Recommendations for Pre-NICU?

  1. If I am unable to get right into the NICU, what area of nursing would you recommend? L&D, postpartum? I really don't want to go into med/surg...especially because I want to work with babies/children.

    Thanks in advance,
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  3. by   NicuGal
    I'd say postpartum/ can get well baby skills there and work on your assessments
  4. by   2banurse
    Thanks NicuGal, that was what I was hoping that you would say. When I'm done with nursing school, I'm hoping to get directly into a NICU, if not, then I will try for the mother/baby division which seems to always have openings.

    Thanks again,
  5. by   Anaclaire
    I did Well Baby Nursery straight out of school and 6 months later our nursery combined with the Post-Partum Floor to become a Mother Baby Unit.

    The experience was absolutely invaluable to me!!! Years later when I went to work in the NICU I had great assessment skills of the newborns, already could start IVs well, do Ballard exams, etc. and my learning stretch was to apply this to working with the preemies. I fortunately "knew" the larger/term babies well. I believe this made my orientation to the NICU much more smooth. Of course I had an extraodinary amount to learn about caring for sick and preemie babies, but my skills from the Mother-Baby Unit helped alot there too. Like, I already knew how to operate the syringe pumps. Little things like that go a long way in allowing you to focus and not feel so overwhelmed sometimes.

    I also learned so much about how to interact with the families... what their normal states are during the postpartum period... like normal questions, normal "nervous" behavior, etc. In the NICU I was able to really see the difference in how families were coping because I already knew what was "normal" for a healthy newborn parent and it made me much more aware of how difficult emotionally having a NICU baby is for them. I believe my ability to know how to interact and talk with parents of healthy babies and parents of babies who were in the NICU (their Moms came to our Mother-Baby unit to recover too) made it much, much easier for me to speak with them and to anticipate their questions when I would talk with them from the NICU nurse point of view.

    I also became really good at helping Moms and babies learn to breastfeed, which is not always as easy as it looks in the books. I also helped hundreds of Moms who's babies were in the NICU learn to operate the breast pumps so they could take their colostrum to the NICU. All I learned about how to teach Moms how to care for themselves and how the breast pumping in's and out's can be truly helped me once I worked in the NICU because I was able to teach them in the NICU too. Many of my co-workers in the NICU would often ask for my help to learn how to operate the breast pumps, help latch babies onto their Mom's breasts, etc. It felt great to help and be able to teach my NICU buddies something too.

    I will say that I worked with many NICU nurses who had either only worked in NICU from their college graduation or who had only worked with adults for a few months. After many years of NICU nursing they tended to be scared to death of adult patients and I wondered if some of them felt a bit "trapped" in the NICU after 25 years... Just a thought...

    I think working on a Mother-Baby Unit would be absolutely the perfect introduction to Maternal-Child nursing! Lots of L&D nurses feel a bit uncomfortable with the newborns because they only have them on their unit for an hour or two and then the Mom and baby are shipped to the Mother-Baby Unit unless of course, they can work in a LDRP situation... which would of course be IDEAL.

    Good luck in whatever you decide! By the way, the way I got to the NICU was because an old-timer NICU RN told me she thought I'd be great there. She and others had worked with me in tandem a few times when I was pulled to the NICU and when they came to assist me in the Transition Nursery a few times. I also interacted with them when one of our babies needed transferring to the NICU so they would see how I practiced when giving report to them, etc. Evidently they felt I'd fit in nicely. I took the plunge after 7 years on the Mother-Baby Unit and have never looked back! I felt I had come close to mastering the patients on the Mother Baby Unit and was ready for another challenge. I found that challenge in the NICU. I hope you will to!

    Believe in it and it will happen!!!

  6. by   2banurse
    thanks Anaclaire,

    So would you actually suggest I go first to the mother/baby couplet care then NICU even if the NICU is available to new grads? I see a lot of good reasons for doing this, and I want to make sure that I am well prepared for the NICU.

    Again, I appreciate your feedback,
  7. by   Anaclaire

    I can't say definately for sure what YOU should do. For ME, the Mother-Baby Unit first was incredibly beneficial and if I had to do it all over again, I'd do it all the same way.

