Questions from a new NICU nurse

[pheonic]

I was recently hired right out of nursing school to a level 3 NICU. I am very honored to earn this position, but I’d love to hear opinions from parents of babies who were in the NICU. I want to make sure I go into this job serving the babies and parents to the best of my ability.

1. What were the qualities of the best NICU nurse you had?
2. What help could a NICU nurse have offered you to cope better during the process?
3. If you had any negative experiences with a NICU nurse, what could have been done to avoid them?
4. What expectations do you have of a NICU nurse?
5. Any other advice you’d like a new hire to hear

Thank you all!

 

[kevintri99]

@pheonic What sweet questions! I hope you have a great time at your job, we appreciate you so much!

We were in the NICU for 12 weeks (I had a 26 weeker). The best NICU nurses encouraged me to take care of myself. I had almost an hour's drive to and from the NICU in a very high-traffic area, so I would arrive usually just before 8am and leave around 3:30/4 to try to beat rush hour traffic. That was right at shift change, and so while I would spend all day with my baby I felt very judged by my baby's primary nurse on evening shift. She'd always say, "oh are you leaving already? Will you be coming back?" Like, no. I spent 8 hours here, no food or drink is allowed so I'm dehydrated and hungry, still have to pump like 5 more times tonight, can't spend 2 more hours driving back and forth and spending another $50 on gas.... that really annoyed me. It made me feel like I wasn't doing enough.

My baby's amazing primary day nurses told me I was doing great and spending enough time, helped me troubleshoot my low production issues, let me process my trauma by telling them my pregnancy/birth story. They encouraged me to take time for myself, to even try to go away for a night or something with my husband before baby was discharged (never happened, but it was sweet)! Some of them even bought my baby presents (this is obviously not something I ever expected, it was just nice. One bought her an outfit, some swaddles and a book).

I personally liked nurses that tried to connect with me, the parent. I guess maybe some parents want to be left alone? Early on I liked best the nurses who would wait for me to let me do the small care measures I could, and would involve me. So oral care, temperature check. Once when I was only a day or so post c-section, I busted my butt to be there for her care time (it takes a loooong time & is painful to walk places when you're post-op!) and the nurse had done it early! After I told her I'd be there, she still did it early. That was really disappointing. I think especially with parents of micros we feel helpless and want to be able to do anything we can. I'd just keep in mind that pretty much every parent there is traumatized, and everyone wants to do the most and best they can for their baby.

Oh, the first time I held her I was really really nervous, and the nurse was not sympathetic at all. I burst into tears because I was scared (she was vented and I couldn't move an inch) and the nurse was like "What are you crying for? You don't need to cry." Um, thanks?

edit: fixed typo

 

[haywood]

@kevintri99 100% yes on the encouraging to take care of yourself. I feel like it’s so easy to feel judged, I did too (spent all day there but left just after 7pm during shift change). Being reminded it is okay to care for yourself was appreciated.

 

[raevenbee]

@kevintri99 +100 on everything above!

It depends on the type of parent- my nicu nurses and I became close over 3 months together, and they eventually learned that I looked like I had it together all the time, but was crumbling under the surface. They really leaned in when I wanted to talk, asked if I needed space when I was quiet, and shared aspects of their lives they were comfortable with when they could, making me feel like we were just people coming together for a really important need. Because of Covid, there were days where they were the only ones I talked to, and it made me feel like a person again, along with a shared caregiver for my tiny guy.

I guess just... don’t be afraid to be yourself while realizing that the job is primarily caring for fragile things, including parents!

I was also lucky that my boy had no major complications, but those parents who had a lot going on had a hard time finding their outlet- while it is never okay to take it out on the nicu nurse, having their understanding on a hard day’s reaction clearly meant a lot.

Thank you, we truly appreciate you.

 

[nogoingback]

@kevintri99 Yes it matters so much to have a nurse encourage you to take care of yourself and not judge you for it!

