"Untraining" someone from adults to NICU

prmenrs, RN · Dec 10, 2010

When you've been a nurse for a while, you develop a "frame of reference". Walk into a pt room, you automatically compare the pt w/that norm. You often get an impression of what's wrong, and how fast you need to fix it. Nurse's intuition, verified (or not) by the real assessment.

I'm not sure if that makes sense to you, but I went from adult ICU nursing to NICU, and I was distressed that it took me so long to assess a baby. And sometimes, another nurse would come over and tell exactly what I wasn't putting together. After about 6 months, it clicked, and I could look @ a baby and get an idea of what I needed to do and look for.

@ the time I made the switch, they didn't really orient me much; I'd been in ICU and adult nursing ~ 2.5 years, and I was more or less expected to jump in and take an assignment w/someone "buddying" me. That's was I expected of myself, too, so it was a shock when I felt so uncertain. Fortunately, things have changed, and NICU's take better care of new nurses.

Lastly, if you haven't heard this before, let me be the 1st: Babies are Different!! You'll be hearing it a lot over the next few months. It's true, babies handle drugs differently, they give you fewer clues as to what is going on, and all that stuff you learned in Physiology is a lot more apparent when you're working w/them. It's a challenge, and I think you'll like it.

Don't do anything different @ this point, learn whatever they want you to, and when you go to the NICU, take advantage of the 12-16 wks of orientation they should give you.

Best Wishes!! on your new adventure!

WorkofHeart8 · Dec 10, 2010

Thank you prmenrs!! That makes a lot of sense. Would you choose Med/Surg or ER as my first job or either one?

Guest343211 · Dec 10, 2010

I did a search but couldn't find anything on this.
I am a LPN student and at my facility LPNs can only work in Med/Surg and the ER. I would like to work in the NICU when I become a RN. I have seen that some facilities prefer people who go straight into NICU vs. starting out with adults, understandably so. They say they don't like to "untrain" them.
My question is, what exactly are they "untraining" them from so that I can try to memorize what to do if it was NICU pt instead of an adult pt, if that makes sense.
Also, would you rather work in Med/Surg or the ER so that it would be easier to use a similar "thought process"?

To me the whole "untrain" attitude smacks of a false sense of superiority among other things. You don't h ave to re-train as much as guide them in helping them to adjust their thinking. Um many human beings are highly intelligent and are quite capable of making the appropriate adjustments--what's more, they indeed can bring a lot to the NICU environment, when those that aren't NICU elitest let them. (Sorry, certainly not meant for all or even most NICU nurses, but I think a few folks know what I am referring to.)

Yes, we all get that neonates are not little adults. But they aren't chimpanzes either--they are still human. So there will be a number of similar things that need to be tweaked and adjusted for the newborn--and adjust a zillion times more for the highly critical premie or newborn with certain serious congenital disorders. A number of those disorders look beyond bizarre, and many of the same kind can look somewhat different for each particular kid.

Here's the biggest thing IMHO. Mostly, when adults start trending down you get some time, some heads up. And of course in certain critical care areas we have nice things like hemodynamic indices from thermodilution and such that can help us note a downward trend a lot earlier. With kids, and the younger and more immature, often the more severe this is--well, they can be stable, fine one second, and within two more seconds you are getting ready to code them. It is enough to make you pizz your pants. So you learn this crazy hyper, hyper vigilance with them, and not to take even the slightest thing for granted. And that too may seem why some that work in this area are neurotic. But once you have watched that downward spiraling of a kid, how quickly it occurs, and that increadibly sick feeling you get, you want to do everything you can do try to not let it happen again. Of course, depending on what is going on with the kid, there are things you can control and things you cannot. Thus, no matter what, some kids spin out of control and you practically kill yourself to get them better. . .and sometimes, with the best of work and practice and insight, well, you can't really get them back.

Is it a specialty all it's own, requiring years of learning and growth? Absolutely. Is it like rocket science taken on by a monkey? No. People that have worked in acute and critical care nursing almost always grow in depth of understanding, even though that understanding may have to be seriously adjusted or "re-applied."

What you need to learn to move into this area is IMHO a lot of humility and patience. You also have to suspend the amount of control in decision-making and functioning that you may have had, say, in adult critical care.

In the pediatric and neonatal world, well, it's very different. You give up a lot of automony many times to work in these areas. And that is totally OK if you like it and learn from working in the area.

What you also need are open, supported, well-educated preceptors and such (that is, educated in how to educate adult learners) with good self-esteems and enough direction to keep you straight but not be teternal, micromanaging control freaks.

Good luck.

prmenrs, RN · Dec 10, 2010

My apologies if my response came off as any of the above. Not my intent @ all.

Guest343211 · Dec 20, 2010

:) I wasn't referring to you at all prmenrs.

It's more of a generalized thing I have seen in these areas with SOME nicu people. Thank God in heaven most I've worked with aren't like what I described.

prmenrs, RN · Dec 21, 2010

I confess to a few "prima donna" moments in the past, but I am well and truely over them!