I feel so stupid in the NICU, will I ever be good enough?

jennylee321 · Oct 18, 2017

It is a huge transition coming from med surg from NICU, but it can be done and what you're feeling is normal.

What will you do the first time you send a baby to the OR or do an admission? You will get help from your colleagues and charge nurse. They are not going to hit you with that kind of stuff right when you come off orientation (we can hope). So next time you see a baby booked for OR, ask the nurse who has them what the steps are. Admissions to NICU are pretty frequent occurrences so take every opportunity you have to help with them. After you've helped with these activities, take the time to make yourself up little checklists. That way next time you get an admission you just whip out your checklist.

Time management is very different in NICU compared to med surg so be open to completely changing the way you manage your time. On a med surg floor, you would be doing a round a vitals, a round of meds,ect. In NICU you want to cluster as many things as you can. Each time you are about to go into the bedspot think of all the things you can get done in that interaction. For example if you've got an antibiotic due at 1000, in addition to giving that med you should be thinking about the following things that can also be done: checking your lines and rates, charting your vitals, checking IV site (this is a given since your about to give an IV med), do your pressure release of the CPAP mask/prongs (if this is something you do on your unit), if the baby has been unsettled take this time to get in there and reposition them/offer pacifier.

When you have your feeds/cares/assessment due, I recommend always starting them early especially when you are new because if you don't your feeds start to fall behind and that will just make you stressed.

A well stocked bedside goes along way, try to make this part of your morning routine as it will save you a lot of time later so you're not running off to the storeroom all day. Same goes for cares, make sure you have everything ready before you go in that incubator (ie. diaper, wipes, thermometer, feed, ect.)

Going back to what I said about having a morning routine, I'll expand on this a bit. Unless I am handed over a very sick baby who needs immediate attention I like to start off with the following:

-fill out whatever brain sheet I'm using, often just a divided piece of paper these days (I do this mostly during report but will add in anything else after report)

-read most recent MD/nurse note ( I realise when your new you might not always have time for this but it is helpful especially for rounds)

-check my orders, check my med doses on the formulary/ check any unfamiliar meds

-check most recent labs, plan any labs that I may have to do this shift

-safety checks (including checking when my lines are due)

-acuity tool

-check fridge to see if I have enough defrosted milk to get me through my shift and see if/when I should pull out milk for the next shift

-stock and clean my bedside (if I have time, might have to leave this cleaning till later depending on the day)

Quick note about bloodwork- ask yourself and the provider how urgent this lab is, if what they are ordering is routine you shouldn't be disturbing a settled baby to take it, try to cluster bloodwork with your cares

Brain/Day Planner- all new NICU nurses should definitely be using one whether your unit provides something or you find one/create one. If you search all nurses there is a good NICU brain that was posted way back

Lastly, the amount of information to learn in NICU can be overwhelming but you don't have to learn it all at once. Take responsibility for your own learning, get a neonatal textbook, print off your units policies and read them at home.

I know this is a lot of info but I hope it is helpful, hang in there!!

rnkaytee · Oct 18, 2017

First of all - I'm kind of glad you're scared and worried, it lets me know you realize what is at stake! I felt the exact same way - I remember going home one morning just thinking I would never get it, I was in over my head, etc, etc. Now I'm an NNP with almost 18 years in the NICU and I love it - can't imagine doing anything else. You'll get the time management piece - 4 babies is a lot on your own anyway. I agree with Jennylee above - start observing the disease states/medications, etc. you are coming across and take learning into your own hands.

tmjwe3 · Oct 19, 2017

Thank you so much. I actually went into clinical today with a note of what you said! I mean my shift today was still really anxiety provoking. When you change the baby, feed, burp get so confused on what to do next. I took on the responsibility of one patient fully. I did TOA and everything. It was scary but I survived. I don't know how I'm going to handle the 4. You guys have given me motivation though, thank you so much for taking the time to write all these tips I will always appreciate it. Im just going to hang in there, I don't want to give up because this is my passion. I too want to pursue my career as an NNP. I am going to try and bust my butt off!

Lyfling83 · Oct 19, 2017

Oh my gosh, no! I started in the NICU right out of school. 4 shifts? Hell, our training for working in the NICU was 4 months long. Classes and preceptor shifts. And even then I didn't feel comfortable doing everything! That's when you ask, ask, ask for help. Ask a nurse who has been there forever, ask your admission nurse, or your charge nurse. You couldn't possibly know everything right away! But with time you will start to feel comfortable. Hang in there!

vintage_RN, BSN, RN · Oct 20, 2017

I came from the adult world with no baby experience. For the first little while I felt pretty dumb too. I'd been successfully taking care of critically ill adults, mentoring students and being a "go-to" person on my unit for 4 years and now I was the clueless newbie again. I can relate. I assure you, it gets better. I felt completely comfortable with intermediate level assignments after 3 months of being on my own. I had a month preceptored before I was on my own. My advice is don't be afraid to ask questions, it's better to ask than to be afraid of looking dumb and not asking. If it helps, this is my routine:

I come in and get report on my babies and then scrub in. Then I go to each bedside and wipe everything down with a virox wipe, all surfaces, the monitor, the outside of the isolette, the counter etc. Then I do my safety checks and make sure that the bag mask is hooked up and working, suction is hooked up and working and that I have the correct baby mapped to my monitor. I check my fluids and rates, and calculate my TFI's to make sure they're correct. The above poster is correct in that we do clustered care. Meaning that if a baby is due for a feed at 9 but they are asleep, I'm not touching them. I just hook up their feed. I only handle babies when they are cueing and awake. Now I am in a level III (highest in Canada) which means I have mostly sicker or preemie babies...but we do have a level 2 around the corner which we all work in also. Level 2 is hard if you have 3-4 bottlers, in this case I start approx. 45-30min early and I wake these babies up to feed...they are term or ex preemies so I'm not too concerned about disturbing them as I am with the preemies. Try to cluster as much as possible when you touch that baby...meds, assessments etc. and if that baby is sleeping next handle time than don't touch them (unless your hospital policy states otherwise).

