Questions from a new NICU nurse

Chiming in! Like PP said, diapers, temp check etc. the cares sometimes feel like the only “parenting” a NICU parent gets to do. I always wanted to do them.
 
@pheonic My LO wore a onesie home from the hospital that said “My superheroes wear scrubs” because we were and are infinitely grateful for the care and love she was shown during her 3 week NICU stay. I can already tell you’re going to be an amazing NICU nurse, because the best ones I had (which were almost all of them) simply showed they cared for us and my LO. The ones who answered my myriad questions and told me that the choices I was making were perfect. The ones who celebrated with me when my milk came in and I started bringing full meals of pumped milk. The ones who comforted me when I cried and told me it was ok to go home and rest. The ones who openly told me that they love their babies there so I didn’t have to worry that my LO was love-starved when I wasn’t there. Just the fact that you care this much already tells me you’re going to be a perfect fit for the NICU, and I’m so grateful to you for taking on a challenging position like this. My absolute best wishes go with you as you embark on this journey.
 
@pheonic My favorite nurses were the ones that encouraged us to be as hands on as possible, the ones who answered our questions.

When I was having a rough day that would sit and talk with me for a minute and encourage us.

My one bad experience with a NICU nurse is a long story. Our daughter had MRSA at about a month old. The staff never had dad or I wear special gear. At about 2.5 months after we had already recovered from the infection, I was having a rough patch. A lead nurse came in and berated my for holding my daughter and not wearing a gown and gloves. I told her I have been doing it all along. I asked how I was supposed to kangaroo or try to breastfeed with these items. She threatened to call infectious diseases. She was very rude and not understanding. Needless to say she wasn’t allowed being near my child for the remainder of her stay.

Our hospital had a very good support team for the parents!
 
@pheonic Learn how to support chest feeding parents! I’ll never forget the first time they told me I could try to nurse my baby. I had NO IDEA what to do and the nurse legit said, “just put baby near your breast and see what happens”
 
@pheonic
  1. The best NICU nurses we had were very gentle with me and my husband, but firm with our families/visitors - we really didn't have the emotional energy left over to kick people out when it was time for feeds, or anything like that. They were also free with praise. Especially if it's your first child and you have no idea what you're doing, it can make so much difference if you feel like you're standing there being a useless lump and one of the nurses says 'you're doing a really good job reading to your baby' or anything like that.
  2. It would have helped me to cope better if what was going on had been explained to me better. The structure of nurses/doctors/midwives was never very obvious to me, and usually we only got snippets of information from a handful of people who didn't know everything. There were a lot of times I arrived and heard something like 'oh, don't worry about that dimple on his spine' and I would be like 'uhh... what dimple?' but nobody could or would tell me what was actually going on. I get that each individual nurse may not have a full medical picture for each baby, but even if somebody had pulled me aside and explained who did know, and how to reach them, that would have been helpful. Also, I wish the nurses had called me when they moved my baby. It was quite upsetting to arrive in the morning and not know where my baby was. There was one day in particular, where I didn't know he'd been moved before we got there, and nobody could even tell me which room he was in. It's an extra level of distress that doesn't feel completely necessary to me.
  3. Some of the worst interactions we had with NICU nurses were with people who had very gruff manners and/or took out the stress of their work day on us. I had one nurse who showed me how to change my baby's nappy and then yelled at me the first time I did it, because he peed and 'she'd warned me to cover him up.' The same nurse also did things like come in to the room while my mother and I were sitting with my son, and told us that we needed to move rooms, immediately. She made the whole thing feel really panicked, she didn't even give us time to check that we hadn't left any of the baby's things behind.
I don't have anything specific in mind for 4 or 5 but I think the fact that you're asking these kinds of questions already means you'll be great.
 
