Almost out of orientation..

  1. I am a new grad who recently passed boards and have been working in the NICU now for about 2 months. I am about two weeks from being out of orientation. I know I have grown so much over the past two months but I know I still have an overwhelming amount to learn.

    One particular area that I feel intimidated by is educating parents. I feel as though I am doing all I can to grasp what is going on, I feel very underqualified to educate them about what is going on. How did you handle this when you were new to the unit? I know I can grab a doc (which is probably most preferable) but are there certain areas that I should study and know well (common things that we will see on most babies)? If so, I would love some ideas.

    I do have my "brain" sheet down and feel rather good about organizing my time. I am able to keep up as long as things go as planned, but it would not take much to throw me off and I would be drowning.

    Also, how do you handle your admission process. In my unit, the nurses are extrmemly helpful to anyone who is admitting. I the few admissions that I have been apart of, someone takes the report from transport while I have gotten the baby settled in. I have found that while it is so nice, I feel as though I do not have the complete picture as to what has gone on with the kid. Any advice here?

    Thanks so much everyone. This site is truly invaluable!
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    About Tiny1Nisolet

    Joined: Jul '05; Posts: 201; Likes: 10
    NICU staff BSN, RN
    Specialty: NICU

    8 Comments

  3. by   EricJRN
    Teaching is tough! You're trying to take extremely complex information from the docs and other staff, understand it yourself, then rephrase it in such a way that a layperson can get it.

    One thing that might help: In my unit, we have videos that talk about the basics - intro to the NICU environment, basic baby care, etc. We also have some literature for parents on things like jaundice. By reading/watching this stuff yourself, you'll not only make sure that you have an accurate grasp of the knowledge, but you'll get an example of how to break it down to the families. You might also have one of the more experienced nurses casually watch your teaching a time or two and see if they can make suggestions.

    Re: admissions, I don't know of any nurse that can do them alone. Teamwork is a good thing, but you're right that it can be difficult trying to understand the whole process when there are several people doing things at once. The next time you know that you're getting an admission, you might ask the charge nurse if you can tag along with the nurse that gets report rather than doing the same old admission tasks.
  4. by   Tiny1Nisolet
    Quote from EricEnfermero
    Teaching is tough! You're trying to take extremely complex information from the docs and other staff, understand it yourself, then rephrase it in such a way that a layperson can get it.

    One thing that might help: In my unit, we have videos that talk about the basics - intro to the NICU environment, basic baby care, etc. We also have some literature for parents on things like jaundice. By reading/watching this stuff yourself, you'll not only make sure that you have an accurate grasp of the knowledge, but you'll get an example of how to break it down to the families. You might also have one of the more experienced nurses casually watch your teaching a time or two and see if they can make suggestions.

    Re: admissions, I don't know of any nurse that can do them alone. Teamwork is a good thing, but you're right that it can be difficult trying to understand the whole process when there are several people doing things at once. The next time you know that you're getting an admission, you might ask the charge nurse if you can tag along with the nurse that gets report rather than doing the same old admission tasks.
    I have been the nurse that gets the report as well. That time I felt like I knew more of what is going on with the patient. However, if it is truly "my" admission, won't I be the one getting the babies vitals, getting the baby tucked in etc..? How do you do it in that case?

    I also loved your idea about reading what we put out for our parent's! I will definately look into that!
  5. by   Humbled_Nurse
    Well my advice to you is:

    Time

    Patience

    Experience

    It is going to take some time to get comfortable with admits. The best thing you can do is watch other nurses admit and get as much experience with admits as possible. First try to get experience with the less critical babies so you can find your own routine when admitting a baby and as you get quicker then you can move on to more critical babies. Admissions can be very stressful and I used to hate them, but now they don't bother me much unless it is an hour before the end of my shift

    As far as education goes that will take time as well. Eric hit it right on. The best way to get a basic understanding of disease process is to read handouts designed for families/lay people. March of Dimes has a great web site with lots of easy to understand info. on neonatal disease processes. I suggest you go there and read.

