“BEEP, BEEP, BEEP, BEEP”. Wake up at 0500 to a screeching alarm. Blissfully unaware of work in my dreams, this sudden jolt to reality already has me exhausted. Not knowing what the day holds – good, bad? Happy, sad? Busy, slow? A day in the life of a NICU nurse is unpredictable, sometimes overwhelming, and every bit as satisfying as it sounds.
Being a NICU Nurse is terrifying, rewarding, and challenging
I get dressed, (do some other hygienic things), and grab my pre-made lunch before walking out the door to catch the train. The peaceful walk in the morning helps clear my mind and ease my anxiety about going to work. The fear of the unknown, of what awaits, doesn’t catch up to me until I step through hospital doors.
I pass security and smile. Offer a wave. I pass the Starbucks that now seems to occupy every hospital. The smell of coffee wafting through the air heightens my senses. I breathe in the familiarity and press the elevator button “up” to head to the NICU.
I’m greeted with stares from other nurses who are also here to work another day. Afraid of what might or might not, who might or might not, await them. We are all sharing the same thoughts… “Will X still be alive? I wonder what happened to X? How many patients are there? Are we short-staffed today?” and so on.
As the elevator opens, I leave the others behind and step onto the floor. Not yet in the NICU, I take one last deep breath before starting my day. “I. Can. Do. This.”
At 0700 I wave my badge across the security system, the doors to the neonatal intensive care unit slowly open. Already overwhelmed and flooded with stimuli. Alarms dinging off. The occasional call for “help”. The night shift nurses charting away on their computers with hopes of leaving on time. I’m met with the smell of cleaning supplies, I hear babies crying, although dark, I see the glow from the computer screens guiding me to the break room where I clock in, participate in the huddle, and place my lunch for later that day.
Once huddle finishes and I’m caught up on how many babies occupy the unit, “hot spots”, and any other pertinent information… it’s go time. I find my assignment, gather my report sheets, and head to get report. As information floods me I jot down what’s important. Meds to give. Tasks to complete. Labs to gather. Relevant history and what the day holds. Why my baby is in the NICU, how long he/she has been here, and any social information relevant to my care. I quickly do my safety checks – bag and mask hooked up to the appropriate amount of oxygen and inflating correctly? Too much pressure – pop a lung. Too little pressure – not enough force to open the alveoli in the lungs for gas exchange. Is the suction hooked up correctly and suctioning to the right number? Again not too high, not too low. I check the code sheet… in case of emergency… and make sure the baby’s weight is correct. I update the whiteboards, introduce myself to parents, and make sure all IV fluids and medications are running at appropriate rates. The night nurse then signs off and leaves me to fend for myself for the next 12+ hours.
I. Can. Do. This. I chant as I make my way from room to room cleaning the bedside, hopefully wiping away any bacteria that dare invades my workspace and make my baby’s sick.
In the NICU days are typically divided into three or four hour periods. For babies eating by mouth… typically three hour periods. For sicker babies that can’t handle frequent “hands-on”… four hours. For this reason, my day is mapped out. Hands-on at 8-11-2-5 or 8-12-4. 9-12-3-6 or 9-1-5. I get my baby’s on a schedule and stick to it. Making sure that they aren’t touched too much or too little. That they are tended to the appropriate amount of time while not overstimulating them and tiring them out.
The first four hours of the day go like this…
For the first four hours I’m still getting to know my babes. Performing my first set of “hands-on” cares. I listen carefully for the gallop of their heart… is their a “swooshing” sound indicating a murmur? I then listen to their lungs as they breathe. Clear? Coarse? If intubated do I need to suction? Next… the abdomen. Can I hear bowel sounds? Although continuously monitored, I check an extra set of vitals just in case. Heart rate, respiratory rate, blood pressure, and temperature. I then score on pain. Did their vital signs change? Are their bodies tense, fingers splayed, face scrunched up? Do they cry out or lie listlessly? What’s their gestational age? Young babies get “scored” for pain because they have pain receptors but no way to block these receptors yet.
The first four hours are typically when the rest of the team comes by to round. Dietitians, doctors, nurse practitioners, social work, discharge coordinators, and anyone else relevant to the care of the patient. The previous day is discussed, changes are made, parents are updated, and the team moves on. It’s at this time that I hopefully get a break.
The second four hours of the day go like this…
I come back from break to begin the second four hours of the day. Another set of hands-on. Taking the changes that were made and turning them into reality. Updating scared and tired parents. Encouraging them, showing them how to change their itty bitty baby’s diaper. I cheer them on as Mom gets her first drop of colostrum. And forgive them when their anger is misplaced. They don’t typically know it, but I am both their child and their biggest cheerleader and advocate. What they don’t see when they aren’t around is that I’m watching like a hawk. Calling the doctors non-stop. And soothing their baby as needed. It’s at this point that I am completely and utterly exhausted. Emotionally, physically, and mentally. I head to lunch (if able) to catch a break and breathe.
The last four hours of the day go like this…
I return to lunch to run through the motions of the rest of the day. Although my senses are heightened when it comes to the care of my baby, everything else is just a blur. I grab all of the materials I’ve used throughout the day from the supply closet to restock everything for the next shift. I grab materials to change out my lines. I string fluids, co-sign fluids, and occasionally stop to give a gentle pat to a baby who has simply forgotten to breathe. I do my last set of “hands-on” to make sure that everything is still status quo. In the NICU… things can change in the blink of an eye. This means that as a neonatal nurse, you always have to be on your toes.
The clock strikes 1900. I breathe a sigh of relief knowing I’ve made it through another shift. Knowing that I can hand off my baby to the next nurse. That he or she will be in just as good of hands and I go home and breathe easily. On an odd day, my shift follows me home where I fret over every single minute. Did I notify the doctors on time? Did I miss something? Did I complete all my tasks?
You see, being a neonatal intensive care nurse is unpredictable. No two days are the same. You can hope and pray that your day will go as planned, as explained above. But it rarely does. Patients come. Patients go. Assignments are switched around and sometimes you’re so damn busy you can barely take a break. And although it can be hard and trying to be a NICU RN, it can also be so damn rewarding. You get to send babies home that you didn’t think would survive. You get to deliver good news to parents! You get to watch these teeny, tiny premature babies go from one-pound alien-like creatures to ten-pound chunks! You get to teach them how to eat and support their every breath. Every time you touch the baby… you’re making a difference. For better or for worse.
So if you’re a NICU nurse or want to be a NICU nurse at some point just know that those feelings of angst that you feel… you’re not alone. And even though I’ve been a registered nurse for five years, going into work scares the shit out of me every single time. You aren’t alone, but hopefully, you’re supported.
Interested in hearing more about life in the NICU? You might like…
If you’d like a better look into the inner workings of the NICU head over to my Instagram page and search in the highlight reel “NICU Life”