Why I want NICU-good reasons? (long)

[raerusse]

I think I've made up my mind that NICU is where I want to be as a new Grad. Please read me reasons and comment whether they are accurate or good reasons if you can. I am including where my strengths are etc.

I am nurturing and have a holistic mindset- I like dealing with pt's and their families emotional and psychological difficulties. In clinicals I gravitate towards choosing pts with cancer and end stage diseases. I am not afraid of the tough issues. I can read people pretty well and have a sense of what to say and what not so say. However, I do get very emotionally involved with my pts-I often end up praying and crying with them. When i observed in the NICU I liked how the nurses went above and beyond what is expected to be therapeutic to their pts-they realized that the little things count for these pts and they can see when their babies and their family is being loved on by a compassionate nurse.

I am assertive- I like to get to be an expert on my patient and even as a student am not afraid to ask questions and talk to the RN about the plan of care and when necessary the MD, PT etc (I don't see a lot of students doing this and I have gotten good results for my pts this way and positive feedback from nurses) I also like to make things better and ask questions about the way things are done.

I have a bad back!! I am only 24 and yet I cringe at the thought of moving another pt up in bed. I like working with adults and babies (I've worked as PCT with newborns )more than kids--that may change after I have kids right now I am a little intimidated by them. I haven't had pedi yet but I can't imagine trying to give a pt a shot and them not only cry but say "I hate you how could do this to me? don't hurt me please!" (I did this to nurses as a kid)

I love continuity of care-again I like to get to know my pts and their families and it's always nice to see the fruits of your labor if your baby gets to go home or the family says that the experience while horrible was better because of you!

Only 2 pts! again I can't stand the thought of not knowing all the details about my pt b/c I am so busy with others or forgetting pts names etc. I want to feel comptetant and in control. Med surg with 8 pts gives me the creeps for this reason. I want to feel like I am giving my pt's the best of me. I am not good at multitasking.

I want to feel competant-knowledable. I am not saying that other fields don't offer this I am just not sure i can be a "jack of all trades master of none" person. I know that in the begining I wont know what to do in the NICU but eventually I want to for the most part be able to say "I've seen it all and I know exactly what to do" That way i can just focus on making what we do now better and learning the new evidence based practices, technology etc. I like to know the "why" and understand all of the patho and pharmacology. I like dealing with complex cases and critical thinking. I also feel like NICU nurses get a lot of autonomy compared to others but I am not sure of this.

I like the idea of going to other settings during the day too. (such as transports, high risk deliveries etc.) Variety is good and keeps things interesting of course.

The things I am most worried about are dealing with the high tech environment (which will become less intimidating I guess after I am trained how to us it), dealing with emergencies (will I do the right thing, will I miss something??) and what about other nursing skills for adults such as IVs, foleys etc, will I lose those? Also, no offense (it probably helps make a good nurse)but I heard that NICU nurses were type A and kind of "anal" and I am not so much. Does that mean that I have the wrong personality type for the NICU? What do you NICU nurses think, am i on the right track? Thank you so much if you read this!!!:bowingpurEveryone asks for help but It takes a selfless person to put time and effort into helping people behind you find their way too.:redbeathe :loveya::redpinkhe

[NeoNurseTX, RN]

rae..your reasons for wanting to nurse in the NICU are all valid, but this one statement is a bit off course! If ONLY I ever had only two patients! This week, we had four staff come on to 19 babies, which included two sets of unstable 25 week twins. The help we get is minimal, and whilst looking after one set of tiny twins, I had to pick up stuff from the other sick wee ones in the icu! I cant remember the last time I had a 1:1, 2:1 shift.

If you want a job where your bum doesn't hit a seat for 14 hours straight..then this is the job for you! Saying that, I would not swap my job for all the tea in China!!! If you go there and love it like I do, then no matter how tired , absolutely bushed you are, you will feel achievement, even if you are too tired to drive home!

Good luck to you babe, just don't equate neonates with easy assignments, its still backbreaking stuff, you need to be a contortionist to bend your back into loading pumps etc!

And in the Special care part of the unit..seven or eight babies to one staff member happens..and babies don't reason with you...when they need attention....they NEED attention!

In Control??? Who said anything about being in control??

Whoa, 8 babies in special care? I used to float to newborn nursery and a busy night was 8 babies! And most of them were in the room with mom.

Some nights I feel like I sit all night, some I don't sit at all..We are mostly 2:1 and every now and then 3:1 if you're on the more level two-ey side of our NICU. 1:1 every now and then or if they're overstaffed and you're first admit. We would NEVER have 4 babies in level III or over 4 in level II. Wow. And when we're understaffed, transport, charge, pod mates, etc will help out. You couldn't pay me enough to work wherever you are because it sounds like a lawsuit waiting to happen...eeeek!

