A Day in the Life of a NICU Nurse

CATHY: Super excited to be here today with Kenya who is a new grad RN in the NICU. You may recognize her as @FiveStarRN from over on Instagram and she's been really kind enough to join us today, answer your questions about working in the NICU and her experience as a new grad RN. So I know you're working night shift now right, Kenya?

KENYA: Well, I'm actually going to go to day shift which is kind of crazy rare.

CATHY: Wow.

KENYA: Where I work is a little bit short-staffed, well not a little bit. But short-staffed on most shifts so it was really just whichever one we wanted coming in so I did my few weeks just for the preceptorship experience and I actually loved it. I remember posting about it like, "What do you all suggest for staying awake? What's the best thing to do?" But I loved nights. It was great.

CATHY: You love nights?

KENYA: Yeah, it was great.

CATHY: But you're moving to days.

KENYA: Yeah, I'm going to go to days. Yeah.

CATHY: Okay, so--

KENYA: It will be better for my schedule. I just got that dog. So that will be better for him and me. Yeah.

CATHY: How old's your dog? Is it a puppy or older dog?

KENYA: He's five months old. But I mean I think he's pretty close to his adult size because he's a cavapoo and most small dogs I think reach their adult size like when they're younger. So hopefully he won't really get any bigger. He's like 12 pounds right now.

CATHY: Oh, my gosh. That's amazing. So is it like having a kid? Is it a lot of work?

KENYA: Yeah. I mean it is. It's a lot different than I thought it was going to be. It is a lot of work. I love him so much. It's great but it is really similar to kind of having a kid. He sleeps through the night just fine. It's just different like that first week I had him taking him out every two hours to get him potty trained to go outside and then when I get off work and he's ready to play and I'm like, "Wow, I'm so tired." But it's fine. He makes it worth it. I'll stay up super late and get no sleep but it's fine.

CATHY: That's so sweet. So how soon do you go to days?

KENYA: Well actually my last day one on one with the preceptor was yesterday and so Tuesday starts my resource week which is basically on your own but your main preceptor that you've been with you'll be on the same hall as them. So they'll be there if you need something. Just kind of checking in on you. and then the week after that, on my own, on my own.

CATHY: You're like, "Done."

KENYA: [crosstalk] Yeah. Everybody on the unit's really, really good about helping each other. Even people that have been there forever, everybody just chips in and helps... so I'm scared but I mean I think I'll be okay.

CATHY: Yeah, for sure. I know for me it was scary when I was done with my preceptor but it was also a chance to be like, "Okay, now I can really focus and go at my own pace and organize stuff how I want to organize it."

KENYA: Yeah, yeah because that is one of the hardest parts about it too especially if you're with multiple different preceptors, everybody likes to do stuff differently. And I mean I had a really, really great preceptor and she did let me do things the way I was comfortable. She would give me suggestions of what to do but then towards the middle of it, she'd like, "Okay, you got it. I'm here to help you, whatever you need." So it will be nice to be able just to do stuff and organize it the way I like it. And that's what multiple people have said. They're like, "Are you excited to come off?" And I'm like, "Not really." And they're like, "Why? It's great. It'll be great. You'll get to do"-- and I'm like, "Okay."

CATHY: Yeah, totally. Well, let's dial back for a second. So tell us, where you went to school? Where do you live? Where do you go to school? What made you decide you wanted to be a nurse? And then specifically what made you decide you wanted to be a NICU nurse?

KENYA: Well, I live in Birmingham. I actually live in a town that's kind of south of Birmingham going towards Tuscaloosa. Everybody knows about the University of Alabama. Roll Tide. But I actually went to UAB which is the University of Alabama at Birmingham. So go Blazers. So I went there for my first degree and I graduated with my degree in health education in 2015. And then I started working as a tech on the CVICU at the same hospital that I'm at now. So that kind of inspired me to go back for nursing and I kind of wanted to do it my first time around too but it just wasn't the best time in life for me to do that. I don't think I would have been very successful in nursing school. So definitely my experiences on the unit that I was on and then just the pathway I was going and then I've always had a passion for helping people and children. So it just made sense for me to go back for nursing. And from day one, our information session, even before orientation of school I was like, "Yeah. This is what I need to be doing."

CATHY: That's cool. So were you around little babies? Do you have a lot of experience with babies just in your personal life?

KENYA: Yeah, I mean I've been babysitting for a long time. Babies in my family. A lot of my friends have kids. I don't have any. I still babysit but I've always loved children. I've always loved helping kids. And then when I was on the cardiac unit, a lot of our patients were babies. So I guess [crosstalk].

CATHY: Okay. So you've always like-- yeah, just always like the babies and have been comfortable around babies.

KENYA: Yeah, I mean babies-- I mean I just love children in general but I mean I love working with babies.

CATHY: So when you were in nursing school was it an accelerated bachelor's program so you already had a degree or was it a traditional bachelor's program?

