NICU New Grads!

Gompers, BSN, RN · Apr 18, 2006

12 weeks plus didactic classes should be fine, don't worry. As long as your coworkers are nice and helpful, everything will be okay.

We do about the same amount of orientation here between the classes and hands-on stuff. Our new grads (we hired about 8 last year) are doing spectacular after that much time. None of them are burnt out and all of them seem to really love the NICU. Some wish they could be on days instead of nights, but it's not a perfect world and they're dealing with that.

I know some units have 6-12 months of "internship" and we don't do anything fancy like that. We do assign a nurse to "buddy" the new nurse after orientation is over, for maybe a month or two. This person kind of watches from the sidelines and makes sure the new nurse is doing well, plus she's the "go-to" person to ask questions, etc. However, our unit (especially at night) is filled with super-helpful people. The new girls know they can ask just about ANYONE for help or advice and they'll be welcomed with open arms. They also see the experienced nurses asking questions and for help sometimes, so they know that they don't have to feel self-conscious when doing the same.

Good luck!

NicuNightRN · Apr 18, 2006

I also graduated in May '05. I still consider myself a new grad, but my unit hired several other new grads in January, so it's weird to realize that at work, when they say "new grad" they are talking about one of the other girls! I had my orientation split into 2 parts. I did low-moderate risk orientation from June-August (some classroom stuff but mostly learning on the job), then was on my own taking care of those kinds of babies from September-November. In December, I went back on orientation for high risk. It was nice doing it this way, because I'd been in a NICU for several months by this time, and was comfortable with the basics, so all I really had to learn was stuff about the vent, hi-fi, lines, etc.

Yesterday, the "old" new grads (my group that started in June) and the new grads that started in January got together and talked about a lot of work things. It's amazing to realize how far I've come even in the last few months, listening to the other girls talk. I was terrified to be on my own at first, but quickly realized that night shift is nothing but supportive of the new people, and I'm not afraid to ask anyone a question or for help doing something. I've seen almost every nurse ask questions to other nurses, no matter how much experience they have.

Having worked in nursery probably helped you...some of our new grads had never held a baby or worked with babies, so they had to start way at the beginning with assessment skills, as well as just learning to be comfortable taking care of such little people! But, those without experience prior to coming to NICU are doing just as well as those who did have experience. :)

Good luck, and let us know how you're doing as you get closer to finishing orientation!

RainDreamer, BSN, RN · Apr 19, 2006

Thanks for the feedback, Gompers and NicuNightRN!

My coworkers are all nice and helpful ..... always asking if I'm doing ok. It seems like they all work really well together.

Hopefully I'll be able to get a buddy nurse once orientation is over too. I'm sure once I'm on my own, they'll have my pod partner be a senior nurse, one with more experience.

I thought I would start out in intermediate, but I didn't. That's one thing that kinda worries me too. I've had 2 weeks of orientation and I've already had babies on the vent, which totally scares me! My preceptor helped me and all, but it scared me trying to reposition those babies. In a way I felt like I was getting too much info at once. But she's exposing me to all kinds of different things, which is good. We were in intermediate one night. One night we were in isolation with a couple of chronic kids on vents. I think I just worry too much ...... I know she's a good preceptor and she knows what she's doing. So I'm just trying to put my faith in her and know that she'll lead me in the right direction.

One nice thing is that I'm on night shift ...... and I just love nights. At my last job I had to orient on days and I hated it. It makes it nice to be able to work on your preferred shift .... it doesn't add on un-needed stress.

NicuNightRN · Apr 19, 2006

I'm glad you get to orient on nights! I had to orient on days, and I hated day shift!! And I think it's a good thing to be scared when you try to reposition a baby on a vent. I don't like to do it alone, unless I am going from supine to left or right or something. If it's a big change, or I'm moving the baby to or from prone...I get RT!! Don't be afraid to ask for help to reposition a kiddo...I'm sure everyone would much rather help than have a baby accidentally extubate!

