NICU newbie

babyNP., APRN · May 18, 2014

I'll bite :)

I did mostly feeder growers during my senior practicum, but I was in a little level III delivery hospital. I would expect that you would mostly be taking care of those types of infants. I'm sure they'll at least let you do that; otherwise, what would the point of you being there?

The 2010 Neofax is out of date; the company only does an online version/app now. You can if you have the extra money (it's like $25) but you don't need to. I definitely wouldn't have your iphone out on the unit as a student, but you can look up the drugs at home if you like. It's very useful.

I wouldn't expect a nursing student to know anything, so I wouldn't worry about that. I had no knowledge of babies and my maternity rotation actually ended up terrible because it was a high-risk delivery center so they didn't let students observe anything. I took vital signs on some antepartum patients and that was the extent of my rotation, so I literally knew next to nothing.

I think you would have a good chance of being hired there if they are like most hospitals, but don't go into it with the expectation that you'll get it (i.e. don't talk about it during your first few couple of weeks). Ask questions of the nurses and always be on your game. Don't look bored (bring your merenstein book for downtime because there usually is some), always be doing something, reading your NICU book, etc. Just be positive and show how you are excited for NICU.

Even if you don't get hired into that NICU, make sure you look into other NICUs. Having a practicum in a NICU is a big help and many academic center NICUs prefer new grads over experienced in other nursing areas NICUs. It was actually very interesting; my center is an academic center and we have terrible luck with experienced nurses (not NICU experience) and great luck with new grads. When I've done agency at other hospitals in the area, they've told me the opposite that they have terrible luck with new grads and great luck with fellows.

HyperSaurus, RN, BSN · May 19, 2014

I did a 90 hour practicum in our level III NICU as a student. We are a smaller NICU and it is very much feast or famine here. I mostly did feeder-growers, I wasn't expected to know much of anything in advance. The merenstein and gardner book is quite nice, but very wordy.

Like I said, you shouldn't necessarily be expected to know a lot ahead of time. I would plan on observing for the first couple of days, but if they offer to let you diaper or feed a baby, take them up on it! Try to do head-to-toe assessments with your preceptor. But don't get ahead of yourself and start doing stuff on your own without your preceptor's express OK.

Be humble, observant, and ask questions. Make a couple of goals for yourself: what do you want to get out of this experience, what would you like to learn more about? NICU covers a lot, but you could maybe see if you could learn more about a couple of commonly or less commonly seen conditions, such as PPHN (persistent pulmonary hypertension of the newborn), TTN (transient tachypnea of the newborn), PDAs (patent ductus arteriosus) , or NEC (ugh...necrotizing enterocolitis). Having goals can help your preceptor in case there isn't a formal student program in your unit (there wasn't for us).

I didn't get hired right away to the NICU after graduating, but they did remember me when I applied 2 years after my internship. Precepting there is no guarantee of a job, but treat it like a continual job interview, just in case.

Enjoy and good luck!

XelaRN · May 20, 2014

Babyrn- Thank you for your response! Great to know about the neofax! I suppose the best approach will be to see what my first few days are like and then decide if I will purchase the online version. I definitely will refrain from mentioning my hopes for a job for a while. I am just excited to get my first taste of NICU experience and see how the nurses at this hospital and on this unit functions. I have heard that NICU nurses tend to be very nurturing and I also imagine that the nature of the environment in a NICU encourages a strong team mentality. I will definitely look into other NICUs, however, if an employment possibility at this unit is not possible once my preceptorship is done. I have heard that having a senior preceptorship in a NICU can be a hindrance when applying for other units if I am unable to find employment in a NICU. Does anyone else have any experience with this?

Hypersaurus, RN- Thank you for your response as well! Did you feel that 90 hours was sufficient for you to achieve what you wanted to during your practicum as far as learning and experience. Obviously, it takes years to gain a good amount of experience in such a specialized field, but for being a student nurse and hoping to become a NICU RN, was your time there satisfactory? I'm definitely ready to jump on whatever experiences the nurses are willing to offer me, but, this is a little embarrassing, I've never changed a diaper before. Will my nurse find it annoying to have to show me how to properly perform such a basic task? Are there certain tasks, like swaddling and changing a diaper that I should youtube or find a friend with a newborn to practice on? I do feel adequate with a typical newborn assessment even though I am sure I won't be completing any on my own.

HyperSaurus, RN, BSN · May 21, 2014

The 90 hours certainly did not replace an adequate orientation, but it at least got my feet wet and me used to the environment and culture of NICU. There's so much that you don't necessarily have to worry about as a student, that you are still essentially a newbie once you finally get a job there.

Don't worry about the simple tasks. From my experience, the nurses literally expect you to know nothing and anticipate walking you through even a diaper change and bottle feed (there is a lot that can go into bottle feeding a preemie).

babyNP., APRN · May 21, 2014

It might be a hindrance when applying to work with adults, but remember that your nursing education is almost entirely focused on adults. You'll be fine; even after your practicum, you're still more qualified to take care of an adult versus an infant. If you're applying for adult jobs, just don't write down where you did your senior practicum in your resume. Word of warning, unfortunately (like anywhere), not all NICU nurses are going to be excited and eager to have you there. The culture of the unit is huge in this regard. I always go out of my way to be welcoming to students and floats, but not everyone has this mentality. I'm not saying this to discourage you, but just to keep it in the back of your mind. this is universal everywhere in nursing, though, so it's not just NICU.

NICU can also be a help for peds and OB/L&D jobs, I would imagine.

zeus&lincoln · May 22, 2014

I think you are definitely proactive and have the "right" attitude to begin your preceptorship in NICU. A positive attitude and asking a ton of questions is the way to garner help from your preceptor as well as other RNs within the unit.We tend to be over protective... With good reason in the NICU. Be humble and eager to learn ...even if it is a simple task like a temperature. This will show your preceptor that you are ready to learn and not a know-it-all. Even a temp is tricky in the NICU... Are they a new admit? Do it rectally to make sure they have a patent orifice. Are they cold 97.2 or less? Adjust the isolette (have to be shown how to so this) or see if the temp probe is on properly and not on a bony prominence. Is 90hours enough... Heck no! My 5 month orientation to NICU wasn't enough... You learn something new every single shift. However the PP is correct, it will get your feet wet and you'll be able to see whether you truly like the reality of NICU or just the fantasy.