Novice nurses in NICU

[sueoct79]

I have been a NICU nurse for 14 years. Currently, I work in a Level IV NICU that is expanding it’s capacity and going to private rooms. The hospital has hired about 30 new grads to accommodate the new staffing needs. I know that it takes time for new nurses to acquire good assessment and general nursing skills, but I fear for the future. I’m finding that babies who do not get the proper nursing care suffer extra septic work ups, xrays, changes in the plan of care, etc. For example, if the CPaP does not have a good seal or if the ET tube is not suctioned properly, the baby shows increased work of breathing, then the doctor’s next move is to get blood or do xrays, when it’s a simple nursing skill fix. I try to provide education and tips whenever possible. Again, I know it takes about 2 years for a new nurse to become competent in such a specialized area, but it’s frustrating in the meantime. Any advice from experienced nurses on how to deal with the lack of good nursing skills from novice colleagues?

[NICU Guy, BSN, RN]

We hire almost exclusively new grad nurses for our 103 bed Level IV NICU. 90% of the new grads were former Summer Externs, Capstone students, or PCAs on our unit. The result is a new nurse that has a good foundation on the care of our patients. From day one, they have the basics down and we can spend more of their orientation time focusing on the higher acuity patients and skills. Their orientation is 12 weeks (combination of classroom and preceptor). During their preceptor phase, the new hires also spend several shifts with a NICU nurse (that has no assignment) and performs any kind of procedures that are needed throughout the unit. That ensures that they have performed all of the common procedures (numerous times) that we do without leaving it up to chance that they will perform those procedures on a normal shift with their preceptor. Once off orientation, they will spend a couple months on day shift. Day shift is heavy with experienced nurses, so the new nurses are surrounded by experienced resource nurses. We try our best to drill in good habits from the beginning so that they carry those habits on through their practice. One indication that we must be doing something right is a recent post of mine that we hit the 2 yr mark without a CLABSI (over 3000 central lines). That indicates that the nurses with less than 2 yrs experience are following proper procedures when accessing our central lines.