Okay, need some help here...

[carolinapooh, BSN, RN]

I'm an Active Duty Air Force RN with almost seven years' experience as a nurse and four of those on active duty. I'm about to drop an application for the Air Force's NICU RN program and there's a question on the interview that's really bugging me, because I have no idea what it means! I want a good answer for it (the interview will be performed by the Neonatal Program Advisor to the Air Force Surgeon General - who happens to be my former commander), I think I'm reading too much into it, and if anyone can give me some insight I'd appreciate it.

The question is: "What changes in your personal and/or professional lifestyle do you anticipate as a clinical nurse in the NICU?"

I have no clue. I've worked Oncology since graduating from nursing school and have been on the DOD's only BMT unit since coming on active duty. I think what's getting me is the phrase 'professional lifestyle' (I think that's a silly way to put it - but a lot of the stuff I read in the military is worded a bit bizarre).

The only way I can even fathom addressing this is ethically: I did my pediatrics rotation in nursing school on Duke Hospital's Level III NICU, and spent time in all three levels of care there (NICU, SCN, and the TCN). Especially in the NICU, I saw (and know I will see in the USAF) things that may or may not agree with my own sense of ethics - but I feel it's not my place to judge. (I see this in CA care all the time as well, especially when we transplant people that no civilian insurance company or facility would allow to be transplanted because of personal history, PMHx, disease status - a host of things that might not make them good candidates otherwise. Not my place to question. I can't put my own personal filter on someone else's situation.)

And personal lifestyle? Nothing - our shifts are exactly the same, our ability to take leave is the same, our chances of deployment - and places we can be deployed - are exactly the same. I don't stress about stuff - I don't bring work home - I leave what happens at work at work. We lose patients all the time - I've been through numerous deaths, codes, you name it. I've been to patient funerals. I've seen patients recover and I've seen them relapse.

Any thoughts? I still say the question's poorly worded, but I was wondering if anyone else had another take on what it might mean/another perspective. Appreciate the help.

[NicuGal, MSN, RN]

I think the biggest thing for me has been struggling with the ethics of some of the things we do and deal with. It really makes you take a look into your sense of, if you will, right and wrong, and looking to the future when death may be better than living. A lot like what you do now. But....should we always keep on with what we are doing with some of the micronates just because we can?

[SoldierNurse22, BSN, RN]

Maybe they're referring to the transition from dealing with adults to neonates? I am also looking into getting into the NICU with a military Onc background and I was told that it is difficult for a nurse who is used to adults to adjust sometimes. It's been likened to learning nursing all over again. Perhaps that's what they mean?

PS, unless you're working at Walter Reed-Bethesda, you're not the only BMT unit in the DOD. :)

[carolinapooh, BSN, RN]

Actually, our BMT unit truly is the only allo BMT unit in the DOD. Many places do AUTOS, but we are the only ALLO transplant center. We are formerly of WHMC but are now at SAMMC. We get allo eligible pts from all over the world. I didn't clarify that. Bethesda only does autos, as does Travis. Several of the VA centers do autos. Allos are a whole other ball game.

You all are providing great ideas. Thanks for your help and keep it coming.

[SoldierNurse22, BSN, RN]

Ahhh, Allos are unique! Glad to hear we have that capability! When we had allos at WR-B, we sent them to NIH.

[hikernurse]

Ethics is huge. Another area to think about is the boatload of self-education that will come with this change. I spend a fair amount of time out of work (sometimes during) keeping up on the latest and greatest NICU research. Reading journals and research and applying them to your practice-both personally and as a unit-is important.

It sounds like you've got a lot on the ball and valuable experience--good luck!!