 

[haywood]

@pheonic I love this! We are fresh out of the NICU as of this Tuesday. Here are my thoughts..

1. I’m going to reference to the qualities of my favorite nurse. She had incredible bedside manners. When we would ask a question or suggest something she never made us feel silly but rather would say something like “that’s not a bad idea but” or “I can see why you would suggest that but”. It made us comfortable to continue to speak up. As the mother I was/am very emotional and she always embraced my emotions. One time taking a moment to sit with me to let me share my worries. One time she caught me crying and when my husband and I left for lunch she “walked us out” (of the NICU) which they do not do at ours so we could speak in private. She was very hands on with me, offering to help during my journal of pumping. Most of all she was personable and straight forward. She told us from day one that although my son could be discharged sooner, that we should expect for it to be close to our original due date. (My son was born at 35 weeks— he was discharged at the gestational age of 37 weeks 3 days!) After several days this helped us to embrace and accept the situation and not count the days.
2. The number one thing that comes to mind is my pumping experience. I had a hospital pump in my room ready for me due to the fact that I could not breastfeed with him in the NICU. I did have a lactation consultant come visit me but was never truly educated on mastitis — which I now have at 21 days postpartum. It was hard for me to be consistent on the pumping schedule with wanting to spend time and bond with him. I wasn’t aware of the serious consequences of not following a more strict schedule. It seems as though many NICU moms are pumping in the early days/weeks so educating moms on this I feel could be helpful!
3. There was really only one time I had a “negative” experience. A nighttime nurse was helping out during the day and said she needed to check vitals. The daytime nurses all had a routine with us and after they performed vitals, myself or my husband would change his diaper. Upon laying him down I told her we would change his diaper. She didn’t respond and continued to remove his diaper. So I said again that we would change his diaper. She then replied “it’s okay I will do it.” I instantly, and privately, broke into tears watching her change his diaper. I could not stop crying for almost 45 minutes. This was by no means her fault, just was her habit as a nighttime nurse (we were not there in the middle of the night) and I could have been more direct. However changing diapers was the only bit of normal we really had with him in the NICU setting and I feel like she robbed us of it (in that moment). My suggestion would be to offer or encourage parents to be as hands on as they are comfortable with. And if they aren’t comfortable talk them through and show them as you do whatever the task is. As a NICU parent I really felt like I missed out on so much bonding and parenting in that first 3 weeks of his life, so I loved doing anything I could to have as close to a normal at-home experience as possible.
4. Explaining things to parents! That moment when you walk into the NICU and see your little newborn in an incubator, with an iv in their little arm, feeding tube down their nose or mouth, heart monitors, oxygen, etc. is it ROUGH! Hearing the alarms going on off the monitors for the first few times worried something is about to go wrong with your baby (we know now these monitors go off all the time lol). Take a moment to explain what everything is and why it’s there. I think it helps parents to rationalize with it and not freak out more than they already are. Explain the beeps on the monitor and that it’s okay. Other than that, really just the simple things you’d want from any nurse. Kindness, understanding, personable, etc. I think the fact that you have even posted this shows that you are already on that path!
5. Good luck! You will be great!

 

[f8th60]

@haywood Regarding the diaper changing, if you are new to the patient, ask the parent what their routine is. Today my son had a nurse I hadn't met before and the first thing she asked was what my routine was. I told her what hours/feeds I am there for, that I do temp and diapers, and we're working on breastfeeding. It was nice that she took a moment to get up to speed so that there was no awkwardness at care time. This also gives the parent the opportunity to share if they want to do more or less or try something different.

 

[guate3]

@pheonic I agree with everything @kevintri99 said! My favorite nurses during our nicu stay also got to know my husband and I a little and told us often to make sure we were taking care of ourselves. Once I was thinking of skipping lunch and our primary nurse basically chased me out to go get food (they provided us meal tickets) which made me laugh. Our primary nurse was a little aggressive in the best way. When I was changing my first diaper by myself I was so nervous and said I wasn't sure I could do it (so many wires and scared to hurt him), she basically said "you can do this, I'm not helping!" Same sort of thing when I was nervous to start picking him up and snuggling him without help once I was allowed to. I needed the push! That really varies by the person though.

