A day in the life of NICU Nurse

Neonatal Intensive Care Unit or NICU is a unit that specializes solely in the treatment of newborns. The NICU combines advanced technology with trained health care professionals such as the neonatologists, pediatricians, nurses, therapists etc. to provide specialized care to these little ones. 

A Neonatal Intensive Care Unit (NICU) nurse as the name suggests takes care of sick babies. These may either be premature babies, babies with some defects or severe illness. Most NICUs may have different levels that will admit babies either for observation, specialized care or have very critically ill babies and working here as in any other intensive care units can be stressful and emotionally draining at times especially if the little one does not make it

Life inside the NICU

In the NICU success comes in small size and measurements such as grams of weight gain or milliliter of feed increased. The schedule in the NICU is quite structured.  Each nurse may be assigned 2-3 babies depending on the severity of the condition. 

A typical day in the NICU begins with taking over from the previous shift nurse, gathering complete information about the baby and checking if the IV or NG tubing’s and other connections are in place. The babies may be attached to a monitor and a ventilator so the nurse needs to check the placement and the settings. The nurse then proceeds with the planned care. Usually cluster activities are done such as giving the feed, checking vital signs, changing the diapers, administering medications etc. to avoid frequent touching as it may make the baby uncomfortable. The nurses usually do not cuddle the baby as it is reserved for the parents. Some babies may be so sick that they cannot be cuddled, in this case they are gently stroked by the fingers. 

Assessment and monitoring of the baby is a continuous process. The nurse also spends time with the parents providing them information on the progress of their little one, teaching them how to touch the baby and of course the much-needed psychological support. The NICU nurse not just takes care of the baby but the parents too as they are going through a challenging phase. She spends time listening to the concerns of the parents and lending a shoulder at times as they cry their heart out. The NICU nurse shares the joy of the parents as their little one makes small improvements and the sorrow too when the condition does not seem to be improving. Depending on the condition of the baby, some routines may vary for each baby for e.g. some may need frequent monitoring of the carbon dioxide levels, some may need frequent blood checks and some may need an x-ray. It is the responsibility of the nurse to ensure that all required investigations and care for the baby assigned to her is carried out by the end of her shift. She clearly documents all the care given and the condition of the baby as per the hospital protocols. 

To sum up the responsibilities of a NICU nurse includes

  • Continuous monitoring of the baby
  • Blood draws (heel stick, arterial)
  • IV cannulation and infusion
  • Medication administration
  • Blood product administration
  • Feeding-Naso, orogastric or bottle feeding 
  • Oral or endotracheal suctioning 
  • Assisting in intubation, resuscitation or other procedures
  • Attending and admitting high risk deliveries
  • Provide psychological support to the families
Challenges of being a NICU nurse

Caring for a sick neonate can be emotionally draining, because at one time the baby may look fine and the next moment they may slip into coma. Sometimes we may do all that is in the best of the capacity but still find no improvement in the babies’ condition. And after all the efforts if the baby does not survive the grief experienced by the nurse can be significant. This becomes even more difficult when the baby has been in the NICU for months and she has developed a close relationship with the family. The nurse may experience a burnout. The nurse needs to practice care and compassion while maintaining distance. 

NICU nurse checking baby
At the intensive care unit. Nurse standing near hospital bed with a baby preparing it for treatment.

Being an NICU nurse also requires that a nurse be alert and observant all the times and in all the care that is being provided e.g dosage calculation, IV administration, feeding the baby. A wrong step may worsen the condition of the already sick baby. This can lead to overwhelming pressure as the nurse needs to be really alert and focused at all the times. 

At times the nurse may also be face with ethical dilemmas when decision to continue care of a very sick baby is taken by the team. 

Do you have in you to be a NICU nurse?

To be a NICU nurse you would require specialized skill sets such as being quick and alert in your care and observations throughout the shift. The condition of the babies may deteriorate suddenly and the team may rely on your critical thinking skills and judgement.  You should be able to practice compassion especially with the parents of the babies you are caring for. You would need a lot of patience in not just caring for the baby but handling the stresses, scared and worried parents. You also need to have updated knowledge on the developmental milestones as well as caring for premature babies, babies with congenital defects and the various disorders seen in new born. Above all you should have the gentleness in handling a tiny fragile baby. The physical stress that is experienced while taking care of babies is less as compared with caring for an adult but the emotional stress can be high and you should know how to have a control over your emotions

Additional certifications such as BLS and NALS will be an added benefit.  

So, If you enjoy being near babies and you have the above skill sets then working in an NICU can be a good option for you.

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