@pheonic I think the most important thing to remember is that many of these moms are going through the worst experience of their life. Some of them will have experienced a traumatic birth, a child that may or may not survive, PPD/PPA, not being able to “normal parent” things, mourning the loss of a twin.... everyone has a story. When my son was about a week old, we headed up to the hospital with a lunch bag of pumped frozen milk. We stopped to get some food and to get a form from my job. By the time we got there, some of the milk started to thaw. I didn’t even realize, nor did I know that would be a problem. The nurse looked at it, rolled her eyes, and said “this was frozen? We can’t use it now. I have to throw it away” and I LOST IT. He was still on Tpn so it didn’t really matter, but all the milk I pumped (pretty much the only thing I could do for my baby at this point) was being thrown away. I stood in the hallway hysterical with my husband trying to calm me down. The nurse saw me and didn’t say anything. I’m not sure if my husband said something to them but she was never our nurse again.
 
@pheonic I think you’re off to a great start if you’re already asking questions like this! I had 26 weeker twins that were in the NICU for 14 weeks and we went through all the NICU levels. I’ll just kind of go through the best nurses we had and the worst.

The best:
- explained everything and always checked to see if we needed more information. If we did or if it was something she didn’t know, she’d reach out to the dr and usually get us information within the next day or two or if something major was happening, she’d help coordinate the doctor being there personally to answer questions even if we missed their rounds.
- formed a personal connection
- encouraged me and my husband to do as much as we could to help with their care
- suggested new things we could do to feel like we were getting the “normal” newborn experience. Ex: on Valentine’s Day she suggested and helped me do a mini photo shoot with our twins and our wedding rings. She took time on a slow day to take foot prints of each kid. She suggested I bring in books to read every day and helped me figure out ways to “customize” their isolettes so we didn’t have to look at the same space all the time.
- she even took time to look up information for our preemie baby book
- basically the best nurses used slow time to help us bond with the kids - sometimes when you’re a nicu parent for a long time you feel like they’re the hospitals baby and you’re just borrowing them. Her methods went a long way to make us feel like the parents.
- she was super supportive when I decided to give up pumping, or really Any any decision I made
- when I went back to work so I could save my maternity leave she helped me feel less guilty about only being able to see them for an hour or two a day
- she really emphasized self care
- strongly supported me when my breastmilk supply wasn’t coming in and I decided to stop. I’ve always been in the “fed is best” camp, but it was incredibly emotional and hard to stop, even if it really was for the best.

The worst:
- questioned us constantly: to my husband asking if he was “leaving already”, to me - and I can’t tell you how many times this came up - questions about my breastmilk supply “is that all?”. Please NEVER ask that. It broke me a little bit every time because I felt like I couldn’t do much for my kids but i should at least be able to give them breastmilk.
- on breastfeeding: suggest a lactation consultant, but never offer suggestions on how to improve supply unless they ask. I always appreciated suggestions when i asked for it, but at the end of my pumping journey, I was power pumping and drinking tea and eating cookies and drinking water and all the things and I just couldn’t increase my supply. Having a nurse that I didn’t know well offering any suggestions just wasn’t helpful at that point. Even the lactation consultant told me that i had done everything thing I could.
- questioned my decision to stop pumping
- this one is from my husband: hovered specifically when he had the kids. He may not have been able to physically be there as much, but he needed to be trusted with the kids more. He’d ask for help when he needed it but the hovering made him feel like he was less of a parent.
- talked down to us when they thought it was a dumb question
- joked about being the mom - there is no context where that is ok
- constantly corrected us. Different nurses do things differently and after being in the nicu so long we figured out which methods worked for us and our kids. Correcting us if it was dangerous was fine, but otherwise if no harm is being done then it just made us feel less bonded
- not listening to us. I saw my kids every day, I learned a lot and then best nurses would trust me when I said something was off - the worst would ignore it or dismiss it. I identified a few issues earlier than they caught it (even if I didn’t know what the issues were exactly) just by knowing something was off.

The main thing: it’s hard and scary and emotional no matter why they’re there or how long they’re there. Nurses who were compassionate and cared - that always came through. It’s a rollercoaster of progress and setbacks that for some can go on for months. The best nurses helped us grow into parents while encouraging us to take care of ourselves. And when in doubt, ask the parents what they’d prefer. I always appreciated that consideration.

You’re going to do great!
 