    Because I spent a few years working with adults, I have had a better transition when having to be pulled to L&D or Mother-Baby once in a while. I don't know about the patients on your hospital's Mother-Baby Unit, but ours had a few patients who were undelivered, too ill to go home but not ill enough to stay in the critical L&D area (beds were more expensive in L&D). Because of this I learned how to take care of Moms who were on bedrest for previa, preterm labor, high blood pressure, etc. We even had two moms who had suffered strokes during their pregnancies! Anyway, I learned a lot from caring for them about finding fetal heart tones, medications they needed, and how to help them cope with the emotional toll bedrest can cause. Not only did this help me relate to the parents who had been on bedrest and had other high risk pregnancies once I was a NICU nurse, the exprience helped me in another way I'd never expected... Once in a while, when working in the NICU, we'd have a low census or L&D would be deperate for help. Sometimes we were required to go to L&D to help for a shift or other times our manager would ask us to volunteer. Well, I had no problem volunteering or going there since the L&D nurses would always give me undelivered patients rather than someone in labor. You see, because of my experience I was able to help out a "sister" unit as well as look good in the eyes of my manager and the L&D manager. The same thing went for Mother-Baby when they were understaffed. I'd help them too sometimes. Also, if I ever needed some overtime and there was none available in the NICU, I could usually get some easily on Mother-Baby and sometimes in L&D.

    Basically what I'm saying is that the Mother-Baby experience gave me lots of more options and general calmness/confidence later on in my career in the NICU. Most NICU nurses who had gone straight to NICU from graduation were freaked about having to go to another unit, even Peds! They'd say things like, "I'd rather eat a bug!", "I've not started an IV on an adult since college ____ years ago!", "If I refuse to go can they fire me?" and stuff like that. On the other hand, for me, it was not a problem. I made sure my manager didn't abuse me by making me go every time and she was very good about keeping up with who went last and who's turn it was, etc., but for me being pulled was not a problem like it was for many of the other NICU nurses.

    If your Mother-Baby Unit has ante-partum patients, delivered Mom's who's babies are in the NICU, as well as regular, healthy Moms and babies, then I'd say the experience you'd receive there would be similar to what I received. Our Mother-Baby unit held up to 60 moms and 45 babies tops and the hosptial was a 640 bed hospital. We also had a special room for Moms who had delivered but needed to continue to be on Mag Sulate drips for 24 hours after delivery for their high blood pressure. They required hourly checks on many parameters but were very stable... our L&D worked it out with our Mother-Baby Unit to set this up. We were scared at first, but eventually learned how to manage them and that experience was very valuable. My resume now looks much better than it would if I had gone straight to the NICU I believe.

    If you're seriously thinking of the Mother-Baby Unit, see if you can check it out somehow. Did you do any clinicals on that unit in school? Do you know anyone who knows someone who works there or knows their manager and what their "scoop" is on the way the department is run?

    I can't think of anything else to say right now other than to say that a good Mother-Baby experience could be helpful for more than one reason. I'll also tell you of something I learned from a seasoned nurse and was echoed by many others over the years. The suggestion is to change what you do every 5 to 7 years to keep yourself fresh and motivated. For instance, do Mother-Baby for a year or two and then go to the NICU for 5 years. Join the NICU transport team. Work up to charge nurse if you like. If you feel you need a change you can consider another Maternal-Child area like L&D, Peds, or a GYN floor. Instead of changing units you could end up enjoying being an RN Discharge Planner or Outreach Coordinator working with other hospitals. My point is to keep learning and pushing yourself so you don't end up "stuck" in one place and feeling like you have to stay somewhere just because you've not used your skills in other areas for several years. Just a suggestion....

    If you believe in prayer, I'd suggest that too! Whatever "feels" right with be the right thing for YOU to do! Sometimes, when we have to work to hard to get what we think we want, we end up realizing that what we thought we wanted really wasn't what we truly needed at that time. For example: When I graduated from college I wanted to work on Pediatrics because I grew up in the hospital having loads of surgeries and felt comfortable there. Unfortunately my sister was the manager on Peds and I couldn't work under her (hospital rules). I figured the Well Baby Nursery would be the next best thing. I also interviewed in the NICU but was completely overwhelmed with the equipment, buzzers, bells, ventillators, etc. and afraid I couldn't do well there. I prayed about it and decided that if I worked in the Well Baby Nursery first then I could get comfortable with them first and be able to recognize a well baby from a sick baby. I decided to take the Well Baby Nursery job even if the NICU agreed to accept me. I just didn't "feel" ready for the NICU at that time. Then, years later, when I felt I had accomplished and pretty much mastered the Mother-Baby Unit patients, I felt the time was right to challenge myself with the NICU. Sure enough, the time was right and everything fit perfectly. This is what I mean about "if it feels right" to you...

