Nursery and NICU

Elvish, BSN, DNP, RN, NP · Mar 9, 2011

I work in nursery a lot and routinely have to transfer babies to NICU. For the most part, we have a decent working relationship but there are times, like you said, when NICU gets onto us for something. The biggest issue is, for us at least, a difference in priorities. I've noticed when NICU transfers a baby to nursery and vice versa, the things I want to know in report are far different than what NICU wants to know. Some of that can't be helped, because sometimes our priorities are different. I usually have to ask what else they want to know before I leave. Now that I've been at it a while, I'm a bit more familiar with what is and isn't important to NICU.

Usually what has happened is that when our NICU nurses float over to nursery and see how crazy it can get (being responsible for 20-50 babies at a time, plus whatever rolls in the door from L&D), they aren't among those who bite our heads off any more. And, after transferring a few babies from nursery to NICU while all hell is breaking loose over there, I can see sometimes why stuff gets missed when transferring a baby over to me. It works both ways.

I sure don't mean this to start a NICU/nursery war, because I have a tremendous amount of respect for what NICU nurses do on a daily basis that I could not. By and large we all get along okay. It's more isolated incidents than a regular occurrence.

jagalu100305 · Mar 9, 2011

I agree 100 percent. I know both specialties work very hard having done both. For us the incidents are not isolated it's every time I or anyone else walks through the doors. The past few times for me I have not even gotten report when I get comments like "Does this baby really need to come over" or just generally attacked for things that are largely irrelevant. When I worked in this same unit before I did not feel like we acted in such a way. Maybe it is just the staff in this unit at this time. That's why I want to come up with something, some way we can bond as sister units and grow mutual respect for each other. I just don't know how!

verytallnurse · Mar 9, 2011

Hey! I can imagine the attitude :))) We don't even have to go as far as the nursery.. Some nurses are like that to each other in the same unit, from shift to shift. Day vs nights. Everyone thinks they are doing more than the other person.. This stinks. Recently we had an email from L&D manager written to our manager: about few things that would improve work (as a team). I thought it was very clever - there are no names, just things like: the erythr. ointment is kept in the other room, next to OR and not in the drawer like it used to be. L&D nurses did not forget to stock ( again) like it is perceived by NICU team, they will be more than glad to go and grab it for you if you don't have time. And etc. Our manager mentioned few things that our nurses complained about but in very nice, professional manner - it's her job :) SO

* MAybe the unit managers could communicate monthly and address things.

* It was mentioned in the report for a month maybe - " nurses, please be kind to each other. Support each other. We work as a team. Try to smile once in a while..:) LOL

* NICU nurses use some sort of format when given report to each other - u probably know what it is - patient summary + MAR for the next shift? We want nursery nurses to "speak our language" LOL like: problem. hx. vitals. oxygen. last labs. meds. and why. :)

Hope any of this helped "))

Love_2_Learn · Mar 11, 2011

We have a 20 bed NICU Level III and believe it or not, NICU nurses sometimes have to go work in Well Baby Nursery. Yep, and many dislike it but others enjoy it for a change. Our L&D, Well Baby Nursery & NICU have the same manager and their budgets are mixed together so I suppose this is how it works out; also the Well Baby nurses sometimes have to come work in the NICU too. I think that fact helps keep us from being so irritating to one another as we realize what each other is going through and that we will possibly have to work together again so why burn bridges.

I like the thought of some type of "Transfer Report" page that would not necessarily be part of the chart but something helpful for the reporting. There could be one for babies going from NICU to Well Baby and vice versa. Maybe the NICU nurses could write down their ideas of the things they want to know in report from Well Baby nurses (and vice versa) and the transferring nurse could fill it out as part of the transfer process to help give report. It need not be super detailed but give the info the accepting nurse needs and wants. Each nursery (well baby and NICU) could come up with their own suggestions and maybe this would help them each buy into the idea. Once it would get rolling any little "bugs" could be worked out & needed changes made I suppose. If the nurses have input into things sometimes they are more receptive to change. It feels good to have someone want to hear your input and opinions about things that affect their everyday working life. Good luck and I hope things get better for you!!!

RainDreamer, BSN, RN · Mar 12, 2011

I can see it from both perspectives, as I'm now a NICU nurse, but I started out in a well-baby nursery at a different hospital.

In the well-baby nursery I worked in we didn't do any IVs or anything of that sort. We kept all the well-babies in the nursery while mom was sleeping, or if she was a recovering c-section and couldn't keep the baby. We also kept all the borders that didn't have a mom in house (e.g. the prisoners, etc). We had phototherapy and methadone kids too. Then we had to transition all the new kiddos that came in. It was very overwhelming at times.

At that place the NICU nurses looked down on us. They felt like we weren't "real nurses" and that all we did was babysit all night. Sometimes it felt like it, but sometimes it'd get crazy .... when you have a kid trying to die during transition and you've got all of this other stuff going on at the same time (your other 5 babies all went to eat RIGHT NOW!), it could be incredibly stressful and hectic. We always had 6-8 babies in our assignements. I never ran my butt off more than when I worked in that nursery. Yeah I have some real crazy nights in NICU, but I've always been able to at least take a bathroom/snack break if I need to and I sit on my butt a lot more now than I used to!

So now (working in the NICU) when I hear comments about the CCN nurses having it easy, I just realize these people don't know what they're talking about. And it makes me more understanding. I haven't had to deal much with the CCN nurses in my current hospital ..... only one time that I can remember. I had a baby that came up to NICU for transition as she was having a slow start, but then transitioned fine so I was given the OK to send her down to CCN. I called CCN to give report and the nurse that would be taking the baby said she was swamped and asked if I could call back in 20 minutes so she could finish some stuff. I told her no problem, that I would go ahead and feed the baby, and then she could call me back when she is done. She was so thankful for that and she just called back when she was done.

Both units are busy and can be crazy at times. But they're so different too. I've noticed in the NICU we help each other out more because we have more resources (than in the well-baby nursery that I worked at anyway). If someone has a lighter assignment they help out with the sicker kids/admits. We also have a charge nurse that doesn't have an assignment, and that wasn't the case in the well-baby nursery. Whereas in the well-baby nursery we all had pretty heavy assignments and admits were coming to us CONSTANTLY.

On the rare occasion that I've had to float to the nursery, usually I leave from that shift and just want to run to the parking garage screaming! I have the utmost respect for those nurses, as I could not do that every shift!

NICU_babyRN, BSN, RN · Mar 13, 2011

We have found that it's really great when the general care nursery starts lab work and xrays specially if the NICU has to make space for a GCN baby. Overall we seem to have a pretty good relationship. What makes it tough is that the GCN wants temps >36.6 and NICU is ok with >36.0 so when it's a 36wkr with temp problems we seem to have some commnication problems. Overall though, we try to work together as much as possible. We do sometimes feel like the RNs in the nursery bathe infants a little too soon. Specially the smaller term infants and then they end up cold or not eating well thus NICU admission. When we look, we find out the babe isn't even two hours old but hasn't been given a chance to transition well!

Some of our older nurses are just plain mean but I would say most of us are happy to help the GCN nurses.