Treating the youngest patients: working as a NICU nurse

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Babies born as young as 25 weeks are surviving more often than ever thanks to advances in technology and the work of neonatal intensive care (NICU) nurses and doctors. Working as a neonatal intensive care nurse can be both challenging and rewarding. In order to evaluate if NICU nursing is a good fit, it is essential to learn what type of care is provided, the role of a NICU nurse and what it takes to succeed.

A gap medics student holding a new born baby on the neonatal ward in Tanzania. What is a neonatal intensive care unit?

Neonatal intensive care is a unit where premature babies and newborns with serious medical conditions can receive specialized care from a medical team consisting of a neonatal intensive care doctor, respiratory therapist, social worker, child life specialist and nurse.

In the United States, there are four different levels of care for newborns that hospitals may provide. A level one nursery provides care for full-term healthy babies. If a sick or premature baby is born at a facility that only has a level one nursery, the baby will be stabilized and transported to a different facility.

A level two newborn nursery provides care to babies over the age of 32 weeks gestation. Similar to a level one nursery, they will transport babies who are born earlier or require advanced care.

The next level of care is a level three NICU. Level three NICU’s provide care to babies born less than 32 weeks and also newborns of all ages with critical conditions.

A level four NICU is the highest level of acute care for newborns. Level four nurseries can treat the most serious conditions. A variety of neonatal specialists are available to provide care. NICU nurses usually work in both level three and level four newborn nurseries.

Responsibilities of a NICU nurse

A NICU nurse is probably at the baby’s bedside more than any other member of the healthcare team. NICU nurses have a wide variety of responsibilities when caring for babies in the intensive care unit. Nurses in the NICU typically perform assessments, administer medication, start IV lines and draw blood.

The role of a NICU nurse also includes educating parents on how to care for their baby when he or she is discharged from the hospital. Education is provided on special procedures required, such as feeding assistance or equipment needed.

NICU nurses are also present at a baby’s delivery in order to provide immediate medical care as needed. This may involve providing lifesaving interventions and stabilizing the baby immediately after birth. 

Most NICU nurses work in hospitals. Some may also work for medical transport companies. Similar to other types of nurses, NICU nurses work all shifts including holidays and weekends.

How to get stared in the field

After graduating from a registered nursing program, nurses interested in working in a neonatal intensive care unit should gain some experience working with healthy newborns. If possible, apply for a position in a newborn nursery, labor and delivery department or post-partum unit.

Although some facilities may hire new graduates, gaining a few years working in a well-baby nursery with healthy newborns is a good way to start. Assessing and caring for healthy full-term babies will teach you the basics and help give you a set of skills to build on.

Nurses interested in working in the neonatal intensive care unit will also need to become certified in neonatal resuscitation, which is offered through hospitals and private organizations. Nurses can also earn a certification in neonatal intensive care nursing from nursing organizations, such as the National Certification Organization.

Traits needed

If you are considering becoming a NICU nurse, there are several traits you should have that will increase your chances of success in the specialty. Having a calm demeanor is a great trait for a NICU nurse. You will be dealing with very small babies who are critically ill. Emergencies are routine in the NICU. Remaining calm will help you deal with stress and focus on your duties.  

It is also helpful to have excellent communication skills. Part of your job is to educate parents, which means taking complicated medical information and communicating it in a way people without medical training can understand.

In addition to educating parents, nurses will work as part of a team of healthcare professionals and need to be able to communicate clearly and effectively.

Attention to detail is also a critical skill for NICU nurses. The smallest detail can make a big difference in treatment, preventing mistakes and improving outcomes. Nurses in the neonatal intensive care unit also need to be able to multitask. There is a lot going on in an intensive care unit, and you will have to juggle multiple duties and possibly multiple patients. 

Pros and cons

As with all specialty areas of nursing, there are pros and cons to working in the NICU. You may see a variety of conditions, which is a great learning experience. The job is often fast paced and can be a challenge, which some people may enjoy. Working as a NICU nurse allows you to play a part in saving the lives of babies, which can be one of the most rewarding careers you can choose.  

With all the rewards also comes a few cons. All types of nursing can be stressful at times, and NICU nursing is no different. You are not only dealing with the patient, but the parents as well. It can be heartbreaking to see what families go through, and not all babies survive. The long hours and stress can be physically and emotionally draining at times.  

Salary and outlook

The outlook for NICU nurses is considered good. As technology advances, babies are surviving at younger ages. In addition, medical conditions and diseases, which were considered fatal in the past, are now being successfully treated.

Salaries for NICU nurses vary depending on your location, experience and credentials held. The average salary range for NICU nurses in the United States is between $45,000 and $95,000 a year. 

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