vintage_RN

me...on night shift...as I shove my 2nd slice of cold leftover pizza into my mouth at 1:53AM: "dude...settle down...."

I started out in adult med-surg for 3 years and then went to the NICU. I'll never work with icky adults again!

We have a few males in our NICU. I would suggest trying to get into a level 3 or higher NICU (I think you have level 4 in the states?) because you will see more critical babies and "true ICU" patients there. I would say generally it is a happy place. But there are a lot of ethical dilemmas I encounter which make it difficult...such as saving 22 weekers, torturing them for a week only for them to die anyway. Doing everything for babies with bilateral grade IV IVH and the parents have no idea what they're in for, parents who don't come etc. But I would say its generally more happy than sad.

My challenge may just be the place where I work and the culture. I came from adults where I did everything...IVs, venous draws, central line dressings, complex wound care etc. In the NICU I work in, you have to be selected to get trained to do IVs, or attend deliveries. So there is only a small core group of nurses who can do venous draws, IVs, attend deliveries and an even smaller group who does central line dressings. The rationale behind this is that if a smaller group knows how to do these things really well, then there will be less adverse outcomes, rather than everyone knowing how to do it moderately well. So I've been in my NICU for 4 years and still cannot start an IV. Part of the culture is they pick their favourite nurses and "groom" them to be part of the group. Another thing is I know in adults and especially adult ICU there is a lot of atonomy and medical directives. I find in the NICU I need an order for everything. I do miss the atonomy.

This is a tough one...on one hand I can see her position...because I have felt that way and it isn't fun. I work in a large NICU, and it is very catty. There is a "cool girls group" like we're in high school that excludes others...it really makes for a toxic work environment. I know you said you don't feel you are excluding, but can you take a really good look at yourself and evaluate if maybe you are contributing to that environment? I say this because it has been brought up at my own workplace about this catty group and all of them claim to have no idea they are portrayed this way. Something to consider. On the other hand, some people persistently feel left out and no matter what you do or your intention they will feel this way because it is a problem with THEM. how do I know this? Because I am that person. I often irrationally feel left out of things, over think things etc....I recognize this and have been working on it. Maybe this person is much the same, and in that case it is a problem with her. I would continue to include her and be pleasant, but I do like the suggestion above of directly asking her to explain how she feels bullied, in a genuine way.

Our charge RN does not take an assignment. We have 2 charge RN per shift (67 bed NICU)...they cant possibly take that many responsibilities effectively!

Our orientation is 30 shifts plus about 2 weeks of in class and some other education days mixed in (NICU)

Its night shift and this is where my brain is going. Just some fun at 3AM... What are some common misconceptions and/or truths about your specialty, or that you have about other specialties? For example, people often think in the NICU we just hold, cuddle and feed babies all day. Maybe in a level 2 unit, but many of our babies are so small, fragile or sick that we don't even touch them unless absolutely necessary. Also, I think there is a thought that NICU nurses are all sugar, spice and everything nice....when in reality NICU nurses have some of the darkest humor I've seen and are savage as hell LOL

I did a high school volunteer placement in the NICU, filing papers and whatnot. But I got to sit in on rounds and listen and see what it was like there. It made me want to be a nurse and work in the NICU. I worked with adult surgical patients for a few years while I worked on my degree but I always knew I wanted to be in the NICU. I've been there for 3.5 years now and cant imagine myself working anywhere else, not only do I love it, but it's so specialized I feel my knowledge won't translate anywhere else LOL

Just curious as to the practice at other hospitals, whether this is standard or not. Here we do RSI (rapid sequence intubation) for all intubations....Atropine, Fentanyl and Rocuronium (or Succinylcholine if intubating for surfactant only) given prior to the intubation attempt (unless for some reason its too emergent and we dont have time). Also I would say 95% of our babies are nasally intubated unless they cant get it....we hate oral tubes! I'm in Canada in a level 3 (highest level) tertiary centre.

I work at another children's hospital in Ontario and we only hire RN's.

We do all those same things as well. I was a little harsh with saying 45 days. Our longest ever was 130 days, which we just had another one so we're back to 0. I wonder what the variance is.

I have to agree with what the others have said here. I understand how it can feel to be overwhelmed, and feel like there is no one supporting you. It isn't a good feeling. Your preceptors, experienced L&D nurses, have had concerns about your ability to provide safe care, after several meetings it seems. I would take this seriously and take their recommendation to start in postpartum seriously. It doesnt mean you won't get there, some people just need some extra time, and thats okay.

What are you guys doing to go this long? We usually manage to make it around 45 days or so before we get another one

We use little plastic beakers with warm tap water, put the feed in a plastic bag into the beaker. We also have very high NEC rates. I don’t know what the correlation would be, as the feeds are prepared sterily in syringes for tube feeds and wouldn’t come in contact with the water. Interesting..

We use poseys to secure vent tubing to the crib.

all of our Intubated babies are RT/RN handles. We’ve see our unplanned extubation rate decline dramatically since introducing this.

I find it a bit weird and unnecessary. In Canada, they have just only released the NICU nursing speciality exam through the Canadian nurses association last year. I feel like NICU is so specialized in its own right that you don’t need all these sub specialties ??‍♀️ Maybe transport because that’s a whole other ballgame, but not the others.

We do not routinely check for residuals. That being said, I do check placement via aspiration prior to each feed. This means sometimes I do get residuals when I do that. Often when I tell the docs they give me hell for checking, but you have to check placement somehow!

Not sure what level you work in @adventure_rn...I’m in a level 3 in Canada (tertiary centre, highest level with all the sickest babies of the region)...and we have a lot of codes, we’ve had at least one every shift this set alone! Lots of very sick babies. A baby died yesterday. Babies that get NEC, perf and need a bedside OR....this happens often in my unit. It’s pretty much always crazy. But I do agree that not every baby is critical like in an adult ICU, we do have lots of feeder growers. I would advise the OP to find out what level the NICU is so they can know what kind of acuity they’ll be dealing with.

Yikes! This is something I’ve never heard of and definitely not something we do in our NICU. Actually all intubated patients are a 2 person RT/RN handle due to having many unplanned extubations.

We don’t swaddle any of our little ones, only once they’re old or term babies. How can you assess their belly and skin/colour/breathing without waking them up all the time?

I worked part time as an RPN and did the bridge full time. It was busy, my last year when I had consolidation placements I had 1 day off a month. But I did it. And it’s worth it.

I did! And now I’ve been working in the NICU for 2 years and I love it. Best decision ever.

I like seeing stuff come up when I suction an ETT. I like making my patient a nice bed with clean, matching cute linens. And getting my babies all snuggled up with their positioning aides to make them look all cozy (im in NICU)...it’s very satisfying. NICU nurses are very anal about their linens and bed appearance!