Starting in a different NICU with about 1 year exp

Jolie, BSN · Nov 23, 2008

I had a little over 2 years experience in a Level II NICU inChicago, when hubby was transferred to a small city where I went to work in the only NICU.

My advice is to be flexible, open to learning new ways of doing things, and keep your comments to yourself, unless patient safety is at issue.

My transfer to a new NICU was an eye-opening experience in the lack of evidence-based practice in neonatal medicine and nursing. Things I was taught to be "Bible truth" in the first NICU were punishable by death in the second one. As tempting as it may be to say, "This is how I am used to doing it..." or "This is what I was taught in XYZ unit..." I suggest you do your best to learn the techniques and rationales that govern care in your new unit. If patient safety is at stake, that's different, of course, but pick your battles wisely. NICU staff are very protective and territorial and don't respond well to challenges from outsiders or newbies. Once you have developed a reputation for excellent care, you may be able to make some subtle changes.

As far as missing out on procedures during night shift, I wouldn't worry much about that. Babies are admitted 24 hours a day, sometimes more so during evening and night shift when inductions are completed. Infants who require intubation, line placement and other stabilization measures are going to need care at all hours of the day and night. Most large units have "ECMO teams" comprised of experienced staff members who have undergone extensive training,so that shouldn't be an issue at first. You can begin building rapport with the other shift by presenting a professional report and doing your best to make sure you have accomplished what needs to be done on your shift. If you are unable to get everything done, be upfront and honest about it and offer to stay and help. (They will probably politely decline, but will appreciate your honesty and offer.)

NeoNurseTX, RN · Nov 23, 2008

I had a little over 2 years experience in a Level II NICU inChicago, when hubby was transferred to a small city where I went to work in the only NICU.
My advice is to be flexible, open to learning new ways of doing things, and keep your comments to yourself, unless patient safety is at issue.
My transfer to a new NICU was an eye-opening experience in the lack of evidence-based practice in neonatal medicine and nursing. Things I was taught to be "Bible truth" in the first NICU were punishable by death in the second one. As tempting as it may be to say, "This is how I am used to doing it..." or "This is what I was taught in XYZ unit..." I suggest you do your best to learn the techniques and rationales that govern care in your new unit. If patient safety is at stake, that's different, of course, but pick your battles wisely. NICU staff are very protective and territorial and don't respond well to challenges from outsiders or newbies. Once you have developed a reputation for excellent care, you may be able to make some subtle changes.
As far as missing out on procedures during night shift, I wouldn't worry much about that. Babies are admitted 24 hours a day, sometimes more so during evening and night shift when inductions are completed. Infants who require intubation, line placement and other stabilization measures are going to need care at all hours of the day and night. Most large units have "ECMO teams" comprised of experienced staff members who have undergone extensive training,so that shouldn't be an issue at first. You can begin building rapport with the other shift by presenting a professional report and doing your best to make sure you have accomplished what needs to be done on your shift. If you are unable to get everything done, be upfront and honest about it and offer to stay and help. (They will probably politely decline, but will appreciate your honesty and offer.)

Thanks for this! I think the new place is more into EBP than the previous but the whole "well, I am used to doing it this way" thing is helpful to know. Except I'd probably ask WHY it is done like the new unit does it. I'm so excited but terrified at the same time at the higher acuity. Ah well, it will just take a little time to get things down.

texas2007, BSN, RN · Nov 23, 2008

Thanks for this! I think the new place is more into EBP than the previous but the whole "well, I am used to doing it this way" thing is helpful to know. Except I'd probably ask WHY it is done like the new unit does it. I'm so excited but terrified at the same time at the higher acuity. Ah well, it will just take a little time to get things down.

