As a neonatal nurse I had an exciting career helping neonates and parents adapt to the challenges of having a critically ill infant. Although many of the neonates I cared for were premature—some as young as 23 weeks gestation, others were born with a genetic defect or experienced a difficult birth.
A career in neonatal nursing is challenging and rewarding. Neonatal nurses have a variety of responsibilities some of which include: attending high-risk deliveries, caring for neonates, teaching parents how to providing developmental care, starting and administering IV medications, examining x-rays, assisting with intubation, and collaborating with parents.
Here is a glimpse into a ‘typical’ day for an RN in the neonatal intensive care unit (NICU).
A Day in the Life of a NICU Nurse
Report for duty. The shift begins at 7 am but it’s important that nurses get there early so they can acclimate to the environment before the hard work starts.
The shift begins with the charge nurse making patient assignments. After nurses are assigned patients they are ready to receive report from the nurse on the night shift. Patient reports in the NICU are detailed because neonatal care needs to be holistic, developmentally appropriate, family-centered, and medically sound.
Now patient care begins. The NICU nurse completes morning assessments on their patients, receives new physician orders, and prepares the workspace and patient for any scheduled procedures. This is typically a very busy time for nurses on the unit.
Depending on the acuity of the neonates the nurse is assigned they may need to assist the infants with parenteral, nasogastric, or bottle feedings. Some premature neonates will be kept NPO until they are physically ready to handle formula or breastmilk and require lipids and total parenteral nutrition to meet their energy needs.
Since many of the babies in the NICU are premature they often have feeding difficulties. NICU nurses are skilled in various bottle and breastfeeding methods. Proper care and feeding of the neonate helps to ensure they receive the nutrition they need to grow and develop.
During this time many neonates will need standard medications like vitamins, antibiotics, iron, and caffeine. Of course, neonates who have more complex medical needs may require medications like dopamine to stabilize their blood pressure or insulin to lower their glucose levels. There are a large variety of illnesses, genetic diseases, and birth related conditions neonatal nurses treat in the NICU.
Support services typically visit the unit on the morning shift to provide occupational therapy, physical therapy, perform echo cardiograms x-rays, or insert PICC lines. There are a variety of support services that bring their equipment to the NICU so the neonates do not need to travel out of the unit. Nurses in the NICU assist support service professionals as they provide their services and physician as they perform minor surgeries on the unit.
With all the excitement on the unit NICU nurses get a chance to recharge during their 30 minute lunch break. They can use this time to relax and socialize with co-workers or take a walk to the cafeteria to unwind from the busyness of the unit.
After lunch the atmosphere of the unit may quiet down or there may be an emergency delivery or change in patient status. For the most part NICU nurses spend time providing direct patient care, teaching parents about basic infant care, assisting parents with kangaroo care, or creating an atmosphere where infants can sleep in a developmentally appropriate environment.
During this time in the energy levels among nurses start to rise because they are getting ready for the end of the shift. Neonatologists are making their final rounds before leaving for the day and may write new orders or change current treatment plans.
Nurses are providing patients with interventions that will hold them over until the next shift arrives. Parents may visit the unit during this time because their children are home from school or they are finished with their work day. For the NICU nurse it is time to continue assessing, monitoring, and providing care for the neonates.
After NICU nurses complete their final assessment, provide all patient care, and complete final documentation it is time to prepare for shift change report. The shift ends by giving the new nurses shift report–ensuring that the neonates receive a continuity of care.
Being an NICU nurse is filled with excitement, stress, and personal satisfaction. Not only do NICU nurses get to care for neonates and their families they are also on the front line of improving the quality of neonatal care.
NICU nurses are an important part of the multidisciplinary health care team who skillfully treat sick infants and provide emotional support to their family members. If you are a hard working, caring individual with a desire to improve quality outcomes of patients and their families consider a career in neonatal nursing!