KENYA: I did the traditional program but there was the accelerated master's option. I didn't want to do it because I thought it might be a little bit too fast-paced for me. And I mean I know multiple people who have done it and they loved it and thought it was great. I mean they were great nurses. They were well prepared. But I don't know. I like to go a little bit slower, make sure I have a good grasp on things and I didn't want to go in too fast. So I just did the traditional program and it worked out perfectly like it was meant for me to do it because all of the classes that I have taken for my first degree were the prerequisites I needed for nursing.

CATHY: Perfect.

KENYA: So I only had to take one extra class, so it was great.

CATHY: That's great. Well, that was totally different for me because I used to be an engineer. And so in terms of prereqs, I had none of the prereqs. So I spend two years at my community college takingall my prereqs before nursing school so that's great that you were able to come in with all those done.

KENYA: Yeah, it was great.

CATHY: Totally. And so how hard was it to get in your current position? Do you feel like since you were working as a tech there before then that really helped you get your foot in the door? Or just how competitive is it in your kind of geographic area?

KENYA: Well, I think having that experience at that hospital really did help but also at the same time, I precepted my last semester on the same unit where I work now. So I really think that helped me too and multiple of my friends who wanted to work on the unit that they precepted on, I think that helped them as well. But the unit that we're in-- UAB's a huge medical school. We have multiple medical degrees, medical areas and it feeds right into the local hospitals. So it's competitive but coming from that school, going kind of into the same system makes it a little bit easier. But that's not to say that-- I mean because I applied for other jobs and I wasn't selected for them. So not that this was-- this is what I want to be doing. I love the unit where I work. But I mean it is hard. It's definitely hard because other hospitals in the area-- I mean it's hard especially fields like labor and delivery, all those specialized areas. It's hard.

CATHY: Yeah, I know when I was in my last semester when we were doing our internships, people were kind of applying for what they wanted to do and I know the students who really wanted to go into labor and delivery, there was two positions for a whole cohort. And for peds, there was maybe one or two positions. So there was definitely more people who want to do peds or labor and delivery than there were positions. That was very, very competitive.

KENYA: Right. And that's kind of how it was for our program too. We had about 130 in our cohort that graduated with me around that. I don't think anybody that wanted labor and delivery got that. There was I think about eight or nine peds spots but the way they base what we got was off our Med-Surg ATI scores. So the better you did, the more likely you got your top picks. So just watching your videos and doing well on the ATI helped me out with that one.

CATHY: Someone else told me that too. The priority was based on their ATI score and they were able to get one of the two peds positions because of their ATI score and from watching our videos and using our cards. So that's really interesting. It sounds like maybe a lot of programs use that as kind of their prioritization.

KENYA: Yeah, I think it's just probably one of the most fair ways they can do it with the number of people that we have. It's so big and there's only so many units. There's only so many spots. We have multiple nursing programs in the area because Birmingham's a big city, so we have schools that have nursing programs everywhere. And so you have all these schools trying to send their nursing students to these main hospitals so that makes it even more competitive.

CATHY: Okay. So your advice to students who are watching who want to go into peds, want to go into NICU-- so probably one piece of advice is to score-- if they're basing those positions on scores is to really nail your test and [crosstalk].

KENYA: Yeah, if they're basing your preceptorship placement on any type of test or anything like that definitely do well on that. I started studying for ours probably the first day of that semester. Our teacher that semester for adult health made us this little schedule calendar and was like, "Okay, you can get through the whole book if you study like this. Study this together. Study this together." And I did that whole thing. And I feel like that semester all my free time I just studied for ATI.

CATHY: You were studying. Yeah, and you probably did great. You did great.

KENYA: [crosstalk] If it's not based on that, I would suggest just talk to whoever's in charge of your preceptorship placement and then if you're not able to precept on a unit like that, ask about shadowing. Reach out to their nurse manager or their unit educator about shadowing opportunities because that way at least you can maybe see the unit, see if it's something you really want to do. And then maybe meet some of the leadership and then they'll be able to put your face with your application because that always helps too. Because I know a girl, she shadowed multiple times and I really think that helped her too.

CATHY: Okay. It helped her you think kind of get her foot in the door?

KENYA: Yeah.

CATHY: Okay. So you went straight from school into NICU?

KENYA: Yeah.

CATHY: And so what do you think the pros and cons are for going straight into a specialty versus starting on a Med-Surg floor and then moving into a specialty?

KENYA: I think the pros would be fresh out of school, ready to learn their way of doing things because NICU is super-specialized and I know all NICUs are different. So it's not like having to leave a completely different field and learning stuff all over again because I mean I really didn't know anything outside of classroom nursing. So that was great. The main con would probably be that it is so specialized like if I ever decided to do something different, because I thought maybe in the future maybe if I want to go to NP school, I would be leaning more towards doing like family nurse practitioner rather than neonatal just because it's more broad. And that might be something that would be a con too. That might be a hindrance. But I feel like I could probably still get some good experience in the adult field. I have a PR job that deals with adults [crosstalk], so I have experience with adults. So I guess you just kind of have to-- if you know you might want to do something later, go ahead to start preparing for it now so that way, you don't feel like you're just trapped in this one bubble.