With 10 weeks orientation on the unit, you'll be FINE! I think orienting on days will actually be easier for you because you will get to hear the plan of care during rounds. A lot of times you can learn stuff by overhearing what the attending is trying to teach the resident. And then once you go to nights, really the only thing you'll have to learn is hanging fluids but I'm sure you've done that plenty at your old facility. If you're unsure of something, don't be afraid to ask and don't be afraid to call the MD if something doesn't seem right. Pretty much everybody is willing to help and most of the drs will listen to you. As for cardiacs and Ecmo's/potential ecmo's...they seem to give them to the more experienced nurses and/or the ecmo specialists. Since I've been off orientation in July, I've only had 1 cardiac kid, which I admitted, but maybe I've just been lucky (the cardiac kids freak me out after I saw one go from fine to gone in 2 hrs when I first started). Good luck!

NeoNurseTX, RN · Nov 24, 2008

With 10 weeks orientation on the unit, you'll be FINE! I think orienting on days will actually be easier for you because you will get to hear the plan of care during rounds. A lot of times you can learn stuff by overhearing what the attending is trying to teach the resident. And then once you go to nights, really the only thing you'll have to learn is hanging fluids but I'm sure you've done that plenty at your old facility. If you're unsure of something, don't be afraid to ask and don't be afraid to call the MD if something doesn't seem right. Pretty much everybody is willing to help and most of the drs will listen to you. As for cardiacs and Ecmo's/potential ecmo's...they seem to give them to the more experienced nurses and/or the ecmo specialists. Since I've been off orientation in July, I've only had 1 cardiac kid, which I admitted, but maybe I've just been lucky (the cardiac kids freak me out after I saw one go from fine to gone in 2 hrs when I first started). Good luck!

Thanks! There's a line team to help w/ central line fluids, right? If so, that'd be amazing, if not, oh well, I've done it before. How often are you on first admit? I guess I'll see you around when I go to nights - I won't have a clue who you are but I'm sure you'll know who I am - do introduce yourself! (or if I hear about someone who is younger than I am, I'll know who you are! )

Peanut_RN · Nov 24, 2008

Definately keep your comments to yourself unless patient safety is at risk like Jolie said. I learned the hard way that level III nurses are very skeptical of newbies. They basically pushed me out after 14 weeks.

NeoNurseTX, RN · Nov 24, 2008

Definately keep your comments to yourself unless patient safety is at risk like Jolie said. I learned the hard way that level III nurses are very skeptical of newbies. They basically pushed me out after 14 weeks.

Eek, what do you mean by pushed you out?

Peanut_RN · Nov 25, 2008

my 1st NICU position right out of nursing school was in a level III NICU, my dream job!!! After about 10 weeks of orientation, my preceptor, nurse educator, manager, and myself sat down to talk about how things were going. Well, they basically told me I had excellent skills as a new nurse, but my personality didn't fit. And all along I thought things were going fine. Then, I continued to work (keeping in mind what had been said), and then on a night about 2 weeks after our "talk", I had my 1st admission on my own (a term mec kid). No one came to help me or ask if I was doing ok in this 75 bed unit. I had to go seek out my charge nurse (who never took an assignment) to help me start my IV, do a BC, get my other labs, etc. After that I had it and gave my resignation the next day. I mean I actually enjoyed going to work too, and it was to a point where I would cry every day I had to work. My mom (also a nurse) said I should love work at this stage in my life, especially as a new RN.

The other issue, in aspect of keeping comments to yourself, was when I was just talking to my preceptor casually one night and told her how I didn't feelgood "pushing" breast feeding onto mothers. The unit basically told you that you had to tell mothers their babies would die if she didn't pump or didn't allow is to use donor milk. I feel breastfeeding is a mother's decision and after hearing the pros & cons of both breast milk & formula should be able to make an educated decision. They hated me after that...

I then spent 1.5 years in Ortho and Cardiac ICU (post open heart) before realizing NICU was just what I was meant to do. I am now in a level IIB NICU and love it!!! They don't shove things down your throat so bad!! The people are so nice and teamwork is everywhere, but I do miss a level III and the thrill of it. But I have decided (for now), enjoying work is much better then not working NICU at all. Hope this helps and doesn't discourage you...