"Non Moms" good NICU nurses

mom2alyssa · Aug 27, 2004

Whew, what a discussion! I too am one of those "experienced med/surg turned NICU nurses"! I have 7 years of adult med/surg/CCU experience under my belt, and as told in my beginning posts, I decided to transfer to the NICU because of my experience my daughter who was a 26 wkr. I was one of 16 (?) nurses hired into our NICU this summer and I think I am the only one that isn't a new grad. I was told by a friend of mine that works in the NICU that the manager was glad for all these new grad coming in (we are short staffed--funny huh?!) but that she would love to get a few experienced-nicu or not- nurses in there.

I agree with some points on both sides here. I believe the original poster was being a bit harsh though. If I had known I wanted to be nicu nurse in school, I would have gone right to it--not to med/surg first. What's the point? One of my college instructors used to tell us to go into what we are interested in--not to med/surg or the hospital just to get some experience. If you only want to do doc. office, then go to it- don't waste your time. You'll learn what you need to know in that setting.

But I only went through my preemie experience 2.5 years ago and after 1 year of racking my brain on what to do, I decided to transfer. Keep in mind I left a great job, with great hours, good management, great co-workers and docs.--yes I've been smoking crack!!!- to go to the nicu- because I felt in my heart it's where I needed to be.

I'm glad I made the move, but it's been tough. My nursing experienced has certainly helped, but has gotten in my way also. I told myself that when I got there I would try to be a clean slate-but it's hard to do that. I was upfront with my preceptor in telling her not to jip my orientation just because I have experience. I want to be given what a new grad would be given. She agreed, but has said having an experienced nurse to orient has been nice because I do have direction, thinking skills, I know how to listen to heart and lungs, mix up drugs as instructed, chart, confront NNPs, and MDs. But I warned her that I would ask ANYTIME I felt uncomfortable. She has not been hovering, which bothered me at first, but is available when I need her.

I can't say that a new grad will be "better or worse" than me. It is so individual. I have the passion because I've had personal experience in it and it's near and dear to my heart. my situation may be a bit different. New grads are given an excellent orientation. I never had a problem with a new grad taking my baby as long as she had confidence and asked someone else if she didn't know the answer or wasn't sure about something. New grads are just a reality in the nursing world. You're going to have them no matter what--they've gotta start somewhere and if it's the nicu-so be it. But, I don't want other rn's thinking of transferring to the nicu to be discouraged by this discussion either--it can be done.

OK, just my 2 cents!!!!

Renee

nekhismom · Sep 2, 2004

At the level III NICU I retired from, they had a LOT of didactic work before they started working w/a preceptor 1:1 on an intermediate baby, advanced to independant practice in that area, then back to the classroom for more didactic, then being precepted again in the ICU area. The whole orientation is several months. And when they are on their own, they are still mentored by more experienced nurses for the first year.
We treated them carefully because we wanted them to stay, be great nurses for our babies. I don't think any of them ever felt thrown to the wolves, or gnawed on by some grumpy old nurse.

Can I work there?? :rotfl: Really, the one thing that I complain about most in my NICU is the fact that we have NO didactic training. I have NOT been given any classroom orientation. It's all been on the floor. SO while I know what to look for in patients, what is normal or not, and I am starting to pick up subtle changes, I don't always know the rationale for what I do. And THAT bothers me. Personally, I'd rather have someone who knows that you do X procedure for Y condition, and just have to teach them how to do X procedure, than to have things the way I have them. It makes it really really difficult for someone like me who learns best when I know the rationale for things.

prmenrs, RN · Sep 2, 2004

The CNS did the orientation. The "newbies" got a HUGE 3 ring binder w/the lecture info, articles, and the check off lists they needed to complete and turn in for "competency". They also got the latest edition of Merenstein and Gardner, w/assigned reading. Some lectures were done by staff nurses.

You're right, it was a heck of an orientation!

apaisRN, RN, CRNA · Sep 5, 2004

I'm a MICU/CICU nurse, and reading here is making me want to work with babies! Actually I hope to go to CRNA school so will probably not switch, but it is very interesting to read. I did enjoy my PALS course very much, although it didn't stick well because I don't work with kiddos.

I'm curious, what are these things that are so radically different from adult nursing that experienced nurses have trouble shifting? In my job, the most important things are cardiac output, perfusion, oxygenation, ventilation. I assume that would be similar in babies, except that the problems affecting these things would be different. I'm sure my assessment skills would need a total overhaul, since preemies are very different physically and physiologically. It sounds like in NICU you need to be totally on top of every change. In MICU is my patient drops their pressure I might lower their head, stimulate them a bit, give them some time before I call the doc. From what I understand about kids in general, when you see outward signs of distress they have already decompensated, and you need to move fast.

