Transitioning from Adults to Neonates

[rawrrrs]

So... I'm a nurse with 2.5 years of med surg oncology experience transitioning to a level 3 (feels more like level 4) NICU. So all I've ever known was ADULTS. I just finished week 1 out of 12 of my orientation and I'm already feeling defeated. Please share with me when did you guys start feeling competent and any tips and tricks you have for someone with ZERO experience with babies and critical care.

Let me share with you guys how my first week went..

Day 1 the charge nurse already embarrassed me. My preceptor stepped away as I watched the charge nurse start our baby's IV. She asked me for a "chevron" .... I'm sorry what did you ask for? I asked... "A chevron" she repeats irritatedly. I'm sorry I don't know what that is, I said. "Are you a new grad? Where did you come from?" I was furious as you can imagine! But as the new kid on the block how can you bark back to someone especially your charge?!? (it's not in my character to tell or put another person down one way or another anyways) Thankfully my preceptor popped back in and handed her what she needed. Which might I add... she was asking for tape to anchor the IV down. Noted.

Day 2 I'm paired with a different preceptor. We had a 1:2 assignment, which I've heard isn't the best for teaching or learning the first few weeks. We started with 1 baby but even so... this baby had a UV line, was on a ventilator, and had just pulled out his oral gastric tube and his peripheral IV at the beginning of the shift! Poor little guy was NPO cuz he's so sick... And didn't stop crying which caused him to desat. I never left this poor kid's side cuz his monitors kept beeping and the RTs would run in there. I don't even know to do, what to say, what to ask! Not sure if my preceptor thought I was stupid or what... But throughout the day she would say things like "you came from med surg right? So you don't know anything about vents.." yes you are right I don't but I'm here to learn everything and anything you have to teach me ! "Do you regret coming to NICU? If you wanted to... could you still go back to your old job?" Of course I'm questioning if I made the right decision when I leave a place I've already established friendship and competency! Of course I could go back if I wanted to and it doesn't sound like a bad decision when it's day 2 and my own preceptor already seems to have given up on me! I ended up telling her what the charge nurse did to me the other day and started to get tearful, not my intention to cry but I wanted to tell her yeah your coworkers (and partially you) are really mean. I sat in my car balling my eyes out at the end of this day.

Day 3 This day the best of the 3. I'm with the same preceptor as day 2. We get a 1:3 assignment as my preceptor requested for it... for me. She assigns me 1 baby to take care of all day. Thankfully this baby was the most temperamented! Didn't care if I had to reposition the leads on him or swaddle him and reswaddle him cuz I forgot the check his temperature or blood pressure. And my preceptor seemed to care about me.. turns out she had told my educator, who in turn told my manager what had happened on day 1 (wonder if she also told my educator this orientee is stupid too). Both the manager and educator talked to me.. really helped me feel better about everything. Really they did but now I'm concern when word makes it way around.. this charge nurse and her posse might retaliate and gang up on me in the future. (Hello...! You're forgetting I come with exp I know how the game goes with some nurses out there!)

This is so so difficult.... I have some many friends and colleagues (from my old hospital) supporting me but it sucks SO MUCH to feel THIS incompetent all over again. It's so hard not to get defensive. I'm probably better off just saying I'm a new grad so there are no expectations.

I've precepted and trained nurses before at my old hospital and I don't think I've ever made any nurse feel the way I've felt these past 3 days. I've stood up for my orientees and supported them. Whether they had experience or not I guided them through a smooth transition so they are confident to be on their own or at least feel comfortable to go to anyone, especially me, if they had questions. Sigh... maybe I'm asking for too much from my preceptor...

Thanks for reading my rant.. share any horror stories you might have experience as a new NICU RN or exped NICU RN going to a different hospital and how you managed as well.

Xoxo

[babyNP., APRN]

Yeah that sounds terrible. I will say that you should totally expect to feel like a new grad again which probably feels very uncomfortable. I do hope you get better preceptor experiences. I would remind whoever you work with that you have never done peds or babies so everything is new to you. Good luck

[Elizabeth777, BSN, RN]

I can't believe you had a kid on a vent on your second day. It was over 2 months before I even touched a vent and that was under very close supervision. You're going to feel like a new grad, because essentially, you are. NICU is a very specialized area; it'll take you a while to feel competent.

[TiffyRN, BSN, PhD]

I came to NICU from med/surg/tele with 9 years experience. I had been an extremely competent nurse, go-to for IVs and occasional charge nurse. Going to NICU revealed that practically none of my knowledge crossed over. I was for all intents and purposes a new grad. I generally say the only skills I brought were time management in that I mentally knew how to arrange tasks once I figured out which ones were expected.

Thankfully, my preceptors didn't expect me to know too much specific about NICU and treated me respectfully. They would ask my knowledge base on a topic and not scoff that it was so different from NICU. They would just say, "oh ok, great, so in NICU we do feeding tubes like this and we do it differently because of. . . "

Every unit is going to have their own lingo so there is no reason to demean you because you don't know terms like "chevron" which I had only heard in nursing school and then not again until I got to NICU.

In general I had a very positive orientation in my unit, and they gave me as much time as a new grad would have. I never hated med/surg but am ever so thankful to have found the little gem that is neonatal nursing.

[llg, PhD, RN]

Switching from adults to NICU is very difficult and a lot of nurses who try it, end up not finishing orientation -- or leaving soon after. One of the biggest hurdles is often that they expect their past experience to be more relevant and helpful than it is. Few people feel comfortable going back to the "total beginner" phase again and that feeling of discomfort can be downright painful. It's not like going back to being a new grad -- it's more like going back to being a beginner student.

To succeed, you have to put you ego aside and be willing to start nursing all over again. And that is very difficult for most people.

I hope you can take what I am about to say as a positive suggestion ... as that is how I intend it.

You seem to be judging everything in terms of what you used to experience and feel like back in your old job. Let it go: this is not your old job. Things will be different. You also seem to getting emotional about everything very quickly.

Don't expect yourself to know what a "chevron" is -- and don't make a big deal out of not knowing. I've worked in NICU's for 16 years and never used that term! When asked for a chevron, simply speak up and say that is a term you are not familiar with because it wasn't used at your old job. Don't turn it into a big emotional event.

Don't keep judging/critiquing your preceptors and your assignments. Go with the flow and learn from each experience that comes your way. If people feel you are judging them on everything they say and do, nobody will want to work with you. If asked to do something you haven't learned yet, simply say that you haven't learned that yet and offer to help them do it because you would love to learn.

There is nothing unusual or wrong about a 1:2 ratio or a 1:3 ratio. I have worked in 6 different NICU's and never have I worked in one where you could get a 1:1 ratio unless that baby was super-sick. And there is nothing wrong with helping with the care of a stable baby on a vent on day #1. As long as you weren't left on your own to be responsible for things -- it's OK to help your preceptor with the care of any type of baby. So, stop being so judgmental about everything. Half of what you are complaining about sounds normal and appropriate to me. (though nobody should be barking or yelling at you for not knowing things)

Chill out a bit and focus on making some friends in your new job. Remind yourself of why you were interested in the NICU to begin with. Give yourself a chance to be a beginner again -- but with the maturity to not let the little things get in your way of learning what you want to learn.