Being a new grad nurse is hard, especially in an intense environment such as the NICU (Neonatal Intensive Care Unit). There’s no way that nursing school prepared you for the NICU and if you worked in the NICU as an aid before becoming a nurse, it’s still overwhelming. There’s so much you need to know, there are lives at stake, and the patients can be incredibly sick. The good news is that everyone is new at some point so if the thousands of nurses before you can do it – you can too. Below you’ll find my best tips for being a new grad nurse in the NICU.
10 Tips for Being a New Grad Nurse in the NICU
1. Always Stay Curious
This applies to new grads and non-new grads, always stay curious. Things in the NICU are constantly changing and evolving as more research is being done. It’s important to stay up to date with the most common practices, and always stay curious about what you’re doing and why you’re doing it.
One thing I like to do at work is see what is going on with patients other than my own. If there’s an interesting case on the unit I try to make it over during my shift and ask about the patient.
2. Ask Questions Always
This might be an obvious one, but I find that a lot of new grads feel stupid for asking questions. First off, nobody is stupid for asking questions – they are smart. Smart because it’s better to ask and learn then to not ask and make a mistake. Plus, how are you going to learn if you aren’t asking questions? We expect you to ask questions – all the time.
3. Understand the WHY Behind What You’re Doing
I’ll never forget when I was a new grad and it was my first day on the unit with my preceptor who had been a NICU nurse for 20+ years. I had to draw labs and my preceptor instructed me to place a heating pack on the infants foot. When I asked her why we did that, she looked at me and said, “I don’t know”. It’s okay not to know things, but she didn’t even ask someone else or find out the answer for me. It was then that I vowed to myself that if I were going to be doing something, I would know the why behind what I was doing.
Knowing the why behind what your doing makes you a better nurse all around. Not only are you able to explain things to parents better, but you’re also able to respectfully question and challenge providers when you don’t agree with something they ask you to do.
4. Remember it’s Normal to Feel Overwhelmed
Being overwhelmed as a new grad, especially in the NICU, comes with the territory. Everyone has felt overwhelmed at some point, so know that you aren’t alone. Just take things day by day, patient by patient, and eventually the pieces will begin to fall into place.
5. Ask for Help if You Need it
Eight years in, and there are some shifts that I still need help. Everyone needs help here and there and as a new grad, you’re bound to need help. Remember that it’s better to ask for help then to struggle through your shift, not get your work done, and either put the patient at risk or leave a bunch of work for the oncoming nurse to complete.
6. Ask for What You Need
If you’re getting the same patient assignment over and over again or you’re not getting sick patients, I encourage you to stand up for yourself and ask for what you need. I used to think, “Well, the charge nurse will give me the assignment she thinks I should have”, but that couldn’t be further than the truth. The reality is that the charge nurse is probably paying very little attention to your needs when making patient assignments and the only way that he/she is going to know what you need is if you tell them.
This is especially true on orientation when you have a preceptor helping you. This is the time you should be getting the sickest patients (when you’re ready for them), and if you aren’t, speak up.
7. Be Gentle With Parents While Having a Backbone
One of the hardest parts about being a new grad in the NICU is pleasing the parents while having a backbone at the same time. It’s a thin line to walk juggling the needs of stressed and anxious parents, while setting appropriate expectations and boundaries. It is important to do everything you can to please the parents, put them at ease, and allow them as much autonomy as possible while keeping their baby safe. But there are times where parents may take it too far (they might not even know it) and it’s important to stand up for yourself and your patient. After all, the baby is your number one priority with the family being a close second.
When I was a new grad I allowed a mom to give her sick infant a tub bath (who shouldn’t have gotten a tub bath), because I felt bad for telling her “no”. The baby got cold and other things transpired after that. Had I just had the courage to stand up to mom and respectfully tell her that I didn’t think it was a good idea at this stage, the infant wouldn’t have had a rough night.
There are other instances too where parents may make outlandish demands like, “Please go check on my baby every 30 minutes”. This is okay to do, but instead of just being a “yes man”, I prefer to instead phrase it like, “I will do my best to check on your baby every chance I get. Don’t forget that his/hers vitals are constantly being monitored and even if I’m not in the room, someone is always watching”. This way I’ve set appropriate expectations and hopefully prevented the parent from demanding other outlandish things in the future. (By the way it isn’t “outlandish” for a parent to want their baby constantly checked on, but it isn’t always realistic especially if you have more than one patient).
8. Ask Providers for Education
As a new grad one of my favorite things to do and how I learned a lot quickly, was to ask the providers about what was going on with my patient. When they would round, I would ask, “Can you please teach me something about this patient that I might not know or read from the notes”. Or, “Is there anything unique about this patient that I should know about?” I usually would preface it with, “I’m new and I’m trying to learn” and people were more than willing to provide some education.
Eight years in and I still do this if I have a patient with a diagnosis that I’m unfamiliar with.
9. Study When You Can
Most hospitals will provide new grads with study material to learn about the NICU and the main things that go on with sick, premature infants. This is usually a STABLE book and maybe even a general NICU handbook. I encourage you to take a couple hours each week, away from work, to study preemies and other NICU related material.
10. Put Your Mental Health First
And the most important tip of all, always put your mental health first. This might mean saying no to working extra. And it might even mean calling in sick if you’re just feeling too overwhelmed to go in. If you’re having debilitating anxiety about working or other mental health issues, I urge you to speak with someone. If you trust your manager, go to them so that they understand what’s going on. But if not, I highly encourage you to hire a therapist.
Remember, we’ve all been new at one point. The things you’re feeling have been shared by thousands of nurses before you. Find someone more experienced that you trust to go to with questions, concerns, or just general needs you may have. We should all be looking out for each other to ensure that new grads are thriving and set up to become the best nurses that they can be. And remember, eventually you will be that experienced nurse that new grads are going to.
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