jpeters84

As a RN in a San Francisco Level IV NICU I will tell you the only way to get a new grad job in the NICU is to leave the state. That is what all of our CNA's and nurse aides have to do. That is what I did and I was able to come back after three years. It was the best decision I ever made. So the long and short of it is that you're going to have to leave the area to truly get that coveted new grad position in the NICU. Best of luck to you!!!

I've been a NICU RN for almost four years and in this last year I've been in a very high aquity level IIIc NICU so having a baby die is nothing new to me. My unit seems to lose about one a week sometimes multiple babies in a day. Sad as it may be I have gotten use to the reality of it. But I just had a kid get NEC out of nowhere and die a not so pleasant death. I will never forget the way she looked up at me when this all started going down. I will never forget how sweet and loving her parents were. I wasn't there when she actually passed away. I think that is part of what is really bothering me. I never got to say anything to the parents, never got to say anything to the baby at the end, I just came in to my shift and saw a name erased on an assignment sheet and an empty bed space where she had been after fighting for her life for three solid shifts. I'm just so sad for her and her family and I feel like her passing has really affected me. I don't want to go to work tomorrow because I know I'm suppose to just put all this behind me and move on to the next assignment but I just don't feel ready to. I know this is all just part of the job but I'm really feeling this one...

About a year ago I moved from a large level IIIb NICU where developmental care/NIDCAP was a huge priority to a medium sized NICU level IIIC in a large academic hospital where developmental care has not been implemented. I was never one of the huge developmental care advocates in my old hospital but now that I am working in an NICU without developmental care (loud, bright, non-grouped cares, spotty swaddling, every day baths, no sleep preservation, long periods of crying is acceptable, etc.) I am desperate to seem some developmental care implemented. My new job has many nurses who have been there 20+ years and have very rigid ways of doing things. I fear that trying to get developmental care implemented is going to be an up-hill battle especially as a relatively new employee trying to implement this change. Has anyone had developmental care successfully introduced to their unit? What worked and what didn't? How did you get the nurses and all other workers in the infant's environment to adopt developmentally friendly attitudes and behaviors? Thanks for any advice and insight!

Sucrose and the thing that works for practically every kid is something I call gentle bouncing. Swaddle, put them up on your shoulder and gently move up and down and around. Talk to them in a quiet, soothing voice. Sometimes though there are just those kiddos that scream their heads off. Just do your best and know that sometimes theres just nothing that works.

We got blank baby t-shirts and decorated them with Christmas puffy paints and silling sayings related to Christmas and had parents decorate them with puffy paints.

We just don't see it anymore. Only in a few of our ex-micros who had a really rough respiratory course. If you're seeing a lot of it you guys might want to look at your numbers as far as the average # of days your kiddos are on ventilators. After we went to the Ensure research philosophy are numbers got soo much better. Intubate, surf, extubate to Sipap same day, and if the kid decompensates intubate early but extubate early, 24-48 hours after stabilization. If the kid is stable enough we tube up for leaks. I think RAM and SiPap has made a huge difference in reducing BPD.

What does your NICU do to build a good developmental nest with the phototherapy blankets? We have found that the blankets are so stiff, particularly at the bottom with the cord coming out that it has been hard to find a satisfying way to securely nest our micros while on the phototherapy blanket. The last NICU I worked at just build really large nests and used a thin strap over the phototherapy blanket and then tucked under the blanket to create walls on each side of the baby. My current NICU has felt that that eliminates space for lines, transducers, etc. Any suggestions would be much appreciated. Thanks!

There's no easy answer here. Different managers and different units are going to have different philosophies. Some will take you right away, some will want you to get more acute care experience than a couple of months, some will have training programs in-place for experienced nurses transitioning over. The problem is that a new grad with less than a year, really is a new grad. So unless this hospital has a new grad training program I think you're going to be doing at least a year in your tele unit. The other problem is your current unit. If your current nurse manager gets wind of this you can really get yourself in a bad spot. I say do some research on your own. If your hospital has an NICU new grad program than I say talk to the NICU nurse manager right away and see if you can't get a spot in the new grad program. If they don't then I wouldn't talk to anyone, do your absolute best to make it a year on your tele floor and then after a year talk to the NICU nurse manager and see if you can't make it happen. But if I were a nurse manager no way would I take someone with less than a year acute care experience into the nicu unless it was to start in a new grad training program for the NICU. If there are any other hospitals in your area with nicu new grad programs I would look into those as well. Best of luck to you!

Sometimes swap for a larger tube, sometimes put them on the Jet because some Neo's believe this helps, sometimes just except it and work hard on positioning. Depends on how big a leak, how well we're able to ventilate the kid despite the leak, and how stable they are.

I hear great things about UCSD and you can't beat UC benefits! If you're so concerned about the reputation of one hospital why not look elsewhere? UCSD has opennings quite frequently thoughout the year it seems. I also hear good things about Sharp.

