The neonatal intensive care unit (NICU) is a place that few people ever think about unless their baby ends up there. Behind the closed doors, big milestones are met every hour of the day. Parents and nurses celebrate every ounce gained, breath is taken, and milliliter drank. The NICU can be a scary place to spend time. However, if you're a nurse with the privilege of calling the NICU your specialty, you will witness the tiniest patients defy the odds and demonstrate incredible strength. 

A day in the life of a NICU nurse is unpredictable, and can sometimes be overwhelming. However, it's also a very rewarding one. At the start of the shift, you walk through secure doors to a locked unit. You're required to first stop at the sink area to remove any jewelry or extra clothing. Next, you will scrub your hands and arms from fingertips to elbows for a full minute with antiseptic, antimicrobial soap as if you are about to perform surgery. 

Discovering your assignment for the day is almost always a gamble. Will you get an easy assignment, or will you have the sickest baby in the unit today? Most NICU assignments consist of one to three patients, depending on the acuity of the baby. You may have three "feeder growers" or one very ill baby on "life support." Some days, you may find you are the admission nurse and start your day attending a very premature delivery. 

The report usually lasts 30 minutes and is highly detail-oriented. It involves the babies' history, which includes labor and delivery, assessment of each body system of the infant, feeding schedules, feeding mixtures, medications, IV infusions, ventilator or oxygen settings, and psychosocial needs of the family.

What Type of Patients Will I Have in the NICU?

According to March of Dimes, Neonatal Intensive Care Units are assigned levels that span from 1 through 4. 

  • Level 1 - Well Newborn Nursery - babies that need some observation.
  • Level 2 - Special Care Nursery- babies that require a little more advanced care, and attending to infants 32 weeks+.
  • Level 3- babies 23 weeks and up that require critical care.
  • Level 4- Regional NICU - any of the previously mentioned groups, as well as surgical procedures. 

The NICU has a strict schedule for feedings and checking vital signs while minimizing the number of disruptions. NICU days are typically divided into three or four-hour periods, depending on "hands-on" care for the baby. Babies that are eating by mouth usually eat every three to four hours, whereas sicker babies or very premature infants receive less hands-on care to reduce overstimulation. All babies are continuously monitored in the NICU, and each baby is placed on a cardiorespiratory monitor to measure their heart rate and respiration. Other babies may require constant pulse ox monitoring, invasive blood pressure monitoring, and temperature or CO2 readings. 

What Type of Skill Do NICU Nurses Perform?

NICU nurses need to be well-versed in a variety of skills, from diaper changes to IV insertions and managing ventilator settings. NICU nurses must have excellent assessment and critical thinking skills, and be able to recognize the slightest change in vitals or behavior. Alarms go off regularly in the NICU. Premature babies often forget that they need to breathe, and the nurse needs to stimulate them in order to remind them to breathe. 

Typical skills a NICU nurse might perform daily include:

  • IV insertion
  • Sterile IV changes
  • Assist with intubation
  • Oral or endotracheal suctioning 
  • Bottle feeding
  • Blood product administration
  • Naso or orogastric feeding 
  • Medication administration
  • Blood draws (heel stick, arterial)
  • Assist with chest tube insertion
  • Breastfeeding and skin-to-skin care assistance
  • Attending and admitting high-risk deliveries

RELATED: How to Become a Neonatal Nurse Practitioner

What Type of Patients Will I Take Care Of?

According to Nann.org, neonatal nurses work with infants that have a variety of complex medical needs. This includes prematurity, birth defects, cardiac malformations, and surgical issues. Patients can range from a full-term, well newborn infant requiring blood sugar monitoring to a 23-week micro-preemie on full IV and ventilator support. Patients may need to be taught to suck, swallow, and breathe properly in order to bottle feed. Another infant may have a brain injury from birth and need to be cooled for 72 hours in order to preserve the brain and organ function. A baby may also be born with drug addiction and need help with withdrawal symptoms. 

One of the common misconceptions people have about NICU nurses is that they rock and feed babies all day. While that is certainly one perk of the job, it is far from the truth. Neonatal nursing can be challenging, but it is also one of the most rewarding nursing careers.

Janine Kelbach, RNC-OB
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