[scb7620]

Be prepared to deal with a lot of family teaching- I know you probably dealt with family issues on the adult side as well, but families who are in the NICU are often scared out of their minds (even if the baby is there for something simple, it is very frightening to them). You have to continue to be patient with them and often explain the same thing numerous times when they are overwhelmed. Also, maybe mention something about how you will have to use your assessment skills more? (Not that you don't now, but the babies won't be able to talk to you to tell you what's wrong- you will have to rely on your skills and intuition). Patient advocacy is another biggie since they can't talk either. Sorry I don't have a lot to comment on the personal side, looks like others have already covered ethics. :)

[carolinapooh, BSN, RN]

No no this is all good - I appreciate this.

About the self-education: I'd thought about it and I've already started it. I've read two books written by moms who've 'survived' the NICU (one full of information, written by a former physician), bought two of the big 'Bibles' of NICU nursing, and a couple of others. (This is just something I do: I read, look up stuff, get exposure.) The parent books I thought would be useful because they explain things on a 'simpler' level, and I've also already gotten a few teaching points from them. We get a lot of repetitive teachings with new diagnoses, but I get that there will be more of that in a NICU. I'm an ex-NICU baby (a 1970s Tripler alum!!), so I've been grilling my own mom for what that was like to get more of a parental perspective. A sick baby is a sick baby, no matter the era. Fear is fear.

I told my chief RN I like teaching (I do, and to wave my own flag, I'm pretty darn good at it), and it was actually she who said a NICU is a great place to use that skill. I expect that love to be tested many many times.

I'm getting an iPad mini to take to work for reading on, and we have CiNHL/PubMED access at work as well.

Keep the advice coming if you have it.

[Samantha79]

Yes I would say (as others have) that for professional it basically means "re-learning" nursing. Everything is different with Neonates. There is basically no room for error because they are so tiny. Also it means teaching to the parents, EVERYTHING. Most of them are too scared to even touch their baby without you telling them it is okay.

As far as personal, it means spending a lot of your off work time learning the world of neonates. It also means dealing with many ethical issues, and taking them home with you, even if you usually leave work at work.

[carolinapooh, BSN, RN]

I'm basically approaching all this like I approached RN school: I know nothing. I barely know basics. I'm prepared to feel (again!) like I have no idea what I'm doing, because at first, I won't. And I expect to feel just a little bit dumb :) when I'm back at square one and don't know the answers. Not even just a tad.

I'm curious: what makes it hard to leave work at work? Just interested in your perspective.

[TiffyRN, BSN, PhD]

I'm curious: what makes it hard to leave work at work? Just interested in your perspective.

My opinion? These are the most innocent and helpless patients and it draws out a lot of protective instincts. When you as the nurse have a really bad feeling about the family situation, I think it makes it really hard to leave work at work. Also, some nurses get very close with the families. We ride the crazy NICU ride with them and sometimes we put them in their car seats to go home and sometimes. . . I imagine with your current specialty you probably have some patients for a long time so that scenario is not unfamiliar.

As for your original question, I really don't know what they are aiming for. I'd take my chances on it being that you support and are learning about Family-centered care, it's all the rage right now. To be serious though, I have started to really embrace it and it's remarkable how the families really love it and I get more professional satisfaction from it, who knew?

[carolinapooh, BSN, RN]

I'm not familiar with the concept of family-centered care, but I will look it up. Thanks for explaining your viewpoint and I certainly understand what you mean. We sort of do that sometimes in what I do - we have patients with families that want 'everything' done at any cost (though we work with all adults) and they become mouthpieces for the patient, who relents and lets them make all of their decisions for them, including code status, level of care, etc - when you look at the patient or you go into their room in the middle of the night and you just know the patient is trying to tell you I want to die, I'm ready, I'm tired - but they don't say it straight out. And yes, I've already seen quite a few patients through diagnosis, treatment, hospice, and goodbye. It's hard, every time.

I do see how, even as this is the same, it's very, very different. Now I understand why the RNs in my peds rotation had a reputation for being 'protective' - it makes perfect sense.

I've not changed my mind, just glad for the opportunity to think about this. I had already thought about how my ethics would be challenged, but this is a new facet to the process - and I appreciate it.

You all are really helping me.