one yr of adult now nicu - scared

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Have been reading through this site and found some supportive things on the general nursing forum posts, but didn't see anything specific about transitioning to NICU from adult nursing. I have had one year of adult nursing where I could handle 7-8 patients and actually do quite well. Here I am just off a very good orientation and have 2 HFOV/or conventional vent or a mix of bubble cpap or a 3 nippler/feeder/grower group. The shift I am working on is quite "clicky", yet I have actually seen them pull together to help any of the newer people when it really gets rough. I am at a level 3 NICU about 40-45 bed unit. I know that my assignments are harder than most because I see what everyone else has.....thus to get us new ones the experiences that we need. I have only had 4 iv attempts and missed them all. The needles are different, the veins don't pop, I can't see them once i am in, they don't gush out blood when you are in etc., etc. (laugh!) Habits or things that I learned before make me feel that I will do something accidently. Like imagine my surprise that we don't draw off of PICC's, we return any blood off of art lines - there is no waste, etc. Little things are stressing me like formulas, decimal points and just assessing the respiratory system. I watch my pumps like a hawk even though there are safegaurds in them. It is very hard for me to use the word sticky, coorifice, etc. when adults can be much more easily describable and I am afraid that I would not be able to hear less air entry on one side of the chest if it was actually there. How do people assess lung sounds on a HFOV with no spontaneous respirtations when we pop them off? I can't always hear murmurs. RT is always on the floor and I know that I should be able to ask someone else to assess if I have any doubt. I find myself behind, can't make a pretty nest to save my life, feel sick about weighing these babies at night, changing out the isolettes, afraid that I will make a mistake that I cannot fix, etc. Not to mention that there are many nurses that have been at this facility for many years and will grill you in report if you don't know the apgars of someone that has been there for a month or longer. I keep comparing myself to what I used to be able to do. I had a very busy floor and I was able to multitask and keep my patients safe, I had multiple drips going, IV meds, etc. I gave good reports, was able to pick up on things and truly have a gut for what I was assessing or watching on my shift, not to mention the added admitted pt to the mix. Here I don't know for sure if I could pick up on something that was wrong. I told my preceptors that I did not feel comfortable taking a BP one time a day if that was all that was ordered on a kiddo. These would be the feeder/growers mostly now that I am thinking of it. I keep waiting for something cardiac to happen d/t all the experience i had with cardiac. They say that I would see signs, I can't compare it to an adult's heart that has been on multiple bp meds, etc. I remeasure my ETT more than most people do, I can't tape to save my soul. I am not good at nasal suctioning when they are on bubble. I cringe everytime I have to put an OG or NG down. I also measure my bellies more than most people do, because I am afraid of nec., etc. I second guess myself so much and was actually told that I am doing a good job and am a great nurse but that sometimes I ask too many questions. I refer to policies.Now I do not ask too many questions. If I haven't drawn labs off of an art line and been shown it only once which was over a month ago, I need help. Come to me, I have everything ready, just watch me do it when you have time is usually what I say when I need something. Even my heel sticks for labs are bad. Getting blood out of a heel is really an art. Now that my group is off orientation - not to mention that we had many preceptors - some that I could trust some that I don't. I am trying to find my niche. I guess that there is plenty of stocking to do, things that I could do to stay out of the clique, I just don't want to be talked about. I was told that I have a good attitude, that no one has complained about following me, etc. but they wanted to know if I truly liked my job. Sorry, but not yet. It's all new, I miss my old friends, not the old place. The babies don't talk to you therefore not a real interaction going on there. The stories are sad, socially and medically. I take too much home and feel sick everytime I am scheduled. They say that I am a great fit, etc. I made friends quick with the respiratory therapists and the unit clerk....they are always good ones to have in your pocket....no PCT's on our unit. Maybe it's just a learning curve I need to get through. It is way harder than i though that it would be. What's best is that I do not get spit on by ETOH w/d patients, I don't have to lift anyone that weighs more that a gallon of milk and I don't have to give a GI prep to a 600+ # man that can't get out of bed. It's what I always wanted to do but I am depressed. Any suggestions as to how long it will take for me to feel good about what I do and to fit in? I learn something new everynight and rarely get the same assignment. I don't complain. Can anyone tell me how they felt that recently went into NICU from adults. Does it get better? Does it seem harder? Sorry for long post and thanks for any support.

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Specializes in Renal, NICU.

You and I are in the same boat. I was on a renal med/surg unit, filled to the brim with psych, geriatric and withdrawl patients. I did that for about a year and a half before recently transfering to NICU. NICU was the whole reason I went to school. I just got off orientation and I am still very intimidated. I love it, but I have much more anxiety, maybe because of who our patients are. It IS a difficult adjustment...cut yourself some slack. If you know its where you want to be, give yourself some time. You did not mention if you are still on orientation or how long you have been there. It's easy to forget that "I have no clue" eeling when you start a new area, but over time you WILL get your confidence back. It sounds like you are a good nurse. It's the ones who are over confident that scare the crap out of me.....

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Specializes in Neonatal ICU (Cardiothoracic).