@pheonic I’m on mobile so I can’t reference the numbered questions, but in general, I would just keep in mind how emotional it is for the mother. We’re wired to be with our babies immediately after giving birth, so the hormones go crazy when we can’t do that. It was reallllly difficult for me to leave my baby in the nicu even for a few minutes to use the bathroom and especially leaving my baby overnight with a stranger. When we go home we don’t rest, we have to pump every 2 hours and it’s hard to get any sleep on that schedule. Many times people would tell us to get our rest before baby went home or go out on a date and that was frustrating.

I appreciated when the nurses told us exactly how much of my milk they had in the fridge for us so I could schedule my visits to make sure there was enough and they wouldn’t need to resort to supplementing. Some nurses wouldn’t tell us they were running out and the formula supplement would trigger a reflux Brady event that would set us back.

The best nurses were very positive, attentive and just honest about what they were doing or that gave us solicited tips as first time parents.

I only had one nurse that I didn’t like and asked to not have her again. She acted judgmental, made changes to our baby’s care without calling or informing us and made me feel like I wasn’t ready to be a mom. She was constantly quizzing us and giving us advice that went beyond what was necessary. She also switched our baby from a preemie nipple to a regular flow nipple without asking, which caused Brady’s due to her reflux and made us stay 5 days longer. The change also hindered breastfeeding. I have a feeling she also lied about how long she held her up after the feeding, it was supposed to be a half hour but she had most of her reflux events with this nurse and was fine with others.

All the other nurses we had were like super heroes and I was soooo thankful for them. The good ones helped me sleep better at night knowing they were with her. If you’re asking these questions you’re probably going to be an amazing nurse.
 
@pheonic
  1. Someone who talks to you like a person and seemed to care. The ones who treated it like a job were did not make visits a nice experience. If I had questions they did whatever they could to help.
  2. Even during times of COVID, a nurse hugged me when I needed it. A nurse talked to me about other things than NICU things. Basically going back to question 1, being personable and treating my baby more than just a spreadsheet of numbers.
  3. I only had to call the charge nurse on one person and it was because of favoritism. I would see her treating one family with a great attitude and then she would barely hold a conversation with me or wouldn’t listen to my concern, such as my baby being too warm or needing to change his positions. Also, being careful with taking “firsts” away, like baths, bottle-feeding, etc. I think a lot of issues can be avoided with good communication.
  4. I understand that there is a lot of pressure and demand from multiple babies and their parents (I’m a teacher so I understand), but at the end of the day, when the parents aren’t there to help, it is so important that we trust that you are giving our babies the attention they need and not just doing the bare minimum. We love that you guys spend time with them, talking to them, playing with them, and just showing any kind of attention.
  5. Parents know when I nurse truly cares and it trying their best. The NICU is a stressful place and any kind of support and care is very much appreciated.
 
@pheonic O agree with the above statements. I also liked that all of my primary nurses explained to me what was going on, or what to look out for or how my son likes to do his eating, etc., when we get home. I also really appreciated nurses who are attentive to their charges.

I generally really liked the nurses at my hospital. However, I did ask for one nurse to not be put on rotation for my son. My primary complaints were that even though she just started her shift, she didn't want to provide any updates whatsoever. Typically, if I talked to a nurse who recently start their shift, they would tell me everything that happened in the previous shift since the previous nurse would provide updates. The same nurse also didn't bother looking at my son's monitor when he was desating for a 5th time (in a 40 minute window). I personally didn't trust this nurse to care for my son, which I imagine is a complaint a lot of panic parents have of their bad experiences.
 
@pheonic I agree to everything i read from the great comments. And the fact that you even ask those questions shows that you gona be a amazing NICU-nurse!!! All the best to you!
 
@pheonic Congrats on your new job, and thank you for reaching out to us.