Finallyat40 · Apr 20, 2006

and started a 16 week residency program in january of 05. This program was both didactic and preceptor/unit based....we even had 3 tests, 1 midterm and a final exam! I won't lie to you, the first shift off of orientation (and for a while after that), everytime I went on the unit, I had a sick feeling in my stomach....like am I going to be able to do this. It took me a while to realize that there is always someone there to help me and all I have to do is ask for help and it's there! Yesterday, one of my roommates was taking care of a trainwreck of a 25ish weeker...24 hours old, honeymoon was over, started the day with only 1st day TPN running, had 10 drips when I left....we all worked together....she bagged, I bagged, the RT bagged, she hung blood, I fed and assessed her 2nd baby. That's just an example. You'll do fine...just keep plodding along and ask lots of questions...the day I work and don't learn something new is the day I need to resign!

Jamie

elizabells, BSN, RN · Apr 22, 2006

Where I'm doing my preceptorship (and hope to get a job!) orientation is mostly on days. This is so you learn how to take care of post-ops, as we have a LOT of cardiacs and CDH babies. We had a thing a few weeks ago where a nurse who'd been on the unit for two years revealed she had never had a post-op baby! Then after orientation you go to nights to pay your dues.

RainDreamer, BSN, RN · Apr 22, 2006

We have lots of cardiac babies too, lots of operations as nothing is flown out (except transplants), we do it all there. I hope orienting on nights isn't going to hurt me in that area. I had asked in the interview if I would be orienting on days and my manager said they usually try to orient on the shift you're hired for because there is no difference, other than basic shift duties.

I hope it's not going to put me behind though. Hmmmm.

elizabells, BSN, RN · Apr 22, 2006

Well, maybe your hospital does night surgery too? I dunno. I think this is a fairly new development on our unit.

RainDreamer, BSN, RN · May 2, 2006

I had my first post-op baby this past weekend! It was an incredible experience.

My preceptor wasn't there that night, so the charge nurse put me with someone that was getting a new admit ..... we thought it'd be good for me to learn, I hadn't really seen an admit yet. The admit we were getting was a 36 weeker with gastroschisis.

Baby came to us, screaming and crying. I just kinda watched from the sidelines. They were trying to get everything going real fast so they could get her down to OR in an hour. Dad was in there, crying ..... I talked to him for a bit, very nice guy. We took her down to OR, about an hour later they brought her back up. They were able to get all the bowel back in ..... she wasn't even distended or puffy at all ..... her abdomen looked a lot flatter than what I was expecting. The nurses were even commenting on how good it looked. Parents came in and saw her for a bit and were updated.

So we did the post-op care .... monitoring and all that. She was still totally out from the anesthesia. The nurse I was with that night just graduated last May and this was her first gastroschisis too. She wasn't sure when they usually wake up from surgery, but she was expecting probably by the end of our shift she'd be waking up some. Well at the end of our shift she was still completely out.

We come back the next night and they said she still hadn't waken up. The doc had even ordered a CT scan, but had ended up cancelling it after seeing that her pupils were reactive. So the parents come in and are updated by the doc .... he tells them they're a little concerned because she's still out and not showing any signs of waking up yet. I felt so bad for them, how worrisome that had to be They told us to call mom's room if she wakes up at all through the night.

Finally at her 0200 round, when I was changing her diaper and wiping her butt she started opening her eyes! I almost cried ..... I got all teary eyed and said "omg she's opening her eyes!!". Through her round she just opened her eyes a little, but didn't move around much. We called mom and they came down .... but she didn't open her eyes again for mom and dad. Finally at about 0600 to the end of shift she started moving around some and opening her eyes more.

I went in last night but wasn't assigned to her. But I went over to her pod and checked to see how she was doing ..... good to see she was off the vent. Later on I went by to check on her and RT was doing her CPT and she was crying through it, moving all around. Her parents got to hold her. I was so happy for them all!

My preceptor was back last night and I asked her if it was normal that she was asleep for that long after surgery, and she said it wasn't that uncommon. She explained they give such big doses of Fentanyl and they just have to pee it out. It made total sense too. With that 0200 round she had a huge wet diaper.

It was just amazing watching and being a part of all that. She came in with her bowels out, it was so weird to see. Came back from surgery and she looked just fine. Finally woke up, screaming and crying ..... her parents kept thanking us for taking good care of their baby, such sweet parents.

What an overwhelming and incredible weekend.