I know I'm totally clueless anout the NICU, but I guess I feel like a critical care nurse has a framework for any kind of critically ill patient. Tell me how this doesn't work.

prmenrs, RN · Sep 5, 2004

There are several things that are different, but the one thing that struck me many years ago was that my subconcious idea of what was "normal" no longer applied. I had worked in adult ICU for 2 yrs or so, switched to NICU (NO orientation in those days before sliced bread), and I couldn't tell whether a baby was acting normally or not. I was used to relying on that "Gestalt" feeling that something was wrong or not, but I had to re-learn that skill. It took about six months!

If I had a premie w/a low BP, and lowered the head, I'd risk an intraventricular hemorrhage (from the germinal matrix, an immature structure in the ventricles that is pretty much gone @ birth), brain damage, possible death.

The technology is not there (yet) for doing cardiac outputs, so that info is absent. Dopamine is falling out of favor to treat shock because it increases afterload, and premies hate afterload, it makes them re-open their ductus arteriosis and flood their lungs. Dobutamine is better. The margin of error is infinitessimal. There is a more limited choice of drugs, but you pretty much have to check each dose.

There are diseases treated in NICU that don't occur in adults, or even older children. Apnea of prematurity, caused by an immature respiratory center; meconium aspiration; congenital abnormalities like gastroschisis, oomphalocele. We had a baby once w/oomphalitis we wanted to treat in the hyperbaric chamber, called in the RN in charge of the chamber, as she was driving to the hospital, she told us later she kept thinking, "What's an oompha and how does it get inflamed?" Necrotizing Enterocolitis (there is a disorder of the same name in adults, but it is NOT the same problem). Retinopathy of Prematurity.

Families are much more involved and present (usually) than the adult ICUs.

I'm not sure if that helps you understand, I hope so. I do know that once I got into babies, I never went back to grown-ups again!!

cswain12000 · Sep 10, 2004

I'll leave the topic with the comment that I am very glad I'm done having kids, scared for the rest...but at least I'm done. Please send your mom to me and I'll ensure my newest nurses takes care of her post CABG, we'll roll the dice like you have with your new grad. Then again, folks don't care when gramma dies, but they get pizzed when their kid croaks. Funny, I never thought of nursing as a crap shoot...but recent exposure to all of the different fields makes me wonder what we really get done every day.

oicu8bacilli

Your attitude scares me, and as a seasoned NICU nurse--I would take a new grad any day to care for my sick infant rather than you. It is an attitude of humility and a willingness to learn that makes a good nurse in any area rather than an attitude that you are superior to everyone else. I get the feeling that this attitude carries over into your own area of nursing, and I'm not sure that with that attitude you would be a safe nurse in any environment.

cswain12000 · Sep 10, 2004

Apparently someone who has never worked or been trained in this specialty is certain we are all rolling the dice with babies lives because we don't agree with her. Right.... some people just can't handle not being acknowledged as the all knowing expert. I would much rather orient a new grad open to new ideas than an experienced nurse who gets mad if I disagree with her.

I agree with you Fergus 51--as I said above, I would rather have a new grad who is willing to learn and ask questions care for my sick baby than the poster who I addressed my above post to.

RuthieRN · Sep 10, 2004

I agree with you Fergus 51--as I said above, I would rather have a new grad who is willing to learn and ask questions care for my sick baby than the poster who I addressed my above post to.

It is scary to think that there are nurses out there that feel that new grads are idiots and do not belong in specialties (see eating our young thread:o ).... I agree that the new grad is usually more willing to ask a question rather than the seasoned nurse. That question could save a life, especially in the NICU where even the smallest intervention, like the trendelenberg no no, can be deadly. I certainly would not want any nurse with that opinion as a preceptor...

Ruthie

llg, PhD, RN · Sep 10, 2004

There are several things that are different, .......
I'm not sure if that helps you understand, I hope so. I do know that once I got into babies, I never went back to grown-ups again!!

I was tempted to try to respond to the question from the adult ICU nurse that stimulated this answer -- but doubted my ability to do so because I have no experience with adults. Thank goodness I didn't feel the need to try to explain it. When I saw the response quoted above, I knew I could never come close to crafting such a great resonse.

Thanks,

llg

prmenrs, RN · Sep 10, 2004

Wow!! Thanks for the compliment, llg. :imbar

And, now, a word from your moderator [ahem]: please, let's try to debate issue, not each other. I appreciate everyone's effort in that regard. :wink2:

shay · Oct 5, 2004

I agree w/Fergus (hey Fergus!). But I will say that now that I'm a mom, it's much more difficult to see babies in pain and hear them cry. So in a sense it's made my job more difficult on the emotional side of things.

As far as your personal experience and using that to share w/patients, I just keep my mouth shut about my own pregnancy/birth experience/child unless my patient asks me a direct question, kwim?