Your post describes every emotion and occurrence that a new NICU nurse undergoes.... hang in there, and as you become more comfortable, you will learn what is important...

BTW, please don't disconnect your HFOV kids to listen to breath/bowel sounds. Just pause the vent and listen. Otherwise you just wasted all those alveoli that the oscillators recruited....

And, you shouldn't be caring for 2 oscillators, or even 2 vents as a new NICU RN. I realize that they are giving you sicker assignments to learn, but whether they are the norm or not in your unit, no one should have 2 vents. A mix of vents/feeders/CPAPs is safest.

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Sorry, I mean that I silence and listen and only have to pop off to weigh (yes, we have to get kids out every noc, vent/bubble/HFOV, etc. (unless they are in one of our few specialty beds) or when we have to reposition to the opposite end of the beds. They have no problem with staffing 2 vents/HFOV together. Anything with a bubble is nightmare if they don't bubble and have wrapped prongs. We rarely have 1:1. And we are almost always fully staffed they say. However I find it hard to keep the oxygen within range for our protocol when they frequently desat and your kids aren't together, it's hard to be at both bedsides when they become jealous of one another :) I have read some of your posts SteveRN because I have looked through most of the NICU pages and have had some of my questions answered so thanks.

I probably will get more comfortable but there is such a learning curve in a large unit like this. The MD and NNP's are usually very respectful towards new people. Now if just the people I work with would be. Nothing like having your bed torn apart in front of your eyes....can I leave the bedside to go home without you doing it in front of me?? (just had to throw that one in there) I do make developmentally appropriate nests. Sometimes I think being a new grad would have been easier going into a unit like NICU.

How close are you to finishing your NNP by the way.

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Specializes in ICN.

You sound very hard on yourself! That first year is so incredibly stressful. I did not ever do adult care, but when I started in the ICN straight out of nursing school, I felt like I had never, ever been to nursing school at all. Everything was different. It took me probably a year to feel comfortable. I would break out in a sweat just collecting all the tubes and equipment for a blood draw.

You seem to be doing everything that can be done, just take a deep breath, slow down right before any new procedure--or even an old one--and let yourself briefly review what you need to do in that situation. Going too fast is never a good thing.

Keep going, you'll do great! Let yourself be proud of your accomplishments so far!

Dawn

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Specializes in Med/Surg ICU, NICU.

I understand what you are saying completely. I recently moved to the NICU (level III) after a year of adult med/surg ICU. Dang what a difference. I have been there 4 months now and have mixed emotions. I frequently wonder if I made a huge mistake by switching. I feel more like a nanny than a nurse. The new people at our facility get feeder/growers for 8 months to 1 year before given NICU babies. I understand your feelings of constantly being behind, feeling like you work with the clique but are not part of the clique, and generally being overwhelmed by the differences. Everyone tells me it will get better and I will find my niche so I am patiently waiting.

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Specializes in NICU.

I think a solution to "eating our young or new hires" is to mandate that nurses travel nurse to other NICU's one year out of four. I have 26 years of NICU nursing under my belt and feel I had a helpful and sympathetic attitude towards new hires. After working 14 years in my present Level III unit I took off for a year to experience my career in three top units around the country. Aside from some days of general hospital orientation you get one shift of day orientation and one shift on nights and then you carry on with your own assignments. Even with my years of NICU experience, the learning curve was steep and the first month was scary and stressful. Each day you feel you have to prove yourself to nurses, medical staff, and parents. I truly empathize with how you're feeling!! I kept a cheat book and wrote down in my words reminder steps to help me with the computer and things that were new to me in each unit. Then, if I didn't have that experience for a month, I could turn to my 'cheat book' to refresh my mind, before doing it again. Sometimes nurses teased me as I wrote things down, but I think they were impressed that I cared to do things "their way". The book also helped me take measure of how I was progressing, because as time passed I made fewer entries and I needed to refer to it much less. Now when I pull it out it is a great memento of all I mastered in that year and a real reminder to be supportive and kind to our 26 new hires. I have encouraged some of them to get their own 'cheat books' and they have told me that this has helped them as well. I recall sitting in my car before shift many times and praying 'The prayer of Jabez'. Work hard at finding friends as that helps, also. I hated the early weeks of eating alone on my breaks. As I met people who were helpful I jotted their names in my book to help me remember who I could count on for good assistance. It helped me to tell myself that some of those I was working with would never have the courage to leave their comfort zone and try something new. I had done that THREE Times, therefore, even though I felt inept at the beginning of my assignments, my depth of knowledge might be greater than theirs. Sometimes, it helps to pat your own back. ha. Best of luck.

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We have 12 weeks one week classroom and the rest floor time going from nipplers to HFOV doubles. Seems like I am given the assignments that the othes would never have. Why have the same RN take two HFOV in the same area when they are the only ones on it out of the 10 in the room? I understand the nanny thing, I am envious of the RN's that get the easier assignment - but three bad nipplers that don't sleep can be a hell of an assignment especially when they are all due either at the same time or hourly each.

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