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NICU Tips Please (:
Hi there! I'm not actually a mommy, but I thought that this site could help me. I am currently almost finished with school to become a NICU nurse. I'm wondering if any of you ladies have some tips for me. I want to be the best nurse I can be and really help the families. What sort of things did you guys notice that the nurses did that you really appreciated? I'd really like to know any ideas, tips or suggestions you have that you would like to see in a good NICU nurse. Thanks! (:
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Re: NICU Tips Please (:
One of the nurses and I spent a lot of time together. She watched over the girls frequently. She always made sure I knew what the latest news was (they all did, but she made sure even if I had been there before her shift started). She also asked how I was doing. At one point, I was near my breaking point, and she noticed before anyone else. She got to know me and what I needed from her.
They always made sure I got as much holding time as possible. There is nothing worse than having to ask permission to hold your child. I had to wait an agonizing 3 days before I got to hold either one of my kids. A lot of parents have to wait longer.
She always said that the nurses don't remember the babies nearly as much as they remember the parents. The babies change so much from admit to discharge and beyond. The parents stick in their minds. From our experience it is key that you give the parents the respect and patience they deserve. It is a highly stressful situation on them.
Another nurse also made sure to get footprints for us when the girls were just a few days old. We were so stressed out, scared and exhausted that we had not even thought about getting footprints. It meant a lot. When things were slow, they had little crafting sessions and would make little scrapbook signs for the babies. We kept everything, even the blood pressure cuffs and little eye covers from the light treatments.
Every parent will react differently. I think that the biggest thing to remember is that this is most likely one of the hardest times of their lives. A good bedside manner means everything.
Good luck with your career! I never appreciated nurses until I was hospitalized and had to watch my kids grow up in a hospital for the first 6 weeks of their lives. Those nurses made the difference.
All of this. Pretty much exactly.
We'll miss you sweet Debbie Girl (4.21.12) and sweet Cindy Girl (8.9.12)
All of that, yes. The footprint thing - yes. I hadn't even thought of it before they were hanging up for me. One night I asked our nurse if she had time, would she mind making handprints? Well, she took it to the next level and made us a card, with handprints and a message. I was stunned.
I learned almost everything one can do in NICU as a parent online. That didn't sit well with me, and I'd always hear other parents googling my area as they went by. I wanted to call out, you can do it, too! We weren't in a children's hospital (the second time in NICU we were) - it was the hospital I delivered at - a top ten hospital nonetheless. They told me I could bring linens. I read about bringing pictures, sleeping with items so our scent would be on them (hats and his "quilt"), bringing books to read, a blanket for over the incubator, etc, etc. All those personal touch things that we're dying to provide!! I didn't know I could bathe him until nearly a month there! :O
Another thing that stood out was nobody said he was cute in the beginning
I was already shocked that there he was - long baby with skin hanging from his bones and he was a freak. It wasn't like typical "well baby" nursery where people oogled and oggled...I wish someone had said, he's beautiful, or lovely baby. Something normal. Lie to me, I don't care.
When our bay was slow for a few days I brought in my baby books because one of his primaries told me that parents could do prints themselves (again, who knew). I am still in touch with this nurse ... she gave me my first day of laughter with my son. He was all mucked up in ink and making all these faces - the prints came out incredibly imperfect but I adore them. I laughed and laughed and realized I'd never felt happy since his birth. Later I cried, but they were a mixed bag of emotions.
His other primary told me things I might run into - like shifting babies around so I wouldn't panic. She had come to understand my personality and was gentle. I really appreciated that.
We had a lot of good nurses - they were all great - there was one bubble head but I think she just subbed in NICU and lived in L&D. There were only a few that were above and beyond.
So sleepy, sorry this is foggy.
It also made me so happy to see nurses interact with the babies during spare time instead of gossip. We hear you, we see you, we might look in a fog, but you can bet I had eagle eye over all the other babies because watching them being cared for without a parent there spoke volumes about how my son was probably being treated.
