Questions about the nicu nurse for school paper?

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Hi, this is my first time using this and i need to throw out a couple of questions to all of you nicu nurses. I am writing a paper on the nicu nurse for my Nursing class and i would like to get some information right form the sources. I would apprietiate any help that you can give me thanks:

~How does one become a neonatal nurse?

~After becoming an RN are there any special colleges/courses you have to take to become a neonatal nurse?

~Is there any type of special training that needs to be done before going into the field?

~How many CEU's are needed to renew your license?

~and anything else that might be helpful in writing a paper about the nicu nurse..

Thanks again!!!

~ANN

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Specializes in NICU, PICU, educator.

1. Have to graduate from a nursing program and pass boards.

2. No, the hospital provides an orientation and we provide many classes for our new employees, such as NALS, STABLE, breastfeeding, bereavement, and some core classes.

3. See above.

4. Each state is different in the number of CEU's needed, some states have mandatory CEU's for AIDS,law, etc.

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Hi Ann,

Good luck with your paper.

I agree with all BittyBabyGrower said.

I'd also consider suggesting that, like many other Intensive Care Nurses, the NICU nurse often must be a detail-oriented person considering that we can often have one baby requiring several IV fluids/medications in teensy amounts which must be calculated and monitored very carefully. This week I cared for a tiny baby who had Hyperal fluids, Intralipids, Fentanyl infusion, Dopamine infusion, Dobutamine infusion, Insulin drip, and an additional normal saline infusion running at the same time. The dopamine, dobutamine and insulin drip needed to be titrated up and down every hour or every few minutes depending on the blood sugar and blood pressure results were changing. As the infusion rates on these fluids would go up and down I had to increase or decrease the hyperal fluids to maintain a total fluid rate ordered by the physician. The amount of changes are in 0.1 ml/hr increments. It's easy to get side-tracked when you have this many fluids going at one time. In addition to the constantly infusing fluids there was also several medications like Clindamycin, Claforan, Vancomycin, Phenobarbital, and then once in a while we hung blood products including platelets, packed red blood cells, and albumin. Often I had to change the hyperal rate while the blood products were infusing and then change it back when they were finished infusing. The baby also was on peritoneal dialysis where I started infusing the dialysis fluid for 30 minutes on a pump then stop the pump and clamp the line for 30 minutes and then 30 minutes after that open the line for the fluid to drain. Then empty the chamber of expelled peritoneal fluid and start over again with another infusion. All the while this is going on, I needed to continue to assess the baby for seizures, signs of pain, urine catheter drainage, vital signs (continuous arterial blood pressures), keep him comfortably positioned, suction his endotracheal tube, make sure all his tubes (endotracheal tube, orogastric tube, peritoneal fluid catheter in his abdomen, umbilical artery catheter, umbilical venous catheter, peripheral IV catheter, remained in place and in working order. Every hour while on the insulin drip I checked his blood sugar and was doing arterial blood gases through his umbilical artery catheter every hour or two as we were making lots of ventillator changes. He would become acidotic and would sometimes need a bolus infusion of sodium bicarbonate give over an hour and then another blood gas to check to se how this helped to correct his acidosis. While all this is going on I need to be able to record everything I do in the chart, and write down lots of numbers including even the heater temperatures of the peritoneal fluid warmer and ventillator heater. My eyes must be open and alert at all times to all this equipment as well as that the correct fluids are infusing and the correct rates. We record intake and output of all these fluids every hour. I send blood and other specimen for labs and must monitor their results, understand basically what the results mean and how they can affect the baby, and notify the physician or nurse practitioner about them. I need to be aware of the other tests the baby has had and what they may mean to my nursing care. I also must be aware of the age of the baby because their physiological development will dictate certain aspects of the nursing care I will give and certain signs/conditions I will be more prone to look for. When the family is at the bedside I needed to give them my attention and emotional support/teaching while continuing to do all that is required to care for the baby. It can get very hectic when you are trying to make sure all the equipment is working correctly, that the correct fluids are hanging and being titrated and recorded, that the medications you are giving are compatible with other ones running through different lines and being given over the correct amount of time, and that you are keeping up with when the next blood gas is due and that you have told the physician all they need to know. We also write a lot of telephone or verbal orders in the chart which must be written timely and correctly.

Granted this baby was a very sick one and I did not have any other babies to take care of along with this one. I believe you can see the detail required by the nurse in caring for this type of patient. I have never worked in an adult intensive care unit but I'd imagine the detail-orientation is necessary there as well. A big difference with NICU patients is that their volumes of fluid are so tiny and a small mistake can make a huge difference. Most of our dilutions of antibiotics come out to fractions of a mL in the syringes.

I have worked on a regular floor before and it seems to me that the main difference in my NICU work is in the details.

Most NICU babies are not as sick as this one was. Some require ventillators, some require nasal cannula oxygen or oxyhoods and some do not need any help at all with breathing. Some are requiring IV fluids through peripheral IVs, percutaneous catheters or umbilical catheters and others do not need any additional fluids at all. Some are able to eat by themselves but others are still in the process of learning how. The NICU nurse learns to care for all types of babies from the sickest ones to the ones who are just about to get to go home.

