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An extremely common question I get in dms is what in the world a NICU nurse does. Fresh out of school, I think that I offer a well-rounded perspective on working as a nurse in the NICU versus for example, most adult nursing floors. Procedures you thought you knew how to do/assist with are completely different, administering medications is a new ball game, and your medication calculations are in very small increments, in my opinion making them more challenging to calculate.
Although working in the NICU may not be for everyone, after getting pulled to adults just yesterday to work, I was reminded that NICU is right where I belong, the area of nursing that has my whole heart.
I could go on all day of why I chose the NICU and what I love about it, but that is a topic for another post! This post I am going to strictly keep a schedule of my day on a typical day of work. This may look different depending on your baby assignment, acuity of the babies you are caring for, and procedures/medications that require extra time or preparation, however, I will try to outline an ideal and very normal/mellow day of my job, and hopefully it will give those of you interested in this topic some insight into what I do every day.
For purposes of simplicity, I will outline a typical day shift. In the NICU we typically work 12-hour shifts (7am-7pm or 7pm-7am).
So I get up at 4:30am each day I work, do my whole morning routine (outlined in a previous post Daily Routine) and head out for work around 6:30am. I live like 5 minutes away from the hospital, so that is why I leave so late!
When I get to work (around 6:45 by the time you get up the elevator) I clock in, drop my stuff of in the break room, and then head to the sinks to scrub in. Anyone entering the NICU - worker, parent, or visitor - has to scrub with soap and hot water for 2 full minutes from fingertips to elbows. Then we mask up (thanks COVID!) and go into work for huddle & report.
In huddle we get report sheets and look at our patient assignment for the day, the charge nurse communicates any pertinent information to us, such as how many discharges and C-sections for our shift, safety messages, or policies that have changes or need reinforcement. Then we go get report on our patients for the day, at the patient bedside, from the night nurse.
Report includes everything from history, assessment schedule, respiratory status, procedures and results, feeding volumes, duration & type of feeding (breast milk - donor or maternal, or formula type), to just about anything else you would need to know about the baby in order to care for them appropriately. Typically this takes until about 0745 depending on how extensive your babies' histories are and how many babies you have for the day.
After report I always go into my patients' rooms and perform all of my safety checks, such as if their bag/mask is working in the event that you would have an emergency where you would need to bag the baby, checking to make sure your suction is working, your monitor alarms are set per protocol, that their code sheet (a sheet with all dosages for emergency medications in the event that they would code) is up and is for the correct patient, as well as verifying that they are wearing a name band.
After safety checks it is time for your 0800 assessment. Babies in the NICU are generally on a 3 hour assessment/feeding schedule. Of course there are exceptions such as only assessing every 6 hours for critical babies that stress from too much stimulation/touch, feeding ad lib for those babes that are stable enough to know when they want to eat and how much, and all sorts of other individual situations, but for sake of simplicity, let's just pretend every baby is on a 3-hour schedule for this post.
So for this post we will pretend you have a 3 baby assignment, all bottlers and off respiratory support.
So Baby A is your 8,11,2,5. Baby B is your 8:30, 11:30, 2:30, 5:30, and Baby C is your 9,12,3,6. This is a busy day! Typically this will be an assignment if all 3 babies are on anything less than CPAP. Once a babe is on CPAP, the assignment becomes 1 nurse per 2 babies rather than 1 nurse per 3 babies.
So you assess baby A at 0800, making sure you go grab their milk to warm it while you assess. Then you begin your assessment, counting respirations, listening to heart, lungs, and tummy for bowel sounds, palpating for pulses, feeling the head for suture lines, and the tummy for softness/fullness, observing the baby for color, tone, positioning, wakefulness, feeding cues, etc. Basically assessing a lot of things! Then taking a blood pressure, temperature, and changing the diaper. Then it is time to feed the babe. You are allowed to bottle babies for 30 minutes, unless a specific order outlines otherwise. So you take baby A out of their crib/isolette and you bottle for a half hour (usually in a side-lying position so they can self-pace easier). After you bottle, you put them back into their crib or isolette after you burp them. You then get your booty over to your next baby because you are already behind.