1) Don't assume that because the parents don't ask to hold/feed/change/bathe that they would rather have you do it. Initially, DH and I didn't know what we were allowed to do, so we didn't do anything until a nurse asked "would you like to hold/feed/change/bathe her". The answer is, yes, we would. We would be hanging out at home rather than the NICU if we didn't want to do those things.
2) Growth/weight always interests us. I remembered the nurses who as soon as we walked in said "Hi, Corinne weighed xxx this morning, and xxxx happened."
3) After feeding/changing/checking on the baby, some babies get agitated. I always appreciated the nurses who took the time to "cradle" the baby to calm them after performing one of these tasks, rather than just doing the task, and leaving the room. One of my favorite nurses, as we were walking out, I saw her holding a baby, who wasn't on her rotation. She said that she her heard him crying, and wanted to comfort him. So, even though she could have gone down the hall to socialize with the rest of the nurses, she chose to take that time to comfort a baby that wasn't even assigned to her. It spoke volumes. One thing that really bothered me, was one day, there was a group of about 5 nurses, all socializing at the front desk. As we walked back to DD's room, we passed two rooms that had screaming babies in them, and no one around for miles.
4) A few times, the nurses created little cards for us with her name and a few pictures they took the night before. Those were awesome, and and now sitting in her memory box.
BFP #3 via cancelled IUI ~ C (2lb 3oz; HELLP) 5/16/11
BFP #4 via the natural (free!) way ~ E (8lb 11oz) 9/13/12
THIS! At first we didn't know what we were allowed to do/not do. The NICU is a totally foreign place to most people. Don't assume parents know anything about the NICU or having a preemie. We sure didn't and we missed out on a lot those first few weeks because no one explained things.
All of this. Our baby had a sign over his area saying "minimal handling/stimulation" for the first several days, and one time I was told by a nurse when I arrived (not M's nurse) to make sure I didn't bother him because he had been really upset before and they had just finally gotten him settled down. I understood her, but it really upset me to hear, because 1) she was essentially telling me that I couldn't interact with my son and not to bother him, and 2) now I knew that he had been upset AND I wasn't around to help him (not that they would have let me anyway).
Another time my husband and I arrived to find our son crying all by himself, and his nurse was working intake on a new baby. We sat there, staring at him, willing him to calm down, because we thought we couldn't bother him (no one had told us otherwise). Eventually, maybe 20 minutes later, his nurse came by and said, "oh, you can hold his hand if you want, you don't have to sit there." ?!?
It was such a surreal experience and because our son's situation and needs changed from day to day, we really never knew what to expect one day to the next. I know it will be hard at first to get to know the parents and their needs, particularly if the babies you take care of change from day to day (seemed we hardly had the same nurse), so maybe assume the parents need guidance. Or at least check in with them as soon as you can.
Kudos to you and best of luck with your career!
Ten months: Mr. Giggles!
A10 March Siggy: Next vacation - Maine!
kikijbunny (formerly kikijbird)
Our jbunny born April 17, 2011 at 34w 1d (EDD May 28) due to irritable ute + early dilation
Mommy Blog: And Baby Makes Pi
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Ditto to above. Please dont judge us. Unfortunately I had some awful nurses. I was doing the best I could to pump, work, and have 2 babies in the NICU while healing from a c-section. I would have nurses comment on how often and how long I stated to visit my daughters. Of 111 days I did not come 5 days. Every one of those 5 days someone made me feel awful for not being there (3 of them I had a 101 temp and was not allowed to come). DH and I asked a lot of questions. We did not even know what the inside of a NICU looked like until the night before the girls were born. So, please be pacient with questions. Most (not all) parents want to do everything they possibly can. If that is possible in that situation, let them.