The most important thing she said to me was "This is YOUR baby. We're just helping you take care of him right now. We're helping, but he is YOURS." I felt so empowered and grateful for her saying that. Just involve the parents as much as possible, explain the scary beeping and monitors, and remember the parents feel terrified, guilty, and just generally awful and need lots of empathy.

Thank you so much for choosing to be a nicu nurse

 

[fleurrobson]

@pheonic I’m ten years out of the NICU now and the nurses who stick with my memory all these years later are the ones who treated me like I was a part of my daughter’s care plan. The ones who refused to let the doctors start rounds in the morning without calling me into the hallway to participate too. The ones who asked (and valued!) my opinion on how she looked today vs yesterday or last week.

 

[lukeworsham]

@pheonic Congrats on the new job! I’m a SICU nurse (for adults) and give you a lot of credit for being able to do the job you do. It was definitely interesting to be on the other side and be the patient (well, the patients parent). So to answer your questions:

1. The best nurse I had came right after the worst nurse I had. The worst one made me so worried about his IV and made me feel like I wasn’t holding him right. Keep in mind that even as an ICU nurse myself, I had zero experience holding a tiny newborn with all the tubes and wires and she made me feel like absolute garbage about being worried about them. I almost didn’t want to go visit him that night because I just felt like I was failing everytime I was in there. But that night, we went and delivered breast milk and the night nurse was SO laid back and talking to us like he was just a normal baby and asked if I was going to do care. So I said yes and she showed me how to do everything. She told me not to worry about the wires, that that was her job and my job was just to be his mom. It was the best thing I ever heard and it changed my whole perspective for the rest of his stay (it was hard as a nurse to dissociate from the role when I was in such a similar setting at work).
2. Honestly the best way to help them cope would be just to validate how they’re feeling. Some nurses made me feel like just because my baby wasn’t the sickest one in the unit that I shouldn’t be allowed to cry or grieve the loss of the normal birth I thought I would have. The best ones would sit and say “this sucks” with me. Tell them they’re doing great.
3. & 4. I think I answered in my first response but really just remember that this is probably the hardest thing the parents have ever gone through. Don’t make them feel inadequate or act like they should just “know” the rules. There’s no handbook on how to act. No one told me I could pump in his room for like 3 days. So I was holding him then leaving to go pump in my room. One nurse told me he was awake the second I left and I wanted to die because I missed it to pump. Just support them the best you can and remember that most have never done this before.
4. One thing I tell new nurses that I’m orienting is to remember how you feel when you’re learning all these things on orientation. The parents (or in my case, patients/family) don’t get an orientation so this is all brand new. Don’t expect that they just know where to get snacks or how to call for you if they need help.

Good luck! It’s such a rewarding job to be a nurse and remember that everyday you will go into work and effect these people’s lives in a positive way.

Edit: a word; and tried to fix the 4. Coming up twice but Reddit on mobile sucks

 

[trustingin]

@pheonic Hello! My twins were in the NICU for a month and I'm also in the process of a career change to nursing (taking prereqs right now).

Our nurses were for the most part amazing. We did have one or two that we really loved and asked that they be assigned to us whenever they were on shift.

One thing I really admired while interacting with them was the mode-shifting they did so readily. They interacted with the babies, us, and each other so differently. They explained that the babies were their patients, but so was the whole family, and so their job was the baby first and us as the parents second. Also, as queer parents, there was absolutely ZERO issue or discomfort and that's so important.