    Again, if you feel your hospital's Mother-Baby Unit could offer you a rich experience like I had, and you want to try that for a while, I'd say go for it and do it for a year of two. By then you'd probably be good at baby IV's and routine 3-day antibiotics, drawing blood for certain labs, get good at assessments and Ballards, and probably even get some experience at charging the floor. That helped me as I learned to charge in the NICU years later too. What you learn in one unit can often be applied to another unit. On the other hand, there are many people who know in their hearts from the get go that the NICU is their love and they want nothing else.

    One last thought... During our final 3 months of nursing school most of us began looking for jobs. I had worked on a telemetry/medical unit as a student for the last year of my schooling and knew in my heart that I really wanted to work with children. I had kept hearing "Everyone needs 2 years of med-surg before going to a specialty area." I consulted my favorite instructor, the one who taught us L&D, and asked her about that and told her my feelings. She said to me, "Med-Surg experience would be great, but it's not truly necessary this day in time because nearly EVERY area is a specialized area now... I'd rather see you go straight to your babies and be happy than to force yourself into an area you despise and us end up loosing a good nurse who after 2 years of med-surg decides she hates nursing." I took her advice and went to my babies... happily and with a song in my heart. Once I found myself on the Mother Baby Unit (6 months after being hired into the Well-Baby Nursery our unit combined with Postpartum to become the Mother-Baby Unit) I realized how much some med surg could have helped me. ALL kinds of people get pregnant!!! Women with asthma, sickle-cell crisis, mental illness, automobile accidents, needing traction, strokes, gallbladder disease, kidney stones, morbid obesity, drug addicts, alcoholics, you name it!! I see now where the med-surg would have helped. It wasn't necessary but I did have to study a lot at home on my own when I'd encounter these patients. I learned a lot on Mother-Baby. What I truly HATE is when people would say, "Oh you work on Mother-Baby? How nice to rock babies all day and night!" They had absolutely NO idea what all we did there!! If the people in your NICU have that attitude, and you do go to NICU from Mother-Baby, you will most likely have to "prove" yourself, but then again we always have to prove ourselves worthy anytime we accept a new position.

    I've talked too much. I don't have any answer for your situation but I do have caring for you and hopes and prayers that you will make the right decision for YOU!

    You can do it!!!

  8. by   NicuGal
    I went into NICU as a new Grad 16 years ago and I don't feel trapped in anyway. Sure, it has been a while since I did things, but you do what you can and that is it. When we float, we don't do the floor, we only do nursery and when we go to Peds, we usually only get under 1's if they are available. We do go to the PICU also, and if there are infants we take them. I can't say I love going to those places, but it is part of my job and I do the best I can. I also know when to say, nope, can't won't do it. And most of the nurses understand...they float to us and we try not to overwhelm them.

    If NICU is open, go for it! If not, go with the postpartum.

    Also, NICU is very different from us, at least in my unit, the nurseries are much more chaotic for us LOL.

    I don't know if I agree about changing jobs every 5-7 years, sometimes job hopping, especially at one institution is frowned on and that nurse gets the rep as a "unit hopper". Why bother to go thru orientation to all those units and just leave in a few years. That really isn't too fair to those units that put time and money into orienting you there in hopes that you will stay and be a permanent nurse in their unit. Remember....things get around hospitals and NM's and directors know more than we care to think they know. Also, if some nurses get wind of the unit hopper, I have seen it made intentionally harder for them in orientation.

    Just food for thought
  9. by   llg
    This is an interesting thread with lots of good comments.

    I've spent most of my career in NICU's as a CNS/educator -- after having started there as a new grad. I've worked in several areas of the country.

    While I have always managed to find a job in NICU, I sometimes wish I had some experience with another clinical area -- either pediatrics or mother-baby, etc. As my career advanced and I was looking for leadership roles, being limited to ONLY NICU has really narrowed my options.

    I totally support new grads going straight to the NICU if their hearts are set on that and they won't be happy anywhere else. But if someone doesn't mind getting a little "other" experience first, I would recommend it because of the long-term flexibility it will allow later in their careers. Who knows what type of job they might want in the future?

  10. by   2banurse
    I would like to thank you all for sharing your experiences. I really appreciate it.

