"Non Moms" good NICU nurses

[sdg]

I apologize if this question has been asked before. Do you think that generally nurses with children of their own transition better as new grads in the NICU? Do they normally have a higher comfort level that a new grad with no children?

[oicu8bacilli]

I'm not talking about "easy to orient because I don't have to unlearn anything". I'm talking about the mental checklist of a thousand things that I go though immediately and unknowingly because I have a deep and broad crit care background. I'm certainly not the smartest person on the planet, but having been around the block, I have a pretty good list of things I rule out and rule in when subtle changes occur. No offense to new grads, but they just don't have any of the depth and breadth I'd expect a person to have before entering a crit care setting like the NICU. Big changes in any ICU setting, anyone can pick up...but they are usually too late to meet the standard of care. If our standard is simply "prevent death" then we can get away with alot. If the standard is "maximize potential for return to normal function" then we may be best served by folks who have a keen sense of what gives them a "bad feeling" and what is benign.

I wish I had a penny for every person that I told a doc..."I just don't trust this guy and I want you to see him now"..and he was sick sick sick while presenting fairly asymptomatic.

[dawngloves, BSN, RN]

I worked adult ICU for 5 years before doing NICU and it is a whole other planet. I think the things you can't learn is that sixth sense of "somethin' ain't right" But we didn't have that when we started adults now did we.

[llg, PhD, RN]

It's actually easier to orient a new grad to the NICU because they don't have to "unlearn" anything. They are prepared to learn new things, and since NICU isn't really covered in school, they are ready for the unit to educate them. Most orientation programs in NICUs are a couple of months long and include both classroom time and 1 on 1 precepting on the unit. No one just walks in knowing how to deal with preemies! And an adult care nurse needs just as long an orientation as a new grad because things are quite different in NICU.

I agree totally, Gompers. Over the years, I have seen a much higher "success rate" with new grad orientations that with orienting new NICU nurses with a couple of years experience in another field. It is such a different type of area, culture, and patient population that people coming from other fields often struggle with "letting go" of their old basis for judging and acquiring the new, neonatal base.

I believe the worst advice you can give a new grad interested in working in NICU is, "Go and work in adult med/surg for a couple of years -- then go to NICU." Those people have a much harder time of it when they try to switch, feeling that the rug has been pulled out from under them. If a new grad can go to certain peds floors, or newborn nursery, or Level II ... that usually works -- but that adult med/surg or adult ICU background often does not work.

Of course it IS possible for someone with any background to learn NICU. I don't mean to be overly discouraging to anyone out there considering a transfer. But if you check with NICU nurses all over the country, you'll find that a whole lot of them started in NICU's as new grads. It's quite common and most NICU cultures support the new grad very well through his/her first year of practice -- offering more support for those new grads than a lot of other types of units. The units and their orientations are geared to handle new grads and do quite well with them.

llg

[oicu8bacilli]

The only reason I am amazed is because nursing programs don't teach to the critical care environments. I personally wouldn't have a new grad taking care of my 26 weeker, nor my mom with a fresh CABG. My kid has actually spent time in a crit care environment, but the nurses we had were seasoned and provided expert care. If they weren't, they would have had an upset educated parent getting the supervisor to provide appropriate staff for my kid. I have no problem asking my kid's nurse, "how long have you been an RN and how long have you been in peds crit care?" I actually respect pts that want to know my skill level and appreciate that I'm not fresh off of a turnip truck.

BTW, the advice to go get adult med/surg experience is well founded and would be mandatory if we had the staffing to support it. The reason we have new grads entering such highly specialized areas is because we need bodies no matter where they come from. The nursing programs teach towards that med/surg floor goal. I think you'd be hard pressed to find a college that spends a few weeks on adult disease and the remaining semesters on preemies. The disease processes and experiences covered in college are designed to enable a new grad to go take care of those med/surg pts. I've never taught college, but if I do I'm sure I'll never propose that my med/surg trained students run out and take open hearts or 500gram pts. I'd hope that they have sense enough to go get some years under their belt and hone skills (not tasks) before considering a specialty.

[KRVRN, BSN, RN]

Oicu8bacilli,

I know what you're saying about being able to mentally check through several subtle changes. Of course we can't teach that to new grads completely. I started as a new grad and I KNOW I didn't have that ability. We usually put a lot of emphasis on what is normal so if anything is at all off normal we teach new grads to immediately wonder. Perhaps they don't have the ability to judge what it means, but we do teach them to always get another opinion if they have ANY doubt. We encourage new grads to always ask another nurse's opinion on something. Of course you can also ask the MD/NNP but they might not be near and there's always other nurses nearby. Then the other nurse can assist in checklisting what's going on and give an opinion on whether a call to the doctor is warranted. It's also a good opportunity to explain what things you're mentally checklisitng and why.

[KRVRN, BSN, RN]

I think that's the point we're trying to make here... There's NO WHERE to get ANY sort of experience under your belt to do this. I can't speak of adult ICU of course. But there's no where to get NICU experience but in the NICU. I'd actually rather precept a new grad then a nurse already experienced in an adult area. A new grad is a blank slate that knows almost nothing. An experienced nurse might try to draw on experience she/he's had in another area (without even realizing it) and try to apply it to a NICU situation. I'd rather not have preceptee try to apply adult knowledge to NICU pts.

[oicu8bacilli]

I get that blank slate person every now and then and have fun teaching until I realize why I am teaching. I too like to teach them things, but I really find that it's because he knows nothing and I feel like I am imparting the world on him. Now, when I get a new transfer nurse...lots of experience...same crit care setting....I find myself disagreeing with rationales, drug admin, etc....but I know the guy is a seasoned thinker and he has reasons for the pathway. Seasoned nurses will typically disagree on the same crit care pts.