After bottling you usually have to move on to the next baby in a 3 baby assignment, but if you only have a 2 baby assignment (8,11,2,5 and 9,12,3,6) I chart before I go to the next baby. Plus your 2 baby assignments will never be bottlers, as babes can't bottle on CPAP or higher, so you would then instead of bottle them, measure out their feeding in a syringe, connect extension tubing, and program a feeding pump to feed them through their NG or OG they will have in place for feeding and medication purposes.
You then repeat everything you did on baby A on baby B and C (assuming they are all the exact same, lol very unrealistic) and then you sit down and chart all 3 babies. When I have a 3 baby I always chart as much as I can during their assessment time so that after all 3 assessments/feedings are done, there is less for me to chart and remember! Also I start my 0800 as early as possible because if you have an 0800, 0830, and a 0900 that are all bottlers, there is no way to get everything done for each baby in just 30 minutes. If you factor in that your assessment will take you 10 - 15 minutes, each baby will take you 40 - 45 minutes to get done. Time management on these days is huge! You are also needing to go check each baby every hour to count respirations and do a little mini assessment of vitals & overall well-being to make sure nothing changes in their status hour-by-hour.
To break it down, if you start at 0745 for baby A and finish by 0830 (45 minutes) and you spend 45 minutes with each baby, your predictable and perfect day (assuming everything stays perfect all day, ha!) would look like this:
Baby A (your 8,11,2,5) Assess + Bottle 0745 - 0830
Baby B (your 8:30, 11:30, 2:30, 5:30) Assess + Bottle 0830 - 0915
Baby C (your 9,12,3,6) Assess + Bottle 0915 - 1000
Chart your buns off for your one round of assessments from 10:00 - 10:45 because you repeat this all over again at 10:45, and then twice more until your shift is over.
In this time then you need to find time to wash your bottles, write care team notes, and care plan on all your patients for your shift. To say this is overwhelming is an understatement! But it is totally possible the more you do it! Just pretty darn busy. These days humble me, and my coworkers are amazing and I love them, because these days would be impossible without their help and guidance!
Not every day is this crazy! For babies on CPAP it is the same schedule, but eliminate baby B and that is your day, pretty dang good! On those days you do your assessment, connect their feeding (since they typically don't bottle), chart your assessment until the next baby is due, then repeat for your second baby; then you have an hour to care plan or write notes or whatever! Super duper nice.
For babies on respiratory support you have to take off their respiratory device and assess the skin for every assessment as well, maybe switch out mask or prongs based on their schedule (for CPAP babes) and massage their little head because all of their headgear gets a little uncomfortable I would imagine.
Within the day, you take a 30 minute lunch break as well! I usually take mine at 1pm on a 12 hour shift.
After your day is over, around 6:45 I like to update the babies' charts with the happenings of the day and then when 7pm rolls around you give report with the oncoming nurse and then you get out of there around 7:30pm on a normal day.
Some extras you encounter based on your day (or night) is that on night shift, often you will have to fit in a bath for your babies during one of their assessment times. And if they have labs due you draw those at their 5am/6am assessment time usually. Labs & baths are done on nights, as well as steaming bottles, also done at the 5am/6am assessment time.
On day shift if your baby is on TPN & Lipids those will be hung after 5pm, and that is a bit of a process, maybe a full blog post should be dedicated to it!
All-in-all, I go home from every shift knowing I made a difference that day, no matter how exhausted I am; and that feeling is irreplaceable.
I hope that this post gave you some insight into what I do, and if you have any further questions feel free to put them in the comments so I can answer them, or reach out to me on the contact me button, or on instagram (@mindfullymolli) in my dms to get those answered for you.
NICU nursing is a work of heart. I am so glad mine has finally found its place.
you are blessed. you are gifted. you are loved and appreciated, just as you are.
mindfully, molli
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