Another big one for us was how the nurse acted in a crisis. Ella coded 2 times while I was visiting. (surprisingly both times while I was holding her sister). 1st time the nurse didnt speak to me the whole time I was sitting there starring at them bagging my baby who was blue. Then another came by and said dont worry about that baby just worry about your own... she didnt get the memo that was my baby and I had twins... 2nd time however. The nurse calmly looked at me and said, Cait it is going to be okay, Trust me and just breathe as she hit the code button on the wall. She updated me whole time and just was calm and cool. I really appreciated the concern not only for my daughter but for me too. It is very traumatic to watch your child stop breathing.
So true. Also, our NICU rules (that you have to sign when your baby enters the NICU) state that you need to ask to open the isolette and touch your baby. It is really hard to ask if you are allowed to do that when your baby is 2lbs. I thought I was going to damage him if I touched him. I wish someone told me that I could have at least put my hands on him. I wasn't allowed to hold him for 3 days, and it was terrible.
Also, always put up privacy screens if you have an open bay type nicu. It was so much better when they were up. It was like we had some of our own family time. To this end, please don't comment on with the parents are talking about while having hold time behind the screen. Yes, we know you can hear everything we talk about. Yes, we know we have no privacy. Please pretend we do. It was hard enough that we didn't get to hold our baby more than once a day for 30 mins. It sucked even more when we were talking about things with him, having parent conversation, and a nurse would butt in over the screen to add things to the conversation. We had one nurse do this. It was sucky. We felt like we were having court supervised visits with our baby. All the other nurses pretended they couldn't hear us and pretended we had privacy. It was better.
When it is getting close to hold time ending (because lots of times there is a time limit) be gentle with how you end it. Don't just walk over and say, okay, hold time is over. Our favorite nurse would always say, "Your mom and dad are so excited to hold you and see you" when she got him out. She would also give us a 5 minute (very gentle warning) that it was about time to put him back. When she came to put him back she said, "okay buddy, give mom and dad a kiss". It was much better and less jarring than just coming to get him.
We'll miss you sweet Debbie Girl (4.21.12) and sweet Cindy Girl (8.9.12)
everyone covered a lot of great points.
I'll just add to remember that *every* first is important to us. People don't think about how much that first diaper change means, or the first time he gets a pacifier, or tastes milk or wears clothes. I knew that I couldn't be there for every first, but some of them I could.
I had it written in his chart that I would be there the first time he got to taste my milk- and this *** of a nurse we had did it w/o me anyway. It was the only formal complaint I made in 96 days there. I cried for days about it. I STILL can cry about it now and it's been 3 years.
She said it was just some milk on a pacifier, it was no big deal. But it WAS a big deal to me. The first time I came in and he had a paci.. or found out they'd been giving him baths w/o me.. all of those just killed me. No one told me.
Having a preemie- SO MUCH of the usual parenting situation is stolen from us.. we're hanging out to every little thing we can.
My favorite nurses were the ones who seemed to genuinely care for my son. There were those that didn't care if he cried- his oxygen was fine, her job was done. But there were those who would go to break late just to put their hands on him and whisper nothings. I can remember just standing and crying one day because I couldn't get him to calm down for anything, and one nurse just came and stood with firm pressure and cooed at him for a solid half hour until he finally calmed down.
That was a nurse I felt like I could trust with my kid. If she was on- I could go get something to eat in the cafeteria, or go pump w/o worrying that something was going wrong while I was gone.
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Don't ask, in front of the parents, if any family members/friends want to hold the baby without pulling the parent aside to make sure its okay with them first. I don't care how many other family members/friends have already held the baby(ies).
When a parent protests the way their family is holding the baby don't ignore them. I didn't feel comfortable with my MIL holding my baby chest to chest. When I protested the nurse ignored me and said this is better for her reflux but my baby never had an issue with reflux which the nurse didn't know because she never had my babies before. IMO, the only people who should hold the babies chest to chest are the parents.