NICU nurses need to keep up with changes and new knowledge in the care of babies. They need to be aware of the importance of the incredible amounts of teaching and emotional care that the family of the baby needs too.

I probably spoke too much and I pray I didn't frighten you with the sick baby senario. I've been a NICU nurse for many years and did not start my practice by taking care of a super-sick baby like the one in this post. I began with the "feeders and growers" and slowly advanced to ones needing IV fluids, gavage feedings, supplemental oxygen and ventillators. As I became proficient at the less sick babies, I progressed to learning how to care for the ones requiring multiple IV fluids and with more and more serious conditions until I am now where I am. I still have much more to learn though! I have not worked in a hospital that takes care of cardiac babies or ones requiring serious surgeries or ECMO. We transfer these babies to a huge hospital which specializes in this area. I know I will never understand everything and I am quick to say I don't understand something or that I don't feel comfortable doing something for a baby. This is where I realize I need to study more on a certain subject and need to find resources (whether the resources are people like physicians, neonatal nurse practitioners or neonatal clinical nurse specialists or the resources are books, journals, nursing conferences, and even other nurses.)

Nursing is a constant learning profession. When you graduate from nursing school you must understand that you have chosen a job that absolutely requires you continue to learn and keep up with new treatments, drugs and other changes that occur rapidly and change nearly every day. I believe this is true for every specialty area and especially in the intensive care units. The NICU is like any other intensive care unit however a big difference between babies and adults is that babies will decompensate and crash a lot faster than adults often do. Sure, many adult conditions can change quickly and go down quick but babies are famous for this. Babies can have a spontaneous pneumothorax and go from resting relatively comfortably with mild tachypnea with oxygen saturation of 100% to "BAM!" sats drop to 60 and the baby turns cyanotic because of one of his lungs. If the baby's lung is not fixed immediately a large pneumothorax can push on his heart too much and then he is really in trouble. This all can happen in just a few minutes.

NICU nurses must be on the alert at all times.

I'll shut up now. I hope my information has not been too confusing or overwhelming to you. Just remember that as a new graduate in any area including the NICU you will be given training as needed in the area where you go to work. When you graduate from nursing school you know enough about several areas in order to be safe to begin working. Once you start to work in a certain area you will learn more in depth information about the patients you care for and the diseases/care they need from you. It's up to you to look for books, journals, people and nursing organizations related to your specialty to help you grow as a nurse over the years. Another great thing about nursing is that you can change your area of nursing rather easily with a little orientation. (If a doctor decides he/she doesn't like the area they are in, they often have to spend a couple of years "orientation" learning their new specialty.) I love being a nurse for soooooo many reasons!!! I bet you will too!!!

Good luck with your paper and in your career!!!

Tiki

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Thanks a bunch tiki i am sure that all of this information will help me write my paper considering that i am having a hard time finding concrete writings on it..this will definately help me out. Thanks alot and don't worry you didn't scare me:)

Hi Ann,

Good luck with your paper.

I agree with all BittyBabyGrower said.

I'd also consider suggesting that, like many other Intensive Care Nurses, the NICU nurse often must be a detail-oriented person considering that we can often have one baby requiring several IV fluids/medications in teensy amounts which must be calculated and monitored very carefully. This week I cared for a tiny baby who had Hyperal fluids, Intralipids, Fentanyl infusion, Dopamine infusion, Dobutamine infusion, Insulin drip, and an additional normal saline infusion running at the same time. The dopamine, dobutamine and insulin drip needed to be titrated up and down every hour or every few minutes depending on the blood sugar and blood pressure results were changing. As the infusion rates on these fluids would go up and down I had to increase or decrease the hyperal fluids to maintain a total fluid rate ordered by the physician. The amount of changes are in 0.1 ml/hr increments. It's easy to get side-tracked when you have this many fluids going at one time. In addition to the constantly infusing fluids there was also several medications like Clindamycin, Claforan, Vancomycin, Phenobarbital, and then once in a while we hung blood products including platelets, packed red blood cells, and albumin. Often I had to change the hyperal rate while the blood products were infusing and then change it back when they were finished infusing. The baby also was on peritoneal dialysis where I started infusing the dialysis fluid for 30 minutes on a pump then stop the pump and clamp the line for 30 minutes and then 30 minutes after that open the line for the fluid to drain. Then empty the chamber of expelled peritoneal fluid and start over again with another infusion. All the while this is going on, I needed to continue to assess the baby for seizures, signs of pain, urine catheter drainage, vital signs (continuous arterial blood pressures), keep him comfortably positioned, suction his endotracheal tube, make sure all his tubes (endotracheal tube, orogastric tube, peritoneal fluid catheter in his abdomen, umbilical artery catheter, umbilical venous catheter, peripheral IV catheter, remained in place and in working order. Every hour while on the insulin drip I checked his blood sugar and was doing arterial blood gases through his umbilical artery catheter every hour or two as we were making lots of ventillator changes. He would become acidotic and would sometimes need a bolus infusion of sodium bicarbonate give over an hour and then another blood gas to check to se how this helped to correct his acidosis. While all this is going on I need to be able to record everything I do in the chart, and write down lots of numbers including even the heater temperatures of the peritoneal fluid warmer and ventillator heater. My eyes must be open and alert at all times to all this equipment as well as that the correct fluids are infusing and the correct rates. We record intake and output of all these fluids every hour. I send blood and other specimen for labs and must monitor their results, understand basically what the results mean and how they can affect the baby, and notify the physician or nurse practitioner about them. I need to be aware of the other tests the baby has had and what they may mean to my nursing care. I also must be aware of the age of the baby because their physiological development will dictate certain aspects of the nursing care I will give and certain signs/conditions I will be more prone to look for. When the family is at the bedside I needed to give them my attention and emotional support/teaching while continuing to do all that is required to care for the baby. It can get very hectic when you are trying to make sure all the equipment is working correctly, that the correct fluids are hanging and being titrated and recorded, that the medications you are giving are compatible with other ones running through different lines and being given over the correct amount of time, and that you are keeping up with when the next blood gas is due and that you have told the physician all they need to know. We also write a lot of telephone or verbal orders in the chart which must be written timely and correctly.