[RNin2007]

Lots of agreement with PPs, as a mom of 3, and mom to two micro-prems, NICU is definitely not a place to work because *you love babies* (as was said), however it sounds like you have thought it over well and are on a great path! I love my job and can't imagine do anything different for many of the reasons you describe. :) GL and keep us posted.

[littleneoRN]

Whoa, 8 babies in special care? I used to float to newborn nursery and a busy night was 8 babies! And most of them were in the room with mom.

Some nights I feel like I sit all night, some I don't sit at all..We are mostly 2:1 and every now and then 3:1 if you're on the more level two-ey side of our NICU. 1:1 every now and then or if they're overstaffed and you're first admit. We would NEVER have 4 babies in level III or over 4 in level II. Wow. And when we're understaffed, transport, charge, pod mates, etc will help out. You couldn't pay me enough to work wherever you are because it sounds like a lawsuit waiting to happen...eeeek!

Oh my goodness, I totally agree. OP, it's important to find out about staffing if there is an NICU that you're interested in working in. The description of 4 nurses and what, 19 babies, does not sound safe or normal at all. I work in both our Level II and Level III areas. We have a relatively high acuity, I think. We are never ever more han 2:1 in Level III, even with babies who are waiting for beds in Level II. There needs to be hands on deck for emergencies! :) I think we are more liberal with our 1:1 assignments than most places...it's pretty common to be 1:1. And we would most definitely not pair an ECMO (or an oscillator, or a jet, or a PD, or pretty much any unstable baby) with any other baby. In our Level II area, it is standardly 3:1 for the more true Level II patients and 2:1 for the more complex step-down kids. The occasional 4:1 happens if there are ill calls etc., but working full-time, I haven't been 4:1 in more than a year. I don't think it is ever a good idea, especially as a new grad, to work somewhere with bad staffing. It puts babies at risk, makes families uncomfortable, puts you at risk, stressess you out, and minimizes your opportunities for learning and help from other more seasoned nurses. It sounds drastic, but I would sooner mover out of state or take a job with adults (horrors:chuckle) than work in a poorly staffed NICU. Often when new grads come on here to talk about tough experiences with new jobs, it seems they either mention poor work culture (e.g. mean people) or bad staffing that gives you more than you're ready for when you're new. So as you look for a job, I just want to encourage you ask about staffing. Good luck!

[NeoNurseTX, RN]

Oh my goodness, I totally agree. OP, it's important to find out about staffing if there is an NICU that you're interested in working in. The description of 4 nurses and what, 19 babies, does not sound safe or normal at all. I work in both our Level II and Level III areas. We have a relatively high acuity, I think. We are never ever more han 2:1 in Level III, even with babies who are waiting for beds in Level II. There needs to be hands on deck for emergencies! :) I think we are more liberal with our 1:1 assignments than most places...it's pretty common to be 1:1. And we would most definitely not pair an ECMO (or an oscillator, or a jet, or a PD, or pretty much any unstable baby) with any other baby. In our Level II area, it is standardly 3:1 for the more true Level II patients and 2:1 for the more complex step-down kids. The occasional 4:1 happens if there are ill calls etc., but working full-time, I haven't been 4:1 in more than a year. I don't think it is ever a good idea, especially as a new grad, to work somewhere with bad staffing. It puts babies at risk, makes families uncomfortable, puts you at risk, stressess you out, and minimizes your opportunities for learning and help from other more seasoned nurses. It sounds drastic, but I would sooner mover out of state or take a job with adults (horrors:chuckle) than work in a poorly staffed NICU. Often when new grads come on here to talk about tough experiences with new jobs, it seems they either mention poor work culture (e.g. mean people) or bad staffing that gives you more than you're ready for when you're new. So as you look for a job, I just want to encourage you ask about staffing. Good luck!

ECMO and HF vents one to one? Must be nice! Our PDs are always one to one, but nothing else unless crazy unstable/able to die and even then...

[littleneoRN]

Yea, for kiddos on ECMO we have a pump nurse and a patient nurse, and the patient nurse is never ever paired. We have lots of kids on conventional vents who are also 1:1, depending on their stability and comorbidities.

[NFB2008]

In the level 3 NICU where I work, we have gotten pretty strict staffing regulations in place (started before I started there). We never have more than 3 babies. Obviously this varies with different NICUs. I think that you definitely need to like babies to work in a NICU (and be very patient). I heard that the previous manager for my unit (before I was hired) wouldn't hire a nurse if her reason for wanting to work there was liking babies. She wanted someone who was interested in working in an ICU.

And it will be SO overwhelming when you start out, but you will probably get a longer orientation (compared to say med-surg). They want you to know what you're doing. I would say if you know you want to work there just go for it. I am thankful every day that I got hired in my unit. I can't imagine working anywhere else. Even when there is a scary experience, you learn from it. And the next time you have that experience, it isn't as scary.