It is very challenging going from being a near expert, or at least proficient, nurse on one unit where you’re charge nurse, preceptor, and everything in between to essentially feeling like a new nurse all over again. That’s how I felt when I left cardiology to go after my dream of getting into the NICU (neonatal intensive care unit or newborn intensive care unit). So, no, I did work in the NICU as a new grad. I started in the NICU after I had already been a nurse for five years.
I still consider myself very new to the newborn ICU and as a newer NICU nurse, these are some of the things that have helped/ would have helped me during my transition:
1. Ask Questions
If you don’t understand why something is happening, what something is, or what it means, ask questions. «THIS IS HOW WE KEEP OUR PATIENTS SAFE». Yes, there will be nurses who “eat their young” and make them feel less than. Remember this: They are the foolish ones, NOT you. As a standard, nurses have an obligation to work together collaboratively, supportively, and as a TEAM. Find a few nurses that you trust and that make you feel supported when you come to them with questions.
2. Take Notes
Keep a small notebook, that’s easy to carry with you, and use it for keeping track of normal lab values, signs of respiratory acidosis/metabolic acidosis, etc. When you are going from adults to neonates, remember, lab values and procedures may be very different.
3. Listen Up
When the Providers (Providers = neonatologists, physicians assistants, nurse practitioners) are doing rounds, discussing cases, looking at xrays, etc. listen to their conversations, look at the films, and jot down things you need to learn more about.
4. Practice Starting IVs
Whenever you are able, jump in and ask if you can start the IV. The more you practice, the better you will become. Pretty soon you will be known as the unit’s go-to person for IV starts and that’s dope!
5. Double Check
We give a lot of medications in the NICU (anything from vitamins to ampicillin, morphine, fenobarbital, fentanyl, chlorothiazide) and most of them are weight based. We’re talking medication calculations based on weights like 1.5 kg and smaller! Correct dosing is critical. When your Providers put in medication orders- double check their math before you administer the medication to the baby!
6. Include The Parents
Most parents love being involved in any way possible (and safe). So not just explaining to them what you are doing, but let them get hands-on with their baby! Of course everyone knows about skin-to-skin, but also, when safe and according to your unit’s policy, let the parents take the baby’s temperature, place them on the scale for weights, feed them, or do diaper changes. Also encourage the parents to read books to their babies, even if the baby is in an isolette! For parents, it helps with bonding and fosters the feeling of, “Even though I cannot take my baby home and I may not even be able to come see them every day, but this is my baby and I do have something to contribute.”
7. Listen To Your Gut
If you think something is wrong or if something doesn’t feel right, say something. Notify the Provider ( and document the conversation).
8. Practice Critical Situations
Depending on the level of your NICU and the regular acuity of your patients, you may or may not see high risk cases often. If you do not have regular and frequent exposure to high risk newborns, ask your supervisor or your unit’s clinical educator to run monthly simulations (“Sims”) where you can act or situations. Role play things like: a 28 weeker is born not breathing, what do you do 1st, 2nd, and 3rd? If a baby self extubates, what do you do 1st, 2nd, and 3rd? If you work in a level IV NICU, you will probably take care of high risk babies each week. However, if you work in a level II or III or a hospital with low frequency or a small number of beds, you can go months without getting a baby on a vent or with a chest tube, or even a baby under 30 weeks. It’s hard to become an expert at something you’re new to if you only do it once every three months. Be an advocate for yourself and the other new hires after you, by asking for monthly Sims. This will help you on a personal level, ensure safer care for the babies (because you’re more competent), and increase your coworkers trust in your skills. Also, ask if your hospital or any hospitals nearby provide STABLE and memorize MR SOPA.
9. Yes, It’s Scary At First
Yes, transitioning into the NICU is scary at first, and even now sometimes it still is.
10. You Will Be Tested
Sometimes the most trying part of a new job can be the adults. They will all test you- the nurses, the Providers, respiratory, and even family members! Remember, it happens to everyone. You will be tested emotionally and mentally. You will hear very upsetting stories- violence, abuse, neglect, infants born addicted to illicit drugs, and unfortunately, infant death.
So Take Care Of Yourself
#10 leads me to my last point- take care of yourself. We get four off days because we NEED THEM. Relax, have fun, eat good food, exercise, get a massage- do things that replenish you.
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