7 weeks in the NICU, feeling overwhelmed - need advice

[Nurse Magnolia, BSN, RN]

I am a new grad and I work in a level III NICU. I just finished week 7 of a 12 week orientation. I am feeling pretty darn overwhelmed and I just don't know how all of this information swirling in my head will become second nature. I was about to start on my BSN (I have a BS in another field) but I pushed it back because I'm feeling so overwhelmed at work.

I get super nervous when being watched by a preceptor and I find that I make more mistakes when I'm being overseen than I do when my preceptor is at lunch or in a meeting etc... So I feel like my preceptor thinks I'm less competent than I am. Unless I really am incompetent! She says I'm being too hard on myself but at the same time, reminds me of things I *should* know by now. And I do know them....that's the really frustrating part.

I also have trouble when my preceptor "helps" me with things. It messes with my flow and then I forget things because I don't know who was supposed to do it or if she did it already. For example, last night my preceptor got the feed ready in the NG tube...warmed it, set it up in the pump and put the end of it in the isolette and put down the blanket. When I saw she didn't start the pump I programmed it and hit start. Well, I fed the bed because she didn't connect it, and I didn't look (I should have, I know). But had I set up the feed myself from the start I wouldn't have done that because I have my process.....if that makes any sense. The baby had low chems and I felt awful that I delayed her feed. I know my preceptor did that because I was running behind a bit from a morning x ray so she was trying to be helpful. She is a very nice person.

On Saturday I came into work and was promptly told that there were 24 week triplets born overnight....one died the night before, and one just died as I walked into work - and I and my preceptor would have the third 24 week triplet. We did post mortem care on the infant that died that morning and the dad was sobbing and I just felt sick. The third triplet was touch and go and she's still alive thank God, but I've felt sick since Saturday. My nerves are on high alert. This was also the second baby I've personally taken to the morgue in my 7 weeks.

I guess I'm just venting and I want to know that it gets better. I was a 4.0 nursing student and my clinical instructors and clinical preceptors all liked me. During my transitions I was offered a job on that unit so I know I did a good job. But I wanted to be in the NICU - which is an entirely different animal because I didn't see one iota of any of this stuff in nursing school. So I don't know if it's just new nurse jitters coupled with learning an Intensive Care specialty at the same time or what. I'm really used to picking things up quickly and being 'good' at things. High achiever and all that nonsense that really ends up being more of an albatross than anything. So I'm definitely having a crisis of confidence that this isn't coming easily. I'm an old new nurse...47 and a second career. I LOVE being a nurse for whatever that's worth.

I'm contracted to the unit for a year. So I really need to figure out what's happening so that I can be happy. I'm working on a new brain sheet over the next few days when I'm off to reorganize so that I don't miss some things. I also bought the book you guys talk about on here....any other suggestions for surviving your first year in your first nursing job in the NICU?

PS...>They should REALLY include NICU in the nursing school education!

[llg, PhD, RN]

What you are experiencing is very common. I suspect your problem isn't really in knowledge or skill ... it's in anxiety. You get so nervous and flustered that you don't think straight. That is really evident in the example you gave in which you "fed the bed." Everybody knows that you know that the tube has to be hooked up: no one thinks you don't know that. You were simply so flustered, you didn't check the tubing. That type of problem will ease in time for most people. It takes most new grads 6-9 months in NICU before they start feeling comfortable. Your task now is to learn to work while uncomfortable.

You say your preceptor is really nice. Can you talk to her about your nervousness? If not her, maybe there is someone else that you can talk to -- and trust not to judge your harshly for it. You need someone who will help you pause, take a deep breath and count to 10 (or at least 3) before you act so that you can calm down and see the situation clearly before taking action. (Pause, deep breath, I see the feeding pump, the settings are correct. I see the tubing running from the pump to the baby -- oops! No, it's not going to the baby ... Now there, it is connected to the baby. All is well from top to bottom. I can hit start.)

You also might benefit by having a "slow day" at work, one in which your patient assignment is not so busy and challenging. It would be a day to review basics, solidify them, and help you to see how much you have learned. Such a day might boost your confidence. Not a remedial day, but a day to practice skills you have previously learned to help you see how much that is.

Good luck!

[babyNP., APRN]

If your preceptor is telling you that you are doing alright, then try to believe her.

Let go in your mind that you were a 4.0 nursing student and a high-achiever. You're essentially starting from ground zero as a new grad in a specialty like NICU, which is an extremely niche setting. Nursing schools don't spend time learning about all of that because it's so different from adult physiology and it's extraordinarily limited in terms of amount of jobs as compared to amount of adult or pediatric jobs. There's just simply not enough time in nursing school to learn everything.

I would just try to wrap your brain around the fact that none of this will be "easy" and that it's okay for things to be hard. You are in a hard specialty. Sounds like you have a high-acuity NICU as well, which makes it even harder.

