In the NICU, life can change in the blink of an eye. One minute the unit is calm and “q-u-i-e-t,” and the next, a crash C-section is performed and a 26-weeker is being transported to you and your entire team comes together in order to make the admission as smooth as possible. It’s safe to say that the NICU is either feast or famine. The unit slows down a lot during the winter and discharges more babies home than they are admitting. Then comes summer and L&D is popping out high risk babies left and right.
The job of a NICU nurse is so rewarding and unlike any other. You get to help families through quite possibly the hardest time in their lives and see the fruits of your labor grow into “line-backer” toddlers!
As a new nurse starting out in the NICU, here are a few essentials that you should know:
THE BEGINNING OF YOUR SHIFT
After clocking in to work, you meet for morning huddle. Huddle consists of the nursing team and charge nurse who meet together for roughly five minutes to give a “briefing” on the unit. This is when the team discusses general hospital and unit updates, and the plan of care for the day. This includes announcing “hot spots”—which are the sicker, more unstable babies on the unit that we need to keep a VERY close eye on. It is both a safe precaution and a time to bond with your team before you start your day.
After you meet for morning huddle, NICU nurses "SCRUB IN." Leave your jewelry, watches, rings, etc. at home. Your arms will be bare from the elbows down as you scrub with soap and water (for the duration of time that your NICU requires). NICU is "bare arms" in order to keep our little ones safe and healthy.
GENERAL NICU BABY BASICS
MEASUREMENTS: Our patients are measured in grams & centimeters.
GESTATION AND CARE: Baby age (in gestation) drives the care plan. How old they are determines their day to day care.
MEDICATIONS: Our medications are often measured in tenths of mLs. And a bolus might be 3mLs!
OXYGEN: 2L of oxygen is considered “high flow” in the NICU. Don’t panic if you see a patient with oxygen saturations in the high 70s, that might be acceptable for that patient depending on his/her underlying condition (Cardiac defect, Prematurity, PPHN, etc.)
DIET: We measure our feedings in mLs, sometimes only giving drops.
SIZING: We use the smallest blood pressure cuffs you have ever seen and sometimes those are too big! NICU nursing is delicate work.
Sample NICU Head-to-Toe Assessment
What does the baby’s head feel like?
Are the sutures separated or overlapping?
Are the fontanelles flat, soft, sunken, bulging, etc.?
Do I hear a murmur?
What do the lungs sound like? Crackles? Wheezing? Clear and equal?
How are the bowel sounds?
Is the abdomen soft? Firm? Distended? Bruised?
Is my baby’s skin ruddy (red)? Pink? Pale? Mottled? Yellow?
Is the skin warm?
Centrally cyanotic or acrocyanotic?
Are there any skin tears or breakdown?
Can I visualize bowel loops? Any discoloration?
How is the patient’s muscle tone?
Does the infant have full range of motion with their limbs?
Is the patient vigorous, crying, and “fighting” me? Or are they flaccid and do not arouse with my cares?
Questions? Comments? Concerns? Anything I’m missing, let me know in the comments below!