Bottom line is: it's not about me feeling good as a preceptor; It's about us having the most highly skilled people in our critical care areas. Sorry, I just don't buy the party line that new grads that can't think past go are the best choice of nurse for a kid measured in grams. Again, I really believe it's because we don't have the labor pool we used to and we have to take anyone that wants a job.

I've been called a hard *** and maybe that's just because I expect excellence from everyone. Letting a nurse that just passed boards and walked into a crit care job take care of my septic close-to-death kid ain't never gonna happen....sorry, but I'm a pt advocate and stubborn to boot.

[fergus51]

These new grads are generally the cream of the crop and provided with an extensive orientation. Nursing school doesn't prepare them for the NICU, but neither will 10 years in med-surg or adult ICU. It's the orientation and the environment that will determine whether they succeed or fail. No brand new grad is thrown into the NICU and assigned a septic close to death kid. And no seasonned adult ICU nurse would be given that assignment when they are new to the NICU either, cause they wouldn't be safe despite their years of critical thinking with adults. I have found that new grads are often more conscientious and will ask for help if they have any questions, and that's what makes a safe nurse in the NICU, experienced or not. I think that's one reason so many of us like new grads. You don't have to worry that they are going to be overconfident like seasonned adult nurses can be.

I always kind of laugh at the idea that experienced nurse=good NICU nurse. I went into the NICU after a few years in L&D/PP and went through the same orientation as the new grads, because I needed it too. I didn't have a leg up on the new nurses.

[llg, PhD, RN]

I think that's the point we're trying to make here... There's NO WHERE to get ANY sort of experience under your belt to do this. I can't speak of adult ICU of course. But there's no where to get NICU experience but in the NICU. I'd actually rather precept a new grad then a nurse already experienced in an adult area. A new grad is a blank slate that knows almost nothing. An experienced nurse might try to draw on experience she/he's had in another area (without even realizing it) and try to apply it to a NICU situation. I'd rather not have preceptee try to apply adult knowledge to NICU pts.

You said this so much better than I would have had I tried to repond to the previous post first.

NICU is such a different specialty that the experience nurses get on other units does not help them much at all -- and sometimes it hurts them. Their basis for judgement that they acquired on other units is not applicable to the NICU situation, and when they fall back on that knowledge base and experience, they can make the WRONG decision.

New grads are accepted into NICU's not because they need "bodies" so badly that they will take anybody ... but because the specialty has a long established and SUCCESSFUL history of doing so. The educational programs and supportive culture have been in place for years. I began my NICU career in 1977 and have lived through many periods when we had no shortage of nurses, when we could pick and choose. We STILL chose new grads -- if they seemed to be the right person for the job.

It's interesting that the poster to whom we are responding is, in a way, contradicting herself. She says that she has no experience in NICU and has very little knowledge of what goes on there educationally. She says that someone with limited experience is not able to make sophisticated judgments about an area they know little about. And yet ... even with her total lack of NICU experience ... she feels qualified to tell experienced NICU educators that they have been wrong for all these many decades about their field! She presumes to know more about what makes a good NICU nurse and how to best educate them than people who have worked in NICU for years!

I hope that any students reading this thread will consider her total lack of NICU knowledge and experience before taking what she says too seriously.

llg

[KRVRN, BSN, RN]

Well, let me be more specific, of course I would MUCH rather orient an experienced NICU nurse to my unit than train a new grad any day. I'm not saying a blank slate is necessarily a good thing. New grads may not be the best choice for taking care of preemies but other than an already experienced NICU nurse... who would be in your opinion Oicu8bacilli?

[oicu8bacilli]

nicu is such a different specialty that the experience nurses get on other units does not help them much at all -- and sometimes it hurts them.

i'm not arguing the fact that all nic folks are superhuman and possess skills unknown to mankind (never been a nurse from day one or not...must be a super alien gene pool you get new grads from). what does concern me is that you say that no matter how many years...nor how many procedures...nor how much education....i have...i 'm an idiot if i were to walk into your nicu. sorry, but i'm pretty incredibly intelligent and i have to say so every now and then or folks forget. i suppose it's time to agree to disagree.

i don't think new grads with zero minutes and zero seconds of experience are better candidates to work anywhere than i am and i think it is related to the bodies available. if the system were inundated with fully qualified folks, we would never look at placing zero days zero skill kids in our crit care units. sorry..but again...we all disagree. maybe the florist would make a better heart surgeon that the ones i work with...i don't know until we giver her a try...i for one am not ready to make that leap...even though we need a heart surgeon badly....any ideas?

[fergus51]

I think it's related to attitude. There is nothing insulting or degrading in saying you wouldn't have a clue in the NICU. It's not because you aren't intelligent or because those of us who work here are alien like geniuses. It's just because you need training to work there and it is SPECIFIC to that unit. I wouldn't have a clue in adult ICU just because I've worked in the NICU either and I'm not stupid.

The thing is people who can't recognize that and aren't willing to admit a lack of knowledge are the ones who will be dangerous in the NICU. That's where the seasonned nurses sometimes don't work. They get offended that we don't recognize them as so much more knowlegeable than the new grads. They are more knowlegeable in general, just not in the NICU. Imagine throwing one of those super excellent heart surgeons into psychiatry for the day, he may not do better than the psych residents even though he's a knowlegeable, experienced doctor and that's about as close as a comparison as I can think of to having adult trained nurses in the NICU.