    Right now you are still very new and most likely task oriented as most new nurses are. It's very hard to see the "big picture" That will take a long time. Right now you are just focused on what you have to get done in your shift and hoping that you do it right. I can remember when I was a new grad still in orientation and my preceptor said that our intubated baby needed suctioning, but we could wait until we got back from lunch. I was so focused and nervous about suctioning that baby so during lunch that was all I could think about. Now suctioning an intubated baby is no big deal at all, but as a new nurse it freaked my out.

    As you gain more experience and confidence then you won't be so task oriented and you will get a firm grasp on the "big picture" with your patients.

    Remember to be patient with yourself. It will take at least a year or two to feel comfortable in the NICU environment, but even after years of experience there will still be situations that come up that you are uncomfortable with.

    Good luck and keep us updated! Sounds like you are doing a good job!
  6. by   smart99guy
    congrads
  7. by   marie229
    was it hard to get into the NICU right after graduation? Did you have anything else going on that gave you more than other applicants?
  8. by   staciebeth
    I also got a job in the NICU right out of school. There is an awesome book designed for the parents of NICU kids, I read it and it clarified a lot of areas for me and put everything in layman's terms (which is great for your learning and explaining things to parents). The book is called "Preemies: The Essential Guide for Premature Babies". It's by Dana Wechsler Linden, Emma Trenti Paroli, and Mia Wechsler Doron, M.D. I picked it up at Barnes and Noble in the parenting section. Since it's not a textbook, it's not too pricey. It's really easy reading!
    Good luck!
  9. by   kimogieo
    Yesterday was my first day off my orientation, so i was on my own for the first time. I had two weeks of orientation, i thought it was alright but i kept getting pulled aside to do someting thats not even my job. The unit manager thought I was there to help her instead of doing meds and learning how residents take their pills, g tube, etc. I was oriented to 3 units withing 2 weeks. So yesterday was my first time alone, i did 3-11 shift...sadly i had 4 g tube pts, 10 finger sticks and the finger stick pts alone took a bunch of my time. I was not even halfway done giving 5 pm meds and it was already 7 because i wanted to give insulin to my patients since it was so high. I was going crazy and wanted to cry but i had to suck it up, I was giving insulin two hours late. I felt like crap after i got out of that facility. I had 30 patients, i felt like quitting because I mixed some 5 and 9pm meds and gave it but only supplements or colace. and then.....when i got home around 1am, i realized i forgot to do treatment it was horrible. I kept crying to my boyfriend, i kept apologizing to the next nurse after me because i wasnt able to clean the cart and she said she understands that she was like that too in the beginning.

    I will work today again and tomorrow in another unit, less hectic i hope and I will try and get things done on time. Its so stressful, and they thought i was doing good during my orientation because i am a new grad and im able to deal with doctors and everything but with my med pass, i guess i need to speed up more but im scared to make mistakes, i mean i didnt even had the time to look at the labs and call the MD. i need help T_T
  10. by   Love_2_Learn
    I really learned a lot from the book, Newborn Intensive Care: What Every Parent Needs to Know Edited by Jeanette Zaichkin. The newest edition was published in October 2009. It's about $30 on Amazon. You may recognize Jeanette Zaichkin's name as she is one of the leaders in NICU nursing. Her name is big for her contributions to the Neonatal Resuscitation Program books. Anyway, it's written in such a way that helps me explain things to parents in words THEY can understand. It's way too easy to use medical jargon without realizing it and this book has helped me a lot through the years.

    As far as admissions go, I agree with you getting report on the patient now that you have gotten better at performing the routine admission procedures. Where I have worked, the admitting nurse takes report and all the other nurses gather around to help. When you are the one to receive report it puts you in the driver seat to think critically about what is wrong with the baby and the expected plan of care the doctor or nurse practitioner will implement. Of course you will dive in and work on the baby too, but knowing where the baby's "been" helps you know where you will be "going" with the baby over the next few minutes and hours. It will all come together with time, and don't be discouraged if it takes at least 2 years to begin... yes begin.... to feel a bit comfortable. Never stop learning, seeking, and caring with all the empathy your heart can hold for your patients, families and coworkers.

    Wishing you the best nursing career possible!

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