What Are Some of the Challenges of Working in a NICU?
Neonatal intensive care units (NICUs) are a highly specialized area that focuses on the care of newborns who are born premature or have specific illnesses/ disease processes. It takes a special type of person to face the day to day challenges of working in a NICU.
It's important to understand the various levels of NICUs to identify specific challenges:
- Level I: Basic newborn care of healthy infants. Level I nurses can stabilize babies born near term for transfer to a higher level of care
- Level II: Babies may need support with feeding and breathing
- Level III: Babies may require mechanical ventilation and surgeries
- Level IV: Care is provided to babies born at the lowest ages of viability. Mechanical ventilation and surgical procedures are also performed, including open-heart surgery.
One of the most significant challenges, especially in the higher-level NICUs, is caring for babies who are struggling to survive. Sometimes, even when the most cutting-edge technology is employed, babies may not survive. Nurses and nurse practitioners establish a relationship with not only the baby but the parents and family. When a baby does not survive, the grief and loss felt by the nurses can be significant. Nurses must be able to provide comfort to families and seek comfort from their support systems as well.
Giving everything you can to caring for a critically ill patient is also emotionally draining. The challenge of caregiver stress and burnout is also significant. Nurses may feel depressed, anxious, or irritable at home. Being able to identify caregiver burnout and finding healthy outlets for stress is crucial for the mental well-being of nurses.
Alarm fatigue is another challenge. Nurses and nurse practitioners work long hours. Critical care areas, including NICUs, have multiple alarms sounding to guide caregiver interventions. However, while the alarms are set up to keep patients safe, sometimes alarm fatigue places patients at risk. Over time, caregivers can become desensitized to sounding alarms, risking them to be overlooked, ignored, or missed. Many times, repetitive alarms lose the urgency to caregivers who hear them for hours at a time. Luckily, many facilities employ strategies to reduce alarm fatigue among the caregivers.
For neonatal nurse practitioners, long shifts may be required. Some facilities employ NPs in 12-hour shifts, sometimes 24-hour shifts in which they may need to be "on-call." Like with physicians, sleep rooms may be provided.
NICUs are a challenging place to work, but also rewarding. Being able to establish a relationship with an infant and family for days, weeks, and sometimes months allows nurses and nurse practitioners to enjoy the rewarding feeling of making a difference. Being present when a baby is finally healthy enough to go home is priceless.
Amanda Bucceri Androus RN, BSN
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