just hating it now because of all the added stress related to learning the new role!

Any experience you can share or knowledge would be helpful! I will give it some more time, but just wondering about other peoples' experiences! I am not a huge fan of the constant crying etc either and trying to dress a baby that is frustrated and hungry isn't a walk I the park, especially since I never had kids myself.

Thank you in advance!

Undoubtedly a dumb question, but sometimes after NG feeds (via pump or gravity) when I check on baby, they have digested milk back up in their tube. I get confused on if this is considered "residual" or what it would be called (reflux?), and whether I should refeed it if it's quite a bit, especially if it's right before their next feed (wondering if it will just make it worse on next feed). 
There are some questions I don't feel the safest asking as my unit is not very welcoming and this is something that didn't come up in orientation.

Thanks!

1. Helping families understand their baby's care builds trust and confidence 

2. Break down communication barriers so families feel informed, confident, and involved in their baby's care 

                     a. Use simple terms when explaining complex medical situations 

                     b. Avoid medical acronyms or terminology that may confuse families 

3. Be present during interdisciplinary rounds to ensure consistent information is shared 

4. Explain all care being provided during care times and encourage parents to participate when appropriate and ask questions 

                                    Maintain Strong Team Communication 

1. Effective collaboration among the care team ensures safe, coordinated care for NICU patients. 

                    a. Verify information given during handoff report for accuracy 

                                      I. Reduces the risk of missed or incorrect information   

                    b. Review active orders along with the most recent progress notes 

                    c. Perform your own patient assessment to establish a baseline understanding of what is "normal" for your patient 

                                     I. Promptly report changes in patient status to the provider 

                                                Practice Active Listening 

1. Listening is a key component of effective communication and helps build stronger relationships with families and coworkers. 

                     a. Listen without interrupting 

                     b. Recognize emotional cues from families and team members 

                                     I. Respond calmly, respectfully and professionally 

                                         Provide Organized Shift Handovers 

1. Clear report supports continuity of care and patient safety 

2. Ensure critical patient information is communicated clearly 

                     a. Identify priorities for the oncoming shift 

                                     I. Prevents delay in patient care 

                                             Support Professional Growth 

1. Strong communication skills improve teamwork, job satisfaction, and leadership potential. 

                     a. Seek feedback and use it to improve practice 

                                     I. Opens the door for future career advancement 

2. Helps nurses voice their concerns to advocate for their patients 

                     a. Builds trust between bedside nurses and providers 

                     b. Promotes a cohesive and collaborative care team

I used work as a pediatric home health LVN and I also used to work as a school nurse from 2018-2021. I am currently just start my BSN online and will be done next year. 

I have been applying to many NICU new grad positions in California since May 2024 after I passed my NCLEX and constantly kept getting denied. At this point I am starting to lose hope.  I tried skilled nursing facility and mental health hospital before but they were not the right fit for me. I know for sure my heart is it NICU and PED and I cannot imagine myself going into Medsurg, ER, ICU,  and etc. 

By the way, I am planning to start working as RN doing  private duty home health shift care for the time being. I also heard that many new grad nurses went to the other states to get the NICU new grad experience before they move back to CA again and apply to the NICU positions. Some of my friend got hired right away after they finished with there ADN program. Some transitioned from other departments to NICU. I never know before of how NICU new grad positions can be this competitive. 

I do know that that Sunrise Hospital in Nevada has a NICU residency program every year, so I am planning to Endorse my CA license to Nevada after gaining a year of experience in home health. 

Does anybody have any suggestions and recommendations for me ? 

Thank you in advance everyone !:)

There is an opening at my hospital for the NICU, and I have always wanted to work in that specialty, but it's nights.  I have tried night nursing the past and it was terrible, but I realize if I ever want to break into this specialty I will likely have to start on nights.  Is it worth it to do the time on night shift, even if it will be pure torture for me? 

I finally applied for a NICU position at my hospital, it will be night shift which is dreadful, but the manager said it hopefully won't be for too long. She actually uses hospital seniority to decide who gets the next day shift and not unit seniority.  She also said many of her night shift nurses actually want to stay on night shift, which I cannot grasp, but to each their own! ?

Anyway, the point of this post is to ask for any tips for my NICU shadow that is next week. I already interviewed with the nurse manager and will interview and shadow night shift from 7pm until 9pm.   I am guessing they may ask if I like nights shifts and if they do how should I answer?  I don't want to lie and say I love night shift, but I also don't want to tell them how much I truly hate night shift.  Also any other etiquette I should know?   I do work at this hospital already as an RN.  

