RN duties in the NICU

[BrayaRN]

Hi,

I am just finishing up my second week of orientation in our level IIIB NICU. Prior to this postion, I worked as an RN on a cardiac/telemetry floor. I am really enjoying the new position already and am amazed at the scope of practice for the RNs. I was wondering if this is common in other NICUs.

A NICU RN attends every C-Section whether scheduled or emergent to be the baby's provider until deemed stable.

A NICU RN attends any lady partsl delivery that requires assistance or there is meconium present.

Two RNs and one RRT go on neonatal transports with the nearest hospital being fifteen minutes away and the furthest nearly four.

Seasoned RNs are trained in intubation, PICC lines, and UVCs and UVAs, and may be required to do them either on transport, on the unit, or post-delivery.

After leaving a unit where I had to call a physician for Tylenol, I am amazed by the autonomy. Of course, there is much training before an RN performs any of these skills without assistance. I am wondering if this is the norm. Thanks.

[Jolie, BSN]

Yep, that sounds like the units where I've worked.

Especially in large teaching hospitals, NICU nurses have the opportunity to learn and perform a wide range of clinical skills, following standing orders, protocols, or under the guidance of the attending staff.

Many of these procedures require advanced training and competence per the State Nurse Practice Act.

[karnicurnc, MSN, APRN, CNS]

Agree with Jolie. Pretty much the same in my facility - 60 beds. Exception is that the NNP attends deliveries as described above, not a NICU nurses. Our census is usually too high to spare anyone!

[Coffee Nurse, BSN, RN]

Sounds pretty similar to mine. Of course, it's apples and oranges, comparing Tylenol to attending deliveries. No matter where you are or what kind of unit you're working on, prescription falls outside of the RN scope of practice.

[littleneoRN]

We attend deliveries and go on transports WITH and NNP and usually RT. We do not intubate or put in lines. I know this is something many units give their nurses additional training in, but it makes me uncomfortable. It seems like these are just the type of roles and skills a NNP gets the additional education for. And if an RN intubates on transport, is she also responsible for determining the vent settings during transport? The lines don't bother me as much, although I still prefer that it be the job of an NNP or physician. I'd love to hear more about how this works for people.

[karnicurnc, MSN, APRN, CNS]

Our Neo/Peds transport team consists of an RN and RRT, either of whom can intubate in the field. Vent settings are ordered by the MD. The team is in constant contact with the MD.

Lines are placed by the MD, NNP, or transport team RN, not the bedside nurse.

[NICU_babyRN, BSN, RN]

Aside from intubating and placing UAC/UVC, our RNs do all that you mentioned. The transport team is one RN, or RT and one NNP or Peds Resident.

RNs attend deliveries and if there is a "known NICU admission" type of delivery, the attending comes also depending on gestational age and/or anomalies present.

RTs don't intubate in my unit. Only MDs and NNPs.

[LoveANurse09]

Wow I didnt realize all the skills NICU nurses could perform.Do all NICU nurses transport or only a select trained few? Wondering how is was on your units.

[ittybabyRN, RN]

Wow I didnt realize all the skills NICU nurses could perform.Do all NICU nurses transport or only a select trained few? Wondering how is was on your units.

I work at a large childrens hospital (we don't have deliveries) and an RN can train for transport after three years of bedside NICU nursing. (we have our own NICU team that is seperate from peds). On transport the NICU RN & RT go, both can intubate and RN can place lines. The transport RN has the autonomy to do whatever it takes to get the kiddo back to our nicu alive w/o having to call the MD (boluses, pressors etc). It's a 6 month orientation for transport