If the parents ask a question about what is going on with their babies care don't give them an attitude as if we are questioning your skills because we aren't. We are their parents and their advocate so we have every right to ask questions or wonder why you are doing what you are doing. My girls have been in the NICU for over two months, we have gotten a pretty good handle on our girls and what they need. We had a nurse give us an attitude when we questioned why she was doing what she was doing (can't remember what It was now). We know you're the professional but we care more about our girls well being than we do if we've offended you by simply asking, out of curiosity, why you turned up our girls oxygen..just like you would care about your own child's care.
Just make the parents feel comfortable. You are caring for their little babies and, in some cases, keeping them alive. In a situation like that, there is nothing worse than not feeling comfortable enough to leave your baby alone with a nurse that makes you feel uneasy.
Hi NICU Nurse Rosie,
What a rewarding career path you have chosen!! I wish you the best of luck!!
Some of our favorite NICU nurses were the ones who offered the most support and education. The nurses got to know me so well. They would have the recliner, privacy screens, and blankets ready to go when they knew I'd be arriving to Kangaroo or Breastfeed. There were days where they simply left all the supplies there, cause they knew I'd be back.
Encourage the parents to participate in their baby's care. When they are able encourage the parent to change the diaper, check the temperature, bathe them, dress them, etc. Always provide parents with the most up-to-date information. If the doctor's have ordered new tests, explain what they are. If results are in, explain them. Check with the parents to make sure they understand what the doctor has said, you may want to explain it in more detail. Encourage the parents to ask questions, let them know that you are there for them.
One thing that some nurses forget is: We are the parents!! The best nurses know that the parents need to be actively involved in their child's care.
I agree with everyones PP's. Just to reiterate on some things:
1. Most of us have never experienced the NICU before. It is a really scary and uneasy time. Please be patient and explain things. Also, it may be your 700th transfusion (or PIC line, or brain bleed, or apnea, or brady etc.) and it is no big deal... but to us, it is our first or 3rd or whatever and it IS a big deal to us.
2. My LO spent the majority of time in a special care nursery so it was a little different... but things that I LOVED... a) Walking into the nursery to find a nurse sitting in a chair holding my LO. He wasn't fussing, he wasn't eating, he wasn't having A's or B's.... she just was holding him to hold him. I LOVED that. b) Coming in to find a sign or note from a nurse telling us about his day with them or a milestone or something cute he did. c) A surprise when I came in to find LO out of the isolette (even though I had talked to them on the phone an hour or so before), or no cannula, or no NG tube etc.
3. The best nurses were the ones who really knew my LO. They knew that he liked to be on an incline, sung to (or listen to music if they couldn't sing), liked the bouncy chair. They knew when his grunts and groans were real or he was just settling in. They also knew us. They knew when we would be there, what information we would want to know, when we would call, when we would like to talk to the doctors if we couldn't be there for rounds, they knew when we were having a bad day or good day, when I was about to cry or smile. Those were the best nurses. The best nurses are the ones who show us that their job isn't really a job, but it is something that they love.
4. On that note, one day I was in the NICU and the nurses were sitting 2 isolettes over from me complaining about their job and how they didn't want to work. Come on... I know we would all prefer a day off even if we love love love our job, but we don't say it in front of the people we are working for/with/whatever. I am a teacher and I love vacation... but I would never tell a parent how I can't wait for a break from my job... its rude.
Baby is calling... I might write more later!
My MARRIED Bio
What a great way to get advice on beginning your carreer! All the best to you.
Ditto to all the previous ideas.
My biggest thing is to offer to let the parents to the diaper changes. At least give them the chance (if they say no, that's okay). Sometimes it's the ONLY contact we can have with our child for a 4 hour span, and we are looking forward to it - even if it's only a diaper change. It's a chance to touch our child, care for him. I remember sitting at Isaac's bedside all morning, reading, doing Soduku. I went out to use the bathroom, and the nurse had done everything while I was gone (even 20 minutes before he was due to be changed). That ruined my entire day.
