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The pod system level II-III NICUs I've been in will do 4-5 crummy feeders together, provided they don't have a ton else going on. Not a fun assignment, and not fair to the babies.

One place I worked automatically admitted

The edge of viability is hard enough in the hospital setting; bless you for confronting it in the field. Please be kind to yourself. The combination of the birth history, delay of treatment, iffy gestational age (sounds like *maybe* 23-24 weeks based on weight and fused eyelids) no heart tones or response after 10 minutes of CPR... This would not have been a good outcome no matter what. Even if resuscitation measures were to achieve some sort of stability long enough to achieve transfer to a level III/IV facility (sounds highly unlikely), there would probably be discussions of withdrawal of support due to overwhelming neurologic devastation or sepsis. Or, down the road, NEC as a result of gut ischemia from being "down" so long. It sounds to me like you handled a terrible situation in a way that gave dignity to both mom and baby. Thank you for the work that you do.

Wing of tape around the hub, tegaderm over the site, and then thin strips of tape and 2x2 as needed for skin protection. We use pink tape with skin prep for scalps, and paper tape for everywhere else.

On our intermediate/level II side, we have between 3 and 5, but most often 4. No techs or helpers. A night with just 3 babies is like heaven!

I made the transition from adult ICU to NICU about 2.5 years ago. Like someone already mentioned, there have been a number of similar threads on this topic, most of which I have responded to. If you have specific questions, feel free to PM me! In brief, moving from big people to little people was the best decision of my career -- difficult, but very worth it.

For bubble CPAP, we "DIY" our own cannulaides with Duoderm and sticky velcro. They are changed at least q12hr. We only use cannulas on babies who are 40+ weeks with mature skin, so they don't typically require a barrier.

My favorite is when they're upset their 500g intubated dopamine dependent baby isn't circumcised yet.

Thank you! Apologies if you already know this, but there are suggestions listed on their candidate guide: https://www.nccwebsite.org/resources/docs/2015-LRN-Candidate_Guide.pdf

Just an update (and celebration) -- I PASSED! It was mostly what I expected, with a wide variety of questions that were challenging but manageable overall. A lot of questions on ABG and electrolyte interpretation, a handful each on MAS, PDA, hyperbili, and infection. Also five (FIVE) questions each on "anal wink" and brachial plexus injury, but I suspect that was just a funny coincidence. I could almost always narrow down to at least two possible answers; very few questions were on something I hadn't been exposed to at all. For those still studying, I pretty much stuck to the plan that I described above. My only suggestion would be to sit for some longer practice test sessions. My only experience computer testing was my 75 question NCLEX, so 175 questions felt like an eternity and I was quite burnt out by the end!

Oakland native here, lost a college friend in the fire, used to live just blocks from the Ghost Ship, have been to many warehouses in my time in the Bay Area, and lived in some highly unsafe locations as well. Not able to wrap my head around it all right now. It is heartbreaking to watch from across the country, especially as friends wait to hear if their missing loved ones have been identified. Oakland is my heart.

I've registered and am waiting for my authorization, so I'll have to take it within 90 days either way. Wish I could do a review course but it's just not feasible at this point. Good luck on your test! Keep us updated on how it goes.

Thank you both for your responses! There is just so much information that is fair game, I can't imagine ever feeling completely ready for it. I suppose that's the nature of the test, though...

Hi everyone, I'm coming up on my two years in NICU and preparing to sit for the RNC-NIC exam. I've poured over previous threads but wanted to put feelers out for any updated information. My unit has a few certified nurses but most of them tested a long time ago. Answers to the questions below and any general information/encouragement is very welcome! 1. How did you know when you were ready to sit for the exam? I have studied primarily from the Watson question and answer book (Certification and Core Review). My overall score on the first go was 75%, with some areas stronger than others. I have since been using my scores and understanding of the rationales to review weak areas (using Core Curriculum and Merenstein & Gardner). 2. Is Watson a fairly accurate picture of what the test is like? 3. Anyone know of online practice questions? Pediatrix University is currently down. 4. Is there anything you wish you had reviewed more? Particularly heavily tested areas? I understand every test is different, but still... I'm limited on funds and my work doesn't grant time off, so taking a review course or purchasing more materials is not feasible at this point. Thank you in advance!

We use duoderm as a skin barrier, elastoplast to hold the tube, and tegaderm over the top to keep the elastoplast from curling.

Does your hospital have a NICU, or a special care nursery at least? Often it's easiest to start with a lateral transfer within the hospital -- that's how I got into NICU. If you're willing to relocate, take a look at larger regional centers, universities, and teaching hospitals with level III or IV NICUs; they tend to have established residency programs for new grads and experienced nurses who are new to NICU. Take a look at the NICU forum (under "specialties"). This question is asked on a very regular basis and you can read about others' experiences with the hiring process there. Good luck!

I got a good range on my first year off orientation -- fresh s/p reanastamosis, oscillator, iNO, prostin, pressors, micros, new admissions... In my unit (level III), nurses who are committed to learning and have shown initiative get just about anything thrown at them. People who have not yet proven themselves to be safe and responsible (yes, we have some...) tend to get the straightforward assignments. Your unit likely has a policy or tradition of how the first year off orientation works.

I transitioned from adult ICU (everything except CT surgery) to a level III NICU with about 1.5 years of experience. Like others have said, expect to feel brand new again. Even the things I was familiar with -- vasoactive meds, ventilators, assessment skills, time management, etc. -- are different. I'd say I had an easier time overall than the new grads I was hired with, in that I started working with more critically ill patients sooner, but the learning curve was still extremely steep! The ethical issues are still there but different in nature. If you have specific questions, I'd be happy to answer them. Good luck!

Level III NICU, 45 beds: 1:1 patients are extremely rare (maybe a handful per year) 1:2 or 1:3 for our NICU patients Step-down patients anywhere from 1:3 to 1:5 depending on staffing, most often 1:4.

We change everything daily. Central, peripheral, clears, TPN, critical drips, you name it...

Thank you!

Duke, UNC Chapel Hill, and Wake Med (Raleigh) are the level IVs in the area. All do surgeries, head cooling, and ECMO (though at least one, Duke, transfers neonates to PICU for ECMO). I'm not sure if they take travelers. I'm planning to move up there in the next couple years, so I "stalk" their job sites pretty regularly. Usually at least one or two of the three has a listing for experienced nurses. Hopefully someone else can given you some more insight.

We do not have a "transition nurse" as you've described. At my hospital, this is handled by the L&D nurses. After delivery, they promote skin to skin care initially, help the baby latch, do an assessment, eyes & thighs, and prepare the baby for transfer to nursery. The NICU team attends deliveries for a set of conditions (fetal distress, If you want to work with healthy babies, I'd suggest general nursery or post-partum -- they tend to get the most hands-on time with the new babies. Only a fraction of an L&D nurse's time is spent with the baby after it is born. Some units, especially at smaller community hospitals, will cross train and let you work both roles. Good luck! Edit to add: I see you're new here. If you haven't already found it, there is an OB/GYN nursing board on the nursing specialties list -- they should be able to help too!

Fulita (and anyone else), can you tell me about the Developmental Care Specialist exam and how you prepared for it? I've read the NANN developmental textbook but that's all in terms of preparation. There isn't a lot on the website in terms of preparation, test format, etc. Any tips? In terms of your question, I've always heard of CNS as developmental leaders. My unit doesn't have one, or really much of anyone that's passionate about developmental care, unfortunately.

We have a strict no fragrance policy in my level III NICU. (Also, I happen to have a severe lavender allergy -- please be cautious with the oils!)