Hang in there, you will get this! NICU is a whole other world :)

babyNP., APRN · Oct 20, 2017

Totally normal what you're feeling. Hang in there. I cried a few times on orientation too- even spent an extra couple of weeks on orientation when I didn't pass one of the tests we took.

lexann75 · Jan 13, 2018

hello

this is long ... warning.. but I took the jump from adult nursing to NICU .. here is my journey

I have been an RN for 15 years. The past 10 years as Clinical system analyst. I "helped out" on med surg and ICU off and on but mainly I wrote policy and processes and built the EMR to the best I could with trying to meet the needs of regulations, EVBOS, government and the enduser. I needed a change. I loved my IT job, but my personal life changed and I was not able to balance work and life or life and work..

I have been in a level IIb NICU since August. Mind you I though I was going to hop in and take care of babies,

just like you do with well babies, and adults. I was so wrong. Like the ladies above said, Time managmentt is key. I really

struggled with " this is expected because they are a 30 weeker" I am enrolled in a NICU orientation online class

from health stream that I will start next week. it's my fault I have not taken it sooner, but we are really busy

and I don't have time to work on it at work. I have made time at home to get it done.

I have also really struggled with a " brain sheet" ... I have been in the hospital setting way before

computers and, as much as I pushed the EMR, I need my paper!!!

*** If anyone has a brain sheet that they would like to share, you have no idea how much it would help us new NICU nurses, the ones that are transitioning.. I would really appreciate it. NICU Nurses, have their ownlanguage. I have always known SR to mean Sinus Rhythm on a brain sheet.. not in NICU.. self resolved,

Nursing school doesn't do much for NICU, at least mine didn't, but i also might have dodge it like a bullet. I never thought I would work as a NICU nurse, or do labor and delivery. Like I said I needed a change and my family needed me home a lot more.

1st. just know .. IT nurse, is a great job and pays well, but they hear nothing but problems and usually can not fix

them. There was a time that I told myself that I was making a difference just in a different way. My heart needed

to be a nurse again, I need i guess to see that instant, yeah it worked you feel bettere...?

the first 2 weeks I was in thee NICU, i am pretty sure I was in shock. I have always worked in a rural

community hospital, now I am in downtown KC. I had no idea the difference between a resident , fellow and attending

they all go by their 1st names, which is really nice, but so incredibly different. I was used to giving report to the dr

and in a teaching hospital, at least ours you do not.. you listen during rounds. like i said this is all soo new.

coming from IT, and chart auditing, I also struggled with so many "different ways' to do the task or procedure

checking residual and when to feed back and when not, how many times to take a blood sugar after fluids are dc'd

when to start the feeding tool? admitting a baby from well nursery for sugar issues or bili issues, is a transfer to me , but

to others it is and admit.

I will tell you, that I have not been this happy, and look forward to work .... goodness, I can't remember when because of my new career in NICU.

I have found my soul again, I am a nurse, a real nurse. lol I am new, the babies I see are usually premature.

they are fighting for a life they have no idea they are fighting for.

I am humble, more compassionate , than ever.

if anyone has a brain sheet for those of us that are learning all of the lingo NICU nurses use I would be

so so greatful. I thought my preceptor was cussing me out when she kept saying

"ducks up , ducks up" I get it now!!

I experienced my 1st NEC baby over the weekend. I have no words.

Thanks for listening. I am really glad a found this site for information and tools to become a better NICU nurse

prmenrs, RN · Jan 13, 2018

It bugs me when nurses come to the NICU from other areas of the hospital, have had some experience, and get tossed into the unit w/o a clue. That is NOT your fault!! You should spend some classroom time before getting preceptored assignments in the "convalescing" area, then spend some more didactic time before going to [preceptored] assignments in the ICU area. You could, ideally, have some independent time in the level II area before your ICU classroom time. Your preceptor should be available, or @ least, an identified resource nurse to support you.

Meanwhile, study all you can in a basic NICU text, like Merenstein and Gardner, or whatever the folks in your unit like.

I wish you all possible luck! I came from an adult ICU; it took ~ 6 months before I could look @ a baby, and feel confident I knew whether that baby was ok or not ok.

prmenrs, RN · Jan 13, 2018

ps--you are NOT stupid and yes, you will rock!

**NICU Guy, BSN, RN** · Jan 13, 2018

if anyone has a brain sheet for those of us that are learning all of the lingo NICU nurses use I would be so so grateful.

https://allnurses.com/nicu-nursing-neonatal/nicu-brain-sheet-882031.html

lexann75 · Jan 14, 2018

Thank you so much for the encouragement and thee nicu brain sheet. I will try it tonight. Out NICU educator found a software from healthstream, for nicu orientation, and neonatal development, I will start it tomorrow. ill keep everyone posted how it goes .

thanks again for listening.