CATHY: It's one area.

KENYA: Yeah.

CATHY: So you maybe want to be an NP later on? Is that a career goal for you?

KENYA: I think so. I'm just really tired of being in school right now. I've been in school almost like seven, eight years straight, so I want to just work for a while. But I think that probably is my goal--

CATHY: Down the road. You got plenty of time. You're young. You can do whatever you want. With your new grad position, how long did you have a preceptor? It was a new grad program? And did you have other things besides a preceptor, like classes and stuff like that?

KENYA: The hospital I'm at is really, really good about bringing their new grad nurses in. The first two weeks, we were with the whole group of just new grad nurses no matter what floor we're going to. And the lady that was with us was amazing, and that was so helpful. So we all did that together before we even went to our floors. And then our first week actually on NICU was another week of just full class room where I'm just kind of going out to the floor to look, not really doing any patient care. And then they kind of just stepped us into our shift, so we did two weeks of eight-hour shifts. And then we started our 12-hour shifts. We did that for a few weeks, and then we had another full week of classes to learn about the different disease processes, the different services that we have on our unit, the different people that-- the different groups that come in, the multidisciplinary team like PT, OT, nutrition services. So just learning about everything. And I thought that was really helpful doing that in the middle. Because it's like-- you've gone out on the unit, you've seen some of it. And then you come back and "Oh, cool. That's this. That's what that was." And then you go back out to finish up your last few weeks then you have a kind of better understanding about it. So all in all 14 weeks actually on the floor, but I think it was probably like 16 to 18 weeks including classroom training, and just overall hospital orientation, and stuff like that.

CATHY: Okay. That sounds like an amazing new grad program. Sounds like you got--

KENYA: Yeah. So my other friends were in different hospitals. I am really thankful for the new grad program that we have because I feel like it really helps us feel comfortable and more prepared--

CATHY: Totally. Yeah. I love how they had you on the floor for part of the time and then back in the classroom where everything would make a lot more sense since you kind of saw it in action, right?

KENYA: Yes.

CATHY: It kind of helps that all sink in a lot better.

KENYA: Yeah, yeah. We have really good education on our unit. That's one of the main things I like about it.

CATHY: That's awesome. And your preceptor, were they really receptive to having you as a preceptee? Were they really helpful?

KENYA: Yeah, my preceptor was amazing. She's awesome. We got along really, really well. She's very, very, very knowledgeable. The other day, our assistant nurse manager was actually walking around, and she was like, "Oh, make sure you pay attention to her charting." She's amazing at charting. And that's why I kind of got that feeling because the way she would tell me to do things, I'm like, "Why am I doing it like this?" But then later understanding why I was doing it that way towards the end of my preceptorship, I feel like I was learning from one of the best. But I mean they're all amazing. She was a good preceptor.

CATHY: That's awesome. So let's talk about-- what's been one of the hardest things about transitioning from nursing school to being an RN now? What's been in your experience the hardest thing as far as that transition or just something hard in general? I know as a new grad, it was pretty overwhelming. There's just so much information, and charting, and knowledge, and just balancing everything. It can be very overwhelming. Was that some of your experience as well? Or was it easy sailing for you?

KENYA: No, it definitely has not been easy. It actually has been pretty hard. I mean I didn't go into-- I think it was going to be easy at all. But I mean it's a lot harder than I thought it would be especially having that experience precepting there at school. But it's just totally different being the RN. It just was so different. It was still a good experience though. But I think one of the hardest things was people actually coming to you for information about your patient, or needing the information that you had, or paying attention to what you have to say. I remember one time, it just really hit me like, "Wow, I'm for-real nurse now." It was one of my first time to giving report, and the oncoming nurse just stopped and stared at me after I got done talking. And I thought it was cause I said something wrong or said something awkwardly, she was just looking at me to continue and I'm like, "Oh, wait. You need to hear what I'm saying." So that was kind of hard to get used to, people listening to you. Or during rounds when the team asks you stuff, specifically, or tells you the plan or tells you what they're putting in instead of telling your preceptor and it's like, "Okay. Cool."

CATHY: Yeah, I guess I'm in charge here, right?

KENYA: Yeah. That really has been one of the the hardest parts, just being-- just having that weight of being responsible for the patients.

CATHY: Totally. I remember when I was a new grad and on our floor, the floor I used to work on, they do a report with the doctors and sometimes some multidisciplinary-- other people join in. And as the nurse, you're giving a report on those four patients that you literally just got report from 30 minutes ago, right? And some of these patients have a very long, complicated history. You literