As a Neonatal Intensive Care Unit (NICU) nurse, no two days are alike. One of the misconceptions people have about being a NICU nurse is that they are just changing diapers and bottle feeding all day; they think the work is easy. However, that is far from the truth. Although the days vary greatly in the NICU, there are still a lot of consistencies in each day. Most days consist of administering medications, blood products, monitoring IV fluids, charting vital signs, intake/output, more charting and documenting everything that happens on the shift. In addition to your assigned patients, the NICU nurse attends all high-risk deliveries. My shift starts like most nurses in the NICU: you are not really sure of what your shift will bring, but hopeful to finish your day with a sense of accomplishment. Here is a peek into the work life of a NICU nurse:
6:45 a.m. – Get report on from the nurse who is handing off to me on my assigned patients in NICU. In the NICU, not all infants are born premature, some are full-term babies born with some complications. The day is planned based on feeding times, diaper changes and medication administration.
7:00 a.m. – 8:00 a.m. – I review all the medications the babies are on and when they last received them. I double check physician orders and check on my babies to make sure all IV fluid, ventilator and/or oxygen settings are correct. At this point if I am assigned a “feeder and grower”, (i.e. infants no longer on oxygen and IV fluids and are feeding and growing), I will review their feeding and medication schedules. The ratio for feeders and growers in the NICU is 3-4 patients to 1 nurse, but if you are assigned a “sick” baby in NICU, it is a different ball game altogether as you are dealing with lines, electronic equipment, monitors, IV pumps, syringe pumps, etc. Depending on how sick the infant is, the nurse patient ratio can be 1-2:1. Depending on the acuity of the neonates the nurse is assigned, they may need to assist the infants with parenteral, nasogastric, or bottle feedings. Some premature neonates will be kept NPO (nothing by mouth) until they are physically ready to handle formula or breastmilk and require lipids and total parenteral nutrition to meet their energy needs.
The NICU has a strict schedule for feedings, checking vital signs and feeding with the goal of minimizing the time babies are disrupted or getting into their incubators. It is important that babies stay in a neutral-thermal environment and get the right amount of nutrition in order for them to grow.
8:00 a.m. – 9:00 a.m. – Feeders and growers eat every three hours and care is clustered at this time, e.g. head to toe assessment, check vital signs, diaper changes, medication administration and feeding (bottle/breast or nasogastric) are done at the same time to allow for rest periods. Like most newborns, they are fed every three hours — but unlike a baby born full-term, many NICU babies in the growers’ nursery are fed through their nose with a nasogastric tube. Some are also bottle fed. It is also important to consider the time the parents will spend with their babies at the bedside. Time is spent helping parents understand their babies; their questions answered, and encouraged to hold their babies, if possible. During this feeding time many neonates will need standard medications like vitamins, antibiotics, iron, and caffeine.
9:00 a.m. – 11:00 a.m. – By 9 a.m. first round of feeding is finished. Documentation is done in the computer every 3 hours on feeders and growers. Documentation is done hourly on “sick” infants. Check new physician orders throughout the day for feeding increase, new labs, etc. Attend to family members visiting the infants. Assist with physician rounding. Answer phone calls from parents and other departments.
11:00 a.m. – 12:00 p.m. – Complete assessment, change diapers, check vital signs and start feeding again. Constantly on your feet, between patients making sure their temperature hasn’t risen or dropped, their blood pressure is safe and their medication is administered. Hour upon hour, this is your routine. In addition, the nurse has to feed them every three hours, rock them when they cry and change their diapers. It is no picnic, but a full day’s work.
12:00 p.m. – 12:30 p.m. – With all the excitement on the unit NICU nurses get a chance to recharge during their 30 minute lunch break. They can use this time to relax and socialize with co-workers or take a walk to the cafeteria to unwind from the “busyness” of the unit.
12:30 p.m. – 4:00 p.m. – After lunch the atmosphere of the unit may quiet down or there may be an emergency delivery or change in patient status. For the most part NICU nurses spend time providing direct patient care, teaching parents about basic infant care, assisting parents with holding their babies skin-to-skin, or creating an atmosphere where infants can sleep in a developmentally appropriate environment.
4:00 p.m. – 6:00 p.m. – During this time, the energy levels among staff start to rise because they are getting ready for the end of the shift. Neonatologists are making their final rounds before leaving for the day and may write new orders or change current treatment plans.
6:45 p.m. – Alarms go off fairly constantly in the NICU as premature babies can forget they need to breathe and you have to remind them by gently shaking them or tapping their tiny feet. Therefore you are constantly on your feet attending to the alarms or the infants’ needs throughout the shift. Shift documentation is completed at this time. Cribs are stocked with supplies and assignment is made for the next shift. After NICU nurses complete their final assessment, provide all patient care, and complete final documentation it is time to prepare for shift change report. The shift ends by giving the new nurses shift report–ensuring that the neonates receive a continuity of care and hopefully finish your day with a sense of accomplishment.
To read more about our NICU, click here.
Adetoun Anibaba, RN, BSN
Clinical Coordinator, Nursery/NICU, OakBend Medical Center – Williams Way
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.