To answer your specific questions:

1) The nurse who sticks out the most in my mind and who we immediately asked to be our main nurse was just very nurturing. She would talk to our babies like people, tell us that when we came in the door the baby's head popped up at the sound of our voices, and generally just made it clear that while she was a professional who knew what she was doing, we were the parents and that was something different and special to our kids. She was very reassuring and never made us feel like our kids didn't deserve her full attention and care just because they weren't sick (they were feeder-growers, no other health concerns).

2) One thing I would have appreciated that me and the occupational therapist realized after a couple of weeks was that the pressure to nurse/breastfeed began to supersede the importance of me being there to cuddle my babies. I realized I was caught between "I want them to eat" and "I want them to breastfeed" and the worry and anxiety over that became the focus, instead of "I am here to be with my children and give them skin-to-skin time." I wish that hadn't happened. I wish the focus had remained on "we'll try to breastfeed, then they'll eat from the bottle/ng tube, and you will cuddle the crap out of the baby." It was subtle, but it did happen, and it shouldn't.

3) One nurse made us feel like super incompetent parents. It was subtle, but I was a week and a half out from a c-section and my wife had had to return to work and save her leave for when the kids came home. We/I were exceptionally vulnerable and stressed out and already felt like we weren't capable of handling our tiny, fragile children. It was a simple interaction. The baby started to brady and turn blue. And she basically snapped at us about paying attention to the baby and not the monitor. Which is legit - you don't have a monitor at home. But imo she should've handled the immediate situation - the baby was not breathing! - and then walked us through it afterward. It was a short, small interaction, but I still remember it and I still don't like that nurse.

4) As with any time you have a patient, your patient is at their most vulnerable and treat them as such. Be very reassuring and exude the confidence we don't feel. Remember that, in addition, the parent who gave birth is recovering and super hormonal and might have been cut open to get that baby(ies) out. Vulnerable is the word here. Everyone's emotionally and physically vulnerable and you are the caretaker of that situation while you're on shift.

5) I don't have any other advice but I will say I was delighted every time I was told how beautiful my babies were. Any little bit of personality or uniqueness was appreciated - y'all see tiny babies all day. This one's mine. Tell me she's special, even if it's a lie. I'm at my most vulnerable and went through An Experience and I need to hear it.

Good luck! I hope to join you in this journey from the nurse end in the next few years!

 

[leematthew1234]

@pheonic The best nicu nurses I had I felt they genuinely loved my baby too, they told me how beautiful she is, how strong she is etc. It really helped as I was brimming with love for my baby but seeing her all obscured with wires was hard, I was happy others saw her beauty, and I felt happier leaving her in the nurses care.

 

[padfootg]

@pheonic Wow! This is an amazing question. Thank you for asking it.

I wasn't able to hold or see my daughter for 24 hours after she was born because I had been on magnesium. When I finallh showed up to the NICU, they acted like I was in the way. All I wanted to do was scoop her up and hold her. No one explained to me how it worked. They told me that I was in the middle of their rounds and I needed to come back later. My heart broke. I left crying. One of the nurses asked what was wrong with me. When I explained that I was just grieving she looked at me like I was crazy.

I wasn't prepared for the emotions of having my baby in the NICU. I'm not sure these nurses always realize that you were just going about your life and BAM. The next thing you know you are in a hospital months before you expected and then BAM your baby is taken out of your arms. It was confusing and scary. This was my fourth baby so I wasn't a new mom, but the NICU was a brand new experience and one I wasn't prepared for at all.

I finally had a sweet, wonderful nurse take the time to explain it all to me. She told me the routine, how things worked, and how the next couple weeks would go. Her patience and kindness meant so much to me.

When I look back on the experience (it's been about 2 months), I just wish I had it all explained to me from the beginning. When did shift changes happen? When did diaper changes happen? When does she get fed? When is it a problem for me to be there? Etc. Etc.

Congrats on the job!!!

 

[bj1944]

@pheonic I love this I could not agree more about encouraging parents to take care of themselves - especially mamas. I remember when I had a one week follow up at my obgyn - I has a c-section plus preeclampsia so it was important to go see my doctor. I felt like I had to tell every nurse in the unit that I had a doctor appointment because I felt judged for leaving.

