01.01 Day in the Life of a NICU Nurse

Hey guys, I want to take you through a day in the life as a NICU nurse and kind of what the layout is and the good, the bad, and the ugly of being this type of nurse in case you have interest in it. So first let's talk about who you're caring for. So the little, and I mean literally they are so little, sometimes they could fit in the palm of your hand. But other times they're a big chunky baby that just can't breathe well. Uh, the defenseless. So this is really important. They have no immunity, right? They're born, they are completely defenseless. So you have to be there and help them through this process. And then the amazing, literally I've had kids that one second, I think I'm going to be coding them cause they're really deteriorating and not doing well. And then within a few hours or the next day, they have fully recovered and are a totally different baby. Um, which means you really always have to be on your toes. Then you can have your toes and being ready because even if they can improve really quickly, they can also get worse really quickly. So I want to go through a few things that are really important to know. So people always think we're just rocking and feeding babies. If I had a quarter for every time somebody said, "Oh, you get to hold babies all day", no, not the case. So this was not just rocking and feeding. I mean, you are taking care of some really sick, sick babies. You have to have really good assessment skills. It's really important because you want to be able to, um, catch the deterioration or notice if things are going South.

They're not able to speak to you. They can't talk and tell you what's going on or how they're feeling. So you have to be able to use these assessment skills to really gather that information and figure out what's happening. And then another, um, little skill that you'll need is NRP a meander resuscitation program, also known as NRP. So this is kinda like your BLS CPR, but it's for babies and it's for how you go through the resuscitation process and you can check out, we have a lesson actually on this in one of our courses that'll kind of give the lowdown of what NRP is. All right, so a typical day, so I should have put here a first, you're gonna be washing your hands and this is a three minute at least, hand wash. It is the longest 3 minutes of your life. You're scrubbing your hands from your elbows down to your hands. Really getting cleaned cause our hand hygiene is so important cause remember these little guys are so defenseless. We are going to be getting report. So bedside report so that you can go to the bedside, you can see the baby, you can see lines, you can see if there's a vent and you can see what fluids are that are going, all of that. And it's a time to kind of double check with the night shift nurse or day shift nurse to make sure everything is good before that nurse departs. Next you're going to plan your assessments. So normally in other units, you'd probably get report you then you just jump on it, you get onto your assessments. Well, that is not the case for these kids. You want to plan your assessments with hands-on time.

So what that means is we're clustering our care so they will give you in report that this baby is, um, we call it a nine to 12, three, six or they're an eight 11 to five. It is their hands on time. So this means that at 9:00 AM this baby eats, gets its diaper changed and has its full assessment where another baby might be at 8:00 AM and then it's three hours later that you go and you do the next hands on time. So you are going to plan your assessment without hands on time. You don't want to go disrupt this baby, um, at seven 30 in the morning when they don't eat again until nine, there's no need to do that. They need their sleep because their sleep helps with brain development. So it's really important that we don't interrupt that and that we go with the hands on time.

Alright so management of care, so this just means you are going to be looking at their IVs or any other lines that they have. If they have vents, do they have meds that are, do things that need to be assessed and checked or given. So you're gonna do your care management, um, and plan that around with that hands on time. Also in a typical day, attend emergent deliveries. So different NICUs are going to be set up different ways. Some NICUs are maybe going to all meconium deliveries or if we're having a C-section, some hospitals, the NICU nurses go to all C-sections. That's not the case in mine in my hospital. The NICU nurses attend emergent delivery, so if they're invited by the doctor, that's what we call it. If there's a problem that we're worried about or if it's like a stat C-section emergency, I'm in, the NICU nurse will attend.

So that kinda could come at any time. You can't really plan for that, but there's going to usually be one nurse that's assigned that job to go to these deliveries. Okay. And then it's always important to be ready to act. Like I said, you always have to be on your toes. There's keen assessment skills and ready to jump in and help because like I said, they can go South really, really fast. So let's look at a couple special considerations. So we should wear nothing from the elbows down. This is strict hand hygiene. Um, so no rings or they'll sometimes let you do one, um, like silicone band or one band that has no diamonds in it or anything that would Harbor bacteria, um, no watches, nothing. Um, because for that hands on care, we don't want any germs and bacteria to get to that baby quiet. 

So you'll notice if you walk into a NICU, it is very quiet. The lights are turned down, so it's darker for them to help decrease that stimulation. And that's what we want. We want to decrease the stimulation for these babies so they can rest and they can grow and develop the way that they should. And other special consideration that you would need working in the NICU is a neonatal stethoscope. So literally the bell of the stethoscope is like this. It's so small a teeny tiny. So you will need that. But a lot of places will supply the stethoscopes and each baby will have its own stethoscope to cut down on bacteria and germs from being spread from baby to baby. So that way the stethoscope stays with that baby during their hospital stay. All right, so some challenges to tell you all about.

So remember, we're not just rocking babies, right? These babies are sick and things can happen. Death does happen in the NICU. So you need to ask yourself, is that a challenge that I can handle? Can I put up a wall enough? Can I deal with this? You know, you're going to have one NICU room and then you'll have your other patient here and things might not be going so well in this room. And when you walk over to this room, you have to act like everything is fine. So death happens. So just be aware of that. It's not always happy. There are tons of happy moments. These babies graduate from the NICU and they go home. But there are times where the unexpected happens. Um, and even the expected, but either way it can be hard. So just ask yourself, can I deal with that?

Another challenge is detecting deterioration. This is going to come with time. You do have to be able to detach this and know what to look for. So looking at the monitor, I'm watching those heart rates. If your heart rate's getting elevated, kind of being able to critically think what is going on. So the families, they never want their baby to go to the NICU. Some of them, maybe the baby already had a known heart defect. So we already need the baby is going to go to the NICU. That's a little bit better perceived by the families, but then you're going to have families that thought they were having a normal delivery and the normalist things go wrong.

The unexpected NICU admission happens and that can be hard. Um, also there's things unexpected. Things like babies being born with chromosomal abnormalities or congenital defects that were not detected in utero. So it's hard cause these families are dealing now with this NICU admission as well as a different diagnosis for their baby. And then you have to always be ready. Like I said, always on your toes. That's the biggest thing. You can never really just let yourself calm down and settle when you're at work. You have to be ready cause at any moment you could get called to that emergency or your baby could start to spike a temperature or have something else happen that you have to pick up on. All right guys, I hope that you have learned today a little bit more about the NICU. If you look at this picture and think that looks fun, this might be the right field for you. Thanks for joining me today and we love you guys. Now go out and be your best selves today and as always, happy nursing.