I was a 22 year old new grad in a tertiary NICU many moons ago and you can bet that I cried several times on orientation feeling very stupid. I even spent an extra few weeks on orientation because I didn't pass one of tests we were given at first. I'm not saying that people should have my experience, of course not. But the first year of nursing is difficult for anyone, let alone those in a high acuity specialty. Be kind to yourself.

Best of luck to you.

[Nunya, BSN]

Tell your preceptor what you told us about your process. I'm the same way if it's something I don't know. And the other comments are spot on. Your preceptor will tell you if there's a problem. Are there any other nurses at your stage of orientation you can talk to? I started in Level 2 many years ago and I felt the same way, not to mention I worked nights and was exhausted till I got in the swing of it. You can do this!

[EmLa0113, BSN]

I second what everyone else has said! Communicate your concerns with your preceptor. She's been new too and can hopefully help you manage some nervousness.

I also want to add that in my experience, I've also felt very flustered and struggled with my flow while still on orientation. Once I was on my own, I was able to organize my brain/flow better and just reach out for help when needed.

It's all a process and it sounds like you're on track with where you should be at 7 weeks in. Good luck, you got this!

[Nurse Magnolia, BSN, RN]

Thank you all for your wonderful advice. I've been doing some soul searching this week for sure. I have not been able to shake my anxiety since last Saturday when the 24 weeker died (her name was Monroe). I was at Target two days ago and walked by the baby clothes and I had a flash in my mind of the onsie that I dressed the 24 weeker deceased baby in and I started to tear up in the middle of Target. It was at that moment that I realized that I don't think I'm personally equipt to deal with the death of babies. It's not that I didn't know that babies die in the NICU - I did. But I also thought I'd be able to handle it. I guess no one knows how they will deal with seeing a child die until they do it. For me, it was traumatic and I haven't been able to stop seeing her face or the face of her parents. Maybe that makes me a weak nurse, I don't know. But in the end, I spoke with HR and I'm going to transfer to an adult floor. They were more than understanding about it. I feel a bit defeated because I was SO excited about this job, but I also have lived long enough to know that I need to listen to my own gut when it's telling me something. And my gut is telling me that while I love being a nurse, the NICU is just not the place for me to do it. I'm hoping I don't regret that decision.

I know there are some new grads out there who think the NICU is a soft cuddly place full of babies they get to cuddle all day- I was never one of those people - but I hope one of them is reading this right now and understands the enormity of responsibility and high acuity of these tiny patients before they jump in to a new grad NICU position. It is NOT a happy place a lot of the time.

[babyNP., APRN]

I just wanted to say good for you for being self reflective and brave to admit when a place isn't for you. That can be a hard thing to do, especially when one gets caught up in a mindset of a goal and then not realizing later that the goal isn't serving one's needs anymore.

Best of luck to you in your next steps of your nursing career.

[Leader25, ASN, BSN, RN]

On 8/19/2019 at 1:26 PM, Nurse Magnolia said:

I was a 4.0 nursing student and my clinical instructors and clinical preceptors all liked me.

Welcome to the real world of nursing,glad you are happy with your decision to change areas,best of luck to you.

[RNNPICU, BSN, RN]

Before you completely decide to exit NICU, make sure it is not just due to a recent death or complicated babies. LIfe in the NICU is tough and can have lots of highs and lows. Next shift, ask for an assignment that is less acuity, perhaps someone being discharged or is becoming close to a NICU graduate.

Talk to the other nurses about how it is for them, you will be surprised at some responses. Ask what others do after a tough shift, see how long it takes others to recover. For me, it usually takes about a week of just not feeling it, but then I usually get someone that makes me happy. For whatever reason, there always will be some patient that stay with you forever. I still remember my first patient that died on my shift and that was over 13 years ago.

Take care, find time to do good things for yourself on your off days.

Don't make a haste decision, you have only been on orientation 7 weeks, that is 21 shift days, for perspective. Do you think in 21 days it is really a fair assessment of yourself?

Take care and wish you the best

[llg, PhD, RN]

It sounds like you did a lot of thinking before making your decision. I wish you the best of luck with your new job.

[Nurse Magnolia, BSN, RN]

On 9/23/2019 at 11:34 AM, llg said:

It sounds like you did a lot of thinking before making your decision. I wish you the best of luck with your new job.

Thank you. I actually did land in a great place. My background is all in mental health, so while I interviewed and was offered positions on the rehab unit and stroke/trauma unit, I ultimately accepted a position in the behavioral health unit. It's chaotic and interesting and never boring and so far, I'm really liking the unit. It helps that I have a passion and a love for that population. I'm glad I listened to my gut and even though objectively, the NICU was a fabulous job for a new grad - it just wasn't a great place for ME.

[JenniferC123654]

Magnolia Nurse- you spoke of a NICU book in your original post on this topic. I am new to NICU, can you share the title of this book with me.

Thanks in advance