I also wish my nurses would’ve spent more time with us. I don’t mean care time or that I felt neglected or anything - but when my son was in the NICU, our side of the unit always has 1-3 babies maximum and 2-3 nurses at a time. Well once the care and checking up was done, the nurses would sit in the front of the room together and chat, while I sat with my baby and stared at the wall. The NICU is so isolating - I’m not saying it was their jobs to “entertain” me per se, but maybe spending a few minutes of adult conversation with them would’ve helped me ease the loneliness of being in there when my husband was at work. I did have one or two that would include us in their chats about clothes or movies, and it was such a good escape.

I feel like my comment makes it seem like my nurses were terrible - quite the opposite, actually. Those were really the two big things.

 

[zeke4110]

@pheonic We were only in the NICU. For 5 days, but those 5 days were hell. Our baby wasn’t super sick but she had breathing issues that caused her to be on a CPAP for most of her stay. That meant we couldn’t hold her or feed her until she was off. None of our nurses really acknowledged that we were hurting too, only one did and she was amazing. Even though her situation wasn’t exactly life threatening, we hadn’t had any time with our baby since she was born. I never got to breast feed or have skin to skin with her. I also didn’t get to see her until she was about 12 hours old.

I think it’s wonderful that you are really wanting to acknowledge the parents feelings. Our amazing nurse who really changed our lives did as well. She saw that we were hurting and that’s what meant the most to us. She let us help change our baby’s sheets, we got to hold her up while they did, we got to weigh her and put clothes on her, and change her diaper. We hadn’t been able to do any of those things and she was 3 days old. That night, she did “arts and crafts” with our baby. When we woke up the next morning she had made her hand prints and finger prints into little animals and put cute quotes on pictures of them. These are things that we will always keep and treasure. That nurse really brightened up our stay and it was just the little things that she did that helped us.

I know that the babies are your patients, but the parents need support too.

 

[whodabomb]

@pheonic I would say give the parents space. When we were in the NICU it felt like we always had 3 pairs of hands on us and our babies amd rarely got the opportunity to figure things out ourselves. Our favorite nurse told us shed be around the corner if we needed her and would check in every 30 minutes. If we needed help she helped then immediately gave us our space back.

 

[nogoingback]

@pheonic Congratulations! The best nurses I interacted with were those that were both compassionate and mentally organized. I could see how much the nurses cared for those little babies, by how they spoke to them, touched them, worked so hard to make them comfortable. You can tell that they do that when nobody is even watching them, because they care so deeply. It was so reassuring knowing that the care team showed such love to my little baby when I couldn’t be there with him.

Also the nurses that took the time to attend to all the tiny details - making sure the charts were accurately updated every day, looking to see if the tape on his face needed to be changed, repeating their names a couple times so I could remember and telling me if they were leaving for a meal or whatever - I really appreciated that a lot. Obviously there is a lot of overlap in these groups and 99% of the nurses we interacted with were phenomenal, but there were a few who really went above and beyond.

 

[katrina2017]

@pheonic

1. Our NICU nurse was equal parts nurse and teacher. Every question we asked she did her best to answer or found the answer in the team. She was also warm and friendly but honest too. We really had a high level of trust that she was giving our son attention during the times we couldn’t be there.
2. I honestly don’t think our nurse could’ve done more. She listened to our concerns, was reassuring when able and honest when we needed to get important information.
3. Occasionally we had a floating nurse and she was very brusk and short. We felt like our preemie was the most delicate thing in the world and she would use a tone and demeanor that sounded like he was an NFL player. When she was on schedule we tried not to leave the room.
4. The nurses we really appreciated were part nurse, part teacher, and part counselor.
5. I would say, every family and child is different. Try to understand what the family expects and what the child needs. Be warm but honest too. For many, like it was for me, it was almost the most difficult experience of my life to see our son go through the several weeks he was in the NICU.