Thanks for any tips! 

Annie

I'm currently in my second year of college working on my prerequisites, and I plan to apply to a highly competitive nursing program this fall. I'm from California, and my goal is to work in the NICU, and eventually, I'd love to advance my degree.

When I first started college, I was a nursing major, but I switched to general biology because I was considering becoming a neonatologist. However, after taking pre-calc for approximately 2 months, I switched back to nursing because of my very limited math background.

I've always pictured myself working in the NICU—partly because of my own experiences there and also because I'm very family-oriented. It's ingrained in me to want to help others in similar situations.

I've been thinking more seriously about advancing my degree again. When I switched back to nursing, I told myself and my mum, "If I can't become a neonatologist, then I want to pursue the highest practice-based role in nursing for neonatology.” I hold myself to a really high standard.

So here's my question: Is the highest practice-based role for neonatology a DNP-NNP? Is it worth it to pursue that? What exactly do DNP-NNPs do? I've read that they can act as the infant's primary provider (under supervision of a neonatologist), rather than doing "basic" NICU RN things—is that true? How long would it take in total (starting from BSN)? If DNP-NNP isn't the highest practice-based nursing role, then what is?

I haven't looked too much into this yet because I haven't even started my BSN program (I still have about 4.5 years to go), but I'd really like to get an idea of what the path could look like from here.

Also, what's the NICU really like? Is everything in there tiny? I've heard people say it's the "easy" job in nursing because you're just taking care of babies all day—but I don't expect it to be easy at all. Still, I'd rather work with babies than adult patients.

What's the pay like? (That's just a bonus for me—it's not the main reason I want to go into nursing.) Do the babies cry a lot? Can I wear cute cartoon scrubs? I've seen some NICU nurses in my own baby photos wearing fun cartoon scrubs, and I've always loved that! What should I watch out for in the NICU? Are there a lot of babies born with drug exposure, like "fentanyl babies"?

What do NICU nurses experience that I should be prepared for? I know I'm asking a lot of questions, but I've never worked or volunteered in a hospital before, and I'm only 19. I honestly can't see myself working in any other unit or field, so I'd really appreciate any insight or perspectives. :)

Would I be pigeonholing myself in the world of babies and peds if I start in this specialty? How difficult is it to transition to adult care? 

Thank you for your thoughts. 

I need some help with math ? 

I recently started at a level 4 NICU after working in a level 3 for a few years. It is quite different, but I do like it. Every facility has their own policies and different ways of doing things so it's going to take some time to get use to things. Calculating TFL is new for me. I am use to the provider just putting in orders with the set rate. Now, I actually have to calculate TFL and account for multiple drips and feeds.

If one continuous infusion gets titrated then the TPN is adjusted in order to keep the TFL at the set rate. Or if a new med is ordered for continuous...

 How do I calculate the new rate?

If the baby starts enteral or PO feeds with IVF going...how do I calculate that TPN rate to keep the TFL the same? 
 

Example 1: 

3 KG baby. TFL 120. NPO. D10 infusing. no other infusions added on.
- 120 (TFL) x 3 KG = 360

- I then divide 360 by 24 hours? = 15ml/hour D10 will be infusing

Example 2: 

3 KG baby. TFL 120. 

INFUSIONS: TPN. Lipids. Dopamine. Morphine. Versed. 
 

what do I do then? Subtract each rate? 
 

this is so hard ? 
 

Will the doctor(s) and other staff involved be accused of providing an abortion?

Some of the stuff coming from those (and other states) seems crazy, like waiting until the pregnant person is septic before removing a deceased fetus.

Thanks.

I applied for Memorial Hermann Nurse Residency Program for Fall 2023. I applied May 10th. Based on schedule they should start inviting people for interviews this week and yesterday was a holiday. Curious to know has anyone heard anything from a recruiter for interview yet (at any location)?

Do any of you travel as a NICU Neonatal RN? I have 10+ yrs of Level III experience and am considering travel. I have my RNC-NIC and am wanting to branch out and grow. My questions are do you get high acuity patients on your assignments or are put into feeder rooms often? What challenges have you faced in your NICU travel assignments? I have only worked in one neonatal unit.

Thanks!