My daughter was born with GALD (gestational alloimmune liver disease, very rare) and was in NICU for a month. Unfortunately we had some rough experiences with nurses there:
  1. She had to have a lot of blood drawn. At one point, while I was still in the hospital myself, we went to NICU to see my daughter unattended with a (I don't know the correct terminology for this) band wrapped around her leg to draw blood. It took us at least 5 minutes to get someone to listen to us. When we finally got her nurse, she said she had gotten sidetracked and forgot about it. She took the band off and my daughter's leg stayed compressed through our entire visit. If you get called to do something else, complete the task or make sure you don't leave something potentially harmful.
  2. One time when her blood was drawn, someone who wasn't very experienced kept digging around for a vein. My daughter was so upset, she literally passed out. I made them get someone else and they were able to draw her blood immediately. Please reach out for help from a colleague if you need it.
  3. Again, with blood being drawn: they drew 2 vials and forgot to run it down to the lab in time. So they had to draw them again. At this point, she had blood drawn so many times, it looked like freckles covered her hands, arms, and feet. And bruises everywhere of course. The thought of her having to get even more drawn as a result of a screw up was incredibly frustrating.
  4. I didn't find out about programs and benefits offered to us until we were a few days away from going home. For example, my hospital had a Ronald McDonald room and gave food gift cards to mom's who brought in pumped milk. Know what your hospital offers to parents and ensure they're aware of those programs and benefits.
  5. Nurses tried to convince me again and again not to nurse, as my daughter had trouble gaining weight, she was hooked to a bunch of machines, and they had to keep track of her milk intake. They would go so far as to wait til I went to the bathroom to give her a bottle and then tell me I couldn't nurse her afterward because she needed sleep. I had to eventually get a doctor involved to tell them they had to let me nurse. I get that it may have made it more difficult for them, but nursing was very important to me, and for the health of my daughter, and my body didn't react well to pumping so breastfeeding was needed to keep up my supply.
My advice to you is please, no matter how long you decide to work in NICU, never forget that these babies are human. I understand you have to become somewhat desensitized in order to protect yourself emotionally, but just remember they are their parents' world, even if the parents can't always be by their side. The parents, too, are human. And they're terrified, confused, and (in mom's case) healing from labor and/or major surgery. As a side note, I'd also say offer to take pictures of parents with their babies for them. I wish we had some now that we are so far passed that difficult time.

Good luck and thank you for doing something I know I never could. Just you reaching out speaks volumes about who you are as a person and I'm sure you will excel at your career.
 
Also, to a parent, each day their baby is in NICU seems like an eternity. We had no idea anything was going to be wrong with my daughter until a few hours after she was born at 36 weeks. There were many times we thought she was going to die. Though a month on the job may fly by to you, remember that, to the parents, it feels like the days are the longest they've ever lived.

Even though my daughter was at a hospital 2 hours away from our home, I drove to see her every day and took an Uber when I wasn't allowed to drive due to my c-section. Keep in mind, a lot of parents probably live a bit away from the hospital. This adds to their stress levels and can also make it difficult for them to be there on a regular basis, in addition to them having other kids, jobs, etc.
 
@pheonic
  1. What were the qualities of the best NICU nurse you had?
    The amazing qualities my favorite NICU nurses had were only show by 3 nurses from all the staff. They showed empathy, always asked if I needed anything, and they were very patient with my baby, I would be upset when they would switch nurses.
  2. What help could a NICU nurse have offered you to cope better during the process?
    The help not a few nurses offered were just simple friendship while I stayed there. It made me feel like someone cares for me and my baby.
  3. If you had any negative experiences with a NICU nurse, what could have been done to avoid them?
    The negative things would be, most of the nurses would start tube feeding before I even arrived just to get their schedule feed in and out the way when I was really trying to bottle feed my baby. I had to show up an hour earlier to avoid this happening.
  4. What expectations do you have of a NICU nurse?
    The 3 nurses that will always be in my memory were very nice to me and were patient with my baby, one even brought a brownie recipe from home the next day.
  5. Any other advice you’d like a new hire to hear
    I think the NICU will get overwhelming because feeding 3 or 4 babies on your schedule is hard work especially if they are bottle feeding but be motive so thise little guys do go home sooner than later and learning to bottle feed is one way.
 
@pheonic My favorite nurse is a former NICU mom herself, and she refers to herself as "Auntie (her name)" when she's talking to my son. She makes sure that I am taking care of myself and she asks about my husband as well. She has never made me feel bad about leaving when I do or not coming in earlier, but she always makes it clear that I can stay as long as I want or come in as early as I want. Basically, she treats me as if I were just as important as her actual patient, which is important for my son's progress.