You ask a very loaded question. Before going into what you could know about the NICU I think it is important for you to first make sure that they have taken new grads before in this particular NICU and that it is a very supportive new grad training program if they have. I think that is fantastic that you are so passionate about the NICU. Just make sure you're going to start in a unit that will carefully foster that passion and gently ease you into the world of the NICU. I would be sure to ask how many new grads have they trained? How long is the training? How many preceptors will you have? Do you start off with low acquity and then move to high acquity? How long with each until you're on your own? Will you have a NICU mentor? etc. etc. The longer the training program the better. The fewwer amount of preceptors the better to a point you should have at least three to get an idea a couple different ways to do things but not so many that no one is taking a vested interest in your development and progress as a nurse. Now on to what might be helpful for you to know. First off NICU nursing is so unlike any other field that I hesitate to tell you anything. Going in to your interview and just being yourself and letting them know your passion for NICU nursing really should be enough although they're probably going to want to know that you've at least had some exposure to the NICU to know that you're not going to get freaked out and leave early on after they hire you. So if you have had any exposure at all I would definitely mention it. It would probably be helpful to know some broad basics like the different types of infants you will find in the NICU. The preemies-there's micropreemies (Extremely Low Birth Weight or ELBW and Very Low Birth Weight or VLBW) they're genererally the 24-29 weekers. Then there's the later termers which is 34ish/35 weeks-37 weeks gestation. They can be deceiving because they act like they're term but they're not term and can be the sickest. Then there's the term babies generally 37 weeks on. Preemies are generally in the NICU for respiratory issues and well because they're premature but there can be a whole lot of other reasons. Term kiddos can be there for congenital heart conditions, meconium aspiration, congenital defects, delayed transition, infants of diabetic mothers or IDM babies, and many other reasons. Respiratory modes used in the NICU: there are those kiddos on a ventilator- high frequency (usually an oscillator) or conventional ventilaors, there's CPAP, RAM, and high flow cannula or nasal cannula. Different cardiac conditions are PDA or Patent Ductus Arteriosus, Coartaction, ASD, VSD, and many many others. Bread and butter NICU issues are hyperbilirubinemia or bili-babies (those under the lights), kiddos working on feeding and growing, and kiddos with minor respiratory distress needing CPAP and high flow nasal cannula. Everyday nicu nursing issues are worrying about respiraoty issues such as "spells" when a baby drops their oxygen saturation you want to check their positioning, their color, and are they breathing too slow (babies respiratory rate is usually 20-60, heart rate 120-180), are they taking pauses in their breathing, do they need to be stimulated to breathe during the spell? Low blood sugar can often be an issue especially on admissions or babies just born and especially with infants of diabetic mothers. Every unit is different but usually a blood sugar under 50 some units under 40 is considered too low and you will be asked to give a bolus of D10 IV fluids. Gut or belly issues are also huge. There is something called NEC or necrotizing enterocolitis (which its complicated but really condensed down) the issue is that their bowel tissue dies and it is an emergency surgical issue usually and infants can often die and die quickly from it so frequent assessment of bowel sounds, belly color, shape, belly girth, are they toelrating their feeds? When did they last poop, emesis, color of emesis etc. Honestly I could go on and on but... This is a ton of info and I basically mention it so you can go off and research further on these topics at your discretion. I wouldn't really expect a new grad to know any of this and its really hard to put any of this information into the correct perspective until you've seen it at the bedside so I hesitate to even tell you all this. Not to mention I am telling you all this at 3am on a night shift and I may not even be giving you that great of information. But I want to give you some things in case it is at all helpful. But as someone who entered the NICU as a new grad three years ago-I cannot emphasize this next part enough- it is not at all what you know going in that's going to make the difference- it's how good of a new grad NICU training program they have and how supportive of you as a new grad they're going to be. I wish you all the luck in the world. Go into your interview just bursting with passion, humble enough to know you have a lot to learn but driven enough to want to do whatever it takes to learn it. Don't be afraid to say you don't know but you aren't afraid to ask, and I'm sure you'll do great!

ABO Incompatability is one keep searching on allnurses. An old post literally lists like all the possibilities. But the only thing that I could think missing from your list is ABO incompatibility.

Honestly sometime between 1.5-2 years. You stop having weird dreams 7-12 months in, the major anxiety goes away by one year but I didn't really hit my stride and become confident until 1.5-2 years. It does go very fast though. Don't be in too much of hurry. Good luck.

We've had a couple parents threaten and our charge RN let me know that the police would arrest the parents the minute they left the hospital and the child would be brought back immediately to the NICU. The arrest is for child endangerment/neglect and it would immediately become a CPS as well as a criminal issue. I've never had parents actually go through with it though.

A couple of things...It's always good to look to the future and think about long-term goals. But at times it can be, let's not get ahead of ourselves here. Becoming a neonatal nurse practitioner is not as simple as going to nursing school, getting your BSN putting in your 1-2 years as a nicu nurse and going to get your master's and bam you're an NNP. That's the bill of goods they sell you in nursing school. You need to work as a nicu rn first ( in my opinion for at least 5 years or 3 years minimum in a large level III lots of acquity academic medical center nicu) and make sure that not only do you like it but that you love it and do you like the role that NNP's play as part of the NICU treatment team. Because being an NNP is a whole lot different than being a nicu rn. Quite frankly I knew all along I wanted to be an NNP but was still very surprised to get a true understanding of what the job really does entail. It's not for everyone. Also getting your master's to become an NNP is not like getting an MD. You will be calling on your solid foundation in neonatal nursing (read: expert level nursing skills) as an NNP on a daily basis. When you go to get your master's its assumed that you have the skills and past experience to back it up. If you don't it's on you. If you have only had a year or two or spent most of your time in a level II nicu but now you're an NNP for a level III nicu you are going to struggle. You do not want to be an NNP that none of the nurses or MDs trust. They will throw you under the first bus they can find. I wish you all the best. I hope this is helpful. I was an older, 2nd degree nursing student. So don't worry about ebing in such a hurry. You have time. This is one thing you can't rush. There's not cheating the experience you need in the nicu to be a truly good NNP. If you're motivated, hardworking, and truly love neonatal nursing I am sure you will make a wonderful NNP in time.