  11. by   EXOTIC NURSE
    I am a new grad and I went to PICU for a month and I transferred to NICU and I love it.........but I was a LPN for seven years and I basically worked in other fields but not really on the RN level but as far as patient care......I am glad I chose the NICU and I plan to be there for a long time maybe even going into NNP but that is a long time goal..
  12. by   Anaclaire
    some clarification on my part:

    i just knew i would offend someone when i mentioned how some nurses feel "stuck" in a certain job or area. i know this isn't true for everyone who works in a certain particular job for 10 or more years, but i've seen it happen lots and lots of times over the years. i worked with some nurses on mother-baby who had done it for 15 - 25 years and they were so burned out it was pathetic. they made the rest of us miserable to have to work with some of them. just the facts. i also worked with 3 nicu rns who were in the same boat and just as burned out as they could be. on the complete other hand, there were many old timers who were wonderful mentors and excited to help newbies learn things! an angelic lpn who had been working on the postpartum and then mother-baby unit for 30 years taught me the best way to catheterize a mom with a swollen, sutured, and painful vulva. i'll always be indebted to her!! claudette miller, if you read this, you know who you are!!!

    also, when i suggested "doing something different every few years" i did not mean "job hopping" which is in my humble opinion an entirely different situation. job hopping is going from place to place, unit to unit to unit, city to city, etc. with no rhyme or reason or well-thought-out plan for it. to me, "doing something different" means growing and stretching in your chosen field or area. for instance, begin in nicu as a new grad and become comfortable for 4 or 5 years. apply to be a preceptor for the new grads and do that for a few years along with staff duties. a few years later become a charge nurse. after that join the nicu transport team or become a discharge planner or outreach coordinator. after all this experience a person may decide to grow more into another direction such as management or advanced practice nursing in which case they would want to take some classes necessary to pursue that vein of work. i've worked with nurses who "climbed the ladder" in their own unit this way. as a matter of fact our assistant nurse manager started in the lowest rung as staff rn and 3 of our nnps were all staff rns who worked their way up, showed they had what it takes as well as the skills and desire to be a nnp and our hospital sent them to nnp school if they signed a contract to work in our nicu for at least two years. in this way a nurse could begin and end their career without leaving the nicu department while still growing, stretching, making contributions and never becoming burned out. rather than staying and growing in the nicu, another possible scenario would be to work on mother-baby for 5 years until you no longer feel challenged, then try the nicu for another 5 years. after that go to peds for a 5 year stint, then l&d for 5 years. a new grad doing this would be about 45 years old at the end of this rotation and could return to college if she/he hadn't already and become a fantastic maternal-child nursing instructor. wouldn't we all love a nursing instructor who we felt had been in the trenches and knew a lot from their own life experiences about what they were teaching us? i don't consider growing and stretching in a certain area (maternal-child) as job hopping. on the other hand, a nurse who stays at one job for 1 year or less and then goes on to another job and then another on and on because she can't find what she wants or because she is incompetent or difficult to work with as opposed to changing jobs due to moving from place to place as military wives must do is certainly job hopping and to be highly frowned upon i agree wholeheartedly! i would never encourage anyone to do that!

    by the way, i don't think 5-7 years in one job is a short amount of time. one of the blessings of the nursing profession is the ability to go from one area to another with a few weeks of orientation. the doctors have to spend 2 years or more learning their new field and passing competency exams if they decide they'd rather be a psychiatrist rather than an internist. (which is what my sister-in-law did.) being mobile in our profession is one thing that keeps us from becoming burned out. selling our soul to the company store isn't always the best thing for everyone. if a person is completely happy in their job, with their coworkers, their managers, their physicians, and administration and know deep in their heart would never want to work anywhere else, then i say hallelujah and stay where you are!!! great jobs and true happiness are so incredibly hard to find that if it comes to you, grab on and hang on tight to a great thing!!!

    i'm only making clarifications to my earlier post here. not trying to hurt anyone's feelings or anything remotely similar to that!!!

    most respectfully,
  13. by   NicuGal
    In our unit, all the things you mentioned are things that we just do. We dont' have to apply for them, we are all expected to take charge duties and we volunteer for transport and preceptorships. We have no ladder to climb LOL.

    And those people that are burned out to the point of misery would be miserable no matter where they went. Nursing takes a toll on you no matter where you work and how many places you go. It is a tough, demanding job.

    The girls that I work with that want to have all those experiences in different units sign on as PRN and they float among all the Mat. Child Units. They love it

    As for feeling challenged...every area of nursing always has new things and you can feel challenged if you set your mind to it. Make a better d/c plan, set up a group to help with setting new policies, the possibilities are never ending.
  14. by   EXOTIC NURSE
    I agree NicuGal