The good nurses pay attention to my own cues. When I'm breastfeeding I get frustrated when he's not feeding consistently, despite a good latch. Today the nurse squatted down next to the chair and suggested that I try burping him, since he might have air from his previous feeding. And she reassured me that it's expected that he is still feeding inconsistently and he's still making good progress. She didn't make it seem like he's perfect but she assured me that I'm doing everything right.

Both parents are important. The other weekend my husband went and the nurse didn't let him touch the baby and left him to sit there for like an hour because he didn't come right at the care time. I was livid, because the nurses had never done anything like that to me. My husband is so excited to be a dad and he wants so badly to be there. It kills him that he can't really do anything (whereas I can pump and breastfeed) so any time he gets with the baby is precious. So all last week I spoke to every nurse about how I want him to get a chance to bottle feed when he's there, because I didn't want anyone taking that away from him. Some dads might be nervous or unsure, but don't ever test them like a second class parent.

The one nurse that I would like to not see again is the woman who can't keep her mask on her face. She also is mildly judgemental, but the mask thing bothers me more than anything. The health and well-being of your patient is paramount, because you are treating tiny babies with no immune system. Do not let the parents see you not taking that responsibility seriously.

Keep in mind that many of your NICU parents are first timers, so you may have to show mom how to breastfeed or how to hold the baby out how to swaddle. Don't assume that the parents know anything. They need to be confident in their parenting ability, and part of your job is to make sure they know what they're doing. My first dirty diaper was with my son. I had no clue what I was really supposed to do - how hard do I wipe? does the diaper cream actually go on the anus it should I just put it around and avoid that spot? These are questions the nurse answered before I asked them. And when I did it right, they lavished me with praise. My son's nurses make me feel like a professional swaddler because they are always praising my swaddle. This instills confidence that helps me to be a better mom.

Finally, as a nurse you want the parents to want to be there, because that helps your patients, and also you (more hands to do diaper changes always helps, right?). So keep that in mind when you interact with them. Help them to feel comfortable and at ease. Never make them feel like a burden. Assure them that their presence is good. Make them want to come back. Make them feel welcome. The baby might be your patient, but the parent is your biggest ally.

Thank you for what you do! ❤️
 
@pheonic I think many of the suggestions I'd have are already given better than I could. It's always helpful to teach the parents as much as you're willing to; in particular, highlighting why things that sound or look scary may not be as bad as they seem. Learning what NOT to worry about is important!

The thing I didn't see skimming quickly through this thread is that the best NICU nurses were willing to push back (respectfully, of course!) when a different action is in the baby's best interest.

One example: our baby was needing a radiologic GI scan pre-surgery, one that was done with equipment in a room in radiology. Radiology was in the basement, the NICU was on one of the top floors of the hospital. A trip like that for a baby under two pounds and on a breathing tube is extremely stressful for baby. When radiology called the nurse to discuss logistics, the NICU nurse pushed back that it wasn't a good idea to move such a fragile baby any more than absolutely necessary. A radiologist then agreed to do a slightly less than optimal test, but one that could be done without moving her.

The surgeon still got the information she needed to go ahead with surgery, and an unnecessary trip out of the NICU was avoided.

You're not the provider in charge, but you know the baby far better than the providers so. Don't be afraid to use your knowledge!
 
@pheonic Something I really liked, and I don't know if this is mandatory and some nurses just didn't do it or what but, one of our nurses called us at least once a day with updates every time she was with our little one if we couldn't be there that day (which happened often for us because unfortunately work and bill collectors don't care what's going on in your personal life and we simply couldn't always be there at the time) so that was awesome.

Our nurses also always went out of their way to try helping us, like if they couldn't answer a question we had they made sure to ask or get somebody who could answer. The nurses were also super friendly with us, it's almost weird looking back now but our nurses felt more like long time friends than nurses because they were very supportive and caring.

That's about all I've got, also maybe try to understand some parents might be frustrated often because of the position they are in and that can be a lot to handle at times for both them and you because you have to deal with them.
 
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