Granted this baby was a very sick one and I did not have any other babies to take care of along with this one. I believe you can see the detail required by the nurse in caring for this type of patient. I have never worked in an adult intensive care unit but I'd imagine the detail-orientation is necessary there as well. A big difference with NICU patients is that their volumes of fluid are so tiny and a small mistake can make a huge difference. Most of our dilutions of antibiotics come out to fractions of a mL in the syringes.

I have worked on a regular floor before and it seems to me that the main difference in my NICU work is in the details.

Most NICU babies are not as sick as this one was. Some require ventillators, some require nasal cannula oxygen or oxyhoods and some do not need any help at all with breathing. Some are requiring IV fluids through peripheral IVs, percutaneous catheters or umbilical catheters and others do not need any additional fluids at all. Some are able to eat by themselves but others are still in the process of learning how. The NICU nurse learns to care for all types of babies from the sickest ones to the ones who are just about to get to go home.

NICU nurses need to keep up with changes and new knowledge in the care of babies. They need to be aware of the importance of the incredible amounts of teaching and emotional care that the family of the baby needs too.

I probably spoke too much and I pray I didn't frighten you with the sick baby senario. I've been a NICU nurse for many years and did not start my practice by taking care of a super-sick baby like the one in this post. I began with the "feeders and growers" and slowly advanced to ones needing IV fluids, gavage feedings, supplemental oxygen and ventillators. As I became proficient at the less sick babies, I progressed to learning how to care for the ones requiring multiple IV fluids and with more and more serious conditions until I am now where I am. I still have much more to learn though! I have not worked in a hospital that takes care of cardiac babies or ones requiring serious surgeries or ECMO. We transfer these babies to a huge hospital which specializes in this area. I know I will never understand everything and I am quick to say I don't understand something or that I don't feel comfortable doing something for a baby. This is where I realize I need to study more on a certain subject and need to find resources (whether the resources are people like physicians, neonatal nurse practitioners or neonatal clinical nurse specialists or the resources are books, journals, nursing conferences, and even other nurses.)

Nursing is a constant learning profession. When you graduate from nursing school you must understand that you have chosen a job that absolutely requires you continue to learn and keep up with new treatments, drugs and other changes that occur rapidly and change nearly every day. I believe this is true for every specialty area and especially in the intensive care units. The NICU is like any other intensive care unit however a big difference between babies and adults is that babies will decompensate and crash a lot faster than adults often do. Sure, many adult conditions can change quickly and go down quick but babies are famous for this. Babies can have a spontaneous pneumothorax and go from resting relatively comfortably with mild tachypnea with oxygen saturation of 100% to "BAM!" sats drop to 60 and the baby turns cyanotic because of one of his lungs. If the baby's lung is not fixed immediately a large pneumothorax can push on his heart too much and then he is really in trouble. This all can happen in just a few minutes.

NICU nurses must be on the alert at all times.

I'll shut up now. I hope my information has not been too confusing or overwhelming to you. Just remember that as a new graduate in any area including the NICU you will be given training as needed in the area where you go to work. When you graduate from nursing school you know enough about several areas in order to be safe to begin working. Once you start to work in a certain area you will learn more in depth information about the patients you care for and the diseases/care they need from you. It's up to you to look for books, journals, people and nursing organizations related to your specialty to help you grow as a nurse over the years. Another great thing about nursing is that you can change your area of nursing rather easily with a little orientation. (If a doctor decides he/she doesn't like the area they are in, they often have to spend a couple of years "orientation" learning their new specialty.) I love being a nurse for soooooo many reasons!!! I bet you will too!!!

Good luck with your paper and in your career!!!

Tiki

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