This experience was at Children’s Hospital of Wisconsin and other than their parking situation the rest of the care far exceeded our expectations. Really a spectacular facility.

 

[cbscr64]

@pheonic I don't know if I can answer all of your questions, but here's what I can answer.

1. The best NICU nurse we had very clearly cared about our daughter. When I was wheeled into her room for the first time our nurse was sitting with her just feeding her, smiling at her, and talking to her. It was so hard for me to be separated from her, and it was so reassuring to see someone taking care of her just like I wanted to be doing. For the rest of our time there, I was so grateful when this particular nurse was on shift. She was just so gentle, and really understood that while the NICU was normal to her, it was terrifying for me.
2. Our hospital offered a number of activities for the parents of the NICU babies. Everything from scrapbooking to chair massages to art therapy sessions. One of the nurses finally basically ordered me to leave for an hour and attend one of these activities. Being told it was ok to leave for a little bit was something I didn't know I needed to hear, and it made a world of difference in my ability to make it through each day.
3. I had one nurse who didn't believe me about my daughter's aspiration episodes after feeding until she saw it happen herself. Her monitors would always go off, but I suctioned her right away every time (we roomed in). She didn't believe me that anything bad was actually happening until my daughter happened to aspirate while the nurse was holding her and she couldn't recover without intervention. Turns out it was actually a problem and we had to spend an additional 7 days there because of it. I would have liked to have been believed, or at the very least not shot down by that nurse when I brought it up to the doctor the first time at rounds. It could have been solved sooner, and we could have gone home sooner.
4. I am so incredibly grateful to all of the nurses who cared for my daughter during our stay. At the time I was so traumatized I don't think I did a very good job of communicating how much I appreciated them. It's not really advice, but if other parents are anything like me, they are more deeply appreciative of you than they may be able to communicate at the time. (ETA Reddit keeps auto formatting this to read #4, but it's supposed to be an answer to #5)

Congratulations on your new position. I think it's wonderful that you are considering these things as you start your career. Thank you for your caring.

 

[davoarid]

@pheonic 1.) I had a few great ones. One was serious but relaxed, Megan. Another was serious and kind, but high-energy (in a good way), Carrie. Carrie came in before shift to check the baby charts. She’s been a NICU nurse for almost 40 years. Another was kind, relaxed, and easy going, Joni. She was my very favorite. She was right on it when something needed to be done but she had an easy pace that helped me climb off the edge. She had 3/4 preemie kids herself.
2.) Some nurses are really good with babies but not adults. That’s ok, they work in a NICU, but it would have helped if they were not as startled by a parent being present while they worked. A lot of them were newer. I felt awkward when it was clear they were uncomfortable with me there, but I’m not going to leave my kid’s side just because someone is shy.
3.) I had a couple nurses in the special care (step down) nurses who were clearly checked out. I lived in with me son. If the hospital had allowed it, I could have set up most/all of his equipment toward the end. I knew when nurses were at the desk chatting while my son or the baby next door’s feed alarms went off for 15 minutes. I also didn’t appreciate when some of the nurses would insist I do things the way they did. Sometimes it felt like I wasn’t allowed to parent because my kid was in the NICU.
4.) Take good care of my baby. Care about my baby. Be clean. Smile even if you’re shy. It’s hard on parents too.
5.) Thanks for choosing the NICU. The babies there need all the tenderness and support they can get. Please try to remember once it’s old news to you, for many parents it’s their first time. All those beeps and alarms can be very stressful and disconcerting. Please teach EVERY new NICU parent how to watch the screen readout so they can see when their kid is coming out of (for example, a Brady) episode. The alarm will often sound even when baby is recovering but if you don’t know what you’re looking at, it’s so much more scary. Telling parents “if we’re not stressed, try not to worry about the alarms” is way less effective than helping them understand how to read the screen and know if their baby is really in danger.