Good luck!
I didn't read through all of the replies so apologies for repeats:)
1.Each of my boys' rooms had a bulletin board and it made me feel better when the writing was cute with swirls and dots. Sounds silly, but it was a loving personal touch that I noticed right away. On the night they were admitted the nurse wrote Happy Birthday...and I thought that was so sweet.
2. One nurse gave my DD the tiny diapers and bottles for her baby. The fact that she thought of my DD when she wasn't even there, made me love her even more.
3. Tell parents that they are doing a good job. During a care conference when my baby b was doing really bad one of the neos told us that she had been amazed how devoted we were from the start and it really made me feel a lot better.
4. Tell parents about the stuff that's not in the handbook. Like bringing things to decorate the room, clothes, linens, blankets, and pictures of the family. I would rather have known from the start than having to ask.
5. Dote on the babies.
6. Save things for the parents. I wanted any and everything that touched my babies just so I would never forget how far they've come.
Good Luck:) NICU nurses are a special breed.
the nurses that i liked the best were the ones that listened to what was important to me and reinforced that. BF was one of those things. if i hadn't pushed for it, some of the nurses would have just encouraged the bottle, b/c it was easier and quicker. but, the ones that were patient and worked with me and called the LC for me were my favorites. otherwise, there was this one that called me out on the fact that i deffered to my dh (he is a nurse, but not w/kids) when i should have relied on my own instincts. i appreciated the honesty and the vote of confidence she was giving me. i remember it even today when it tries to pull the nurse card on me and it just doesn't ring true.
I agree with everything all the pp's have said!
We had 3 awesome nurses while we were in the NICU with our 25-weeker that I feel could be the best examples for anyone wanting to go into that field. They always made us feel welcome and as involved as we could be. They saved everything for us to keep. They made cute little signs for Cyrus' bed and taped up pictures of my husband and I and her other 3 siblings so she could see her family. They got to know my schedule and always waited for things like baths and weight checks so I could be there for them (they knew I liked to be there all afternoon/evening/late at night, and then I would sleep in the mornings...I liked it this way because it was less crowded and I enjoyed reading bedtime stories to her and her "friends" in the beds around us.) They also made a special place for me to keep all of her bedtime storybooks there by her bed. At one point, Cyrus was having feeding issues, and we had 2 nnp's who seemed to have conflicting ideas about what she should eat. So we had one nurse who actually re-arranged her schedule for a few weeks so that she could always be there when they tried to change her over to a different formula again (or back to one) so that she could be sure they were keeping/changing her to the one that worked best for her! We also had a couple of nurses who actually fought over who got to take care of Cyrus and her little neighbor girl (both were the smallest and sickest on our team) even though they were way more work to take care of than most of the other babies. That made me feel really good! (Even though I know they were the cutest, lol) They always hoarded the best and the cutest outfits and linens to put on her, because she was a "princess". I always got a kick out of it every day when I would come in and never know what fancy little outfit and hairbow they would have on her that day. (We donated 30+ preemie size outfits, onesies, blankets, booties, and hairbows to the NICU after Cyrus grew out of them so they could dress all of the babies up like "princesses"!)
The biggest thing for us is that because we were on vacation when she unexpectedly came 15 weeks early, we were in a NICU in a totally different state than we lived in, so when I would have to come home to my other children for a few days at a time, I felt so comfortable knowing that she was being loved and cared for beyond her basic needs. They would hold her "just because", they would rock her, they would sing and read to her. They diligently replaced her scent circles for me while I was gone so she would have my smell to comfort her. I knew that she was surrounded by a loving environment when we weren't there, and wasn't just another baby in a bed in the corner, with no interaction other than scary medical stuff. I think this is what separates and NICU nurse from a regular nurse.
They also got to know me and my family as people. They would ask me about the kids, and knew about activities and things they were in. They remembered their names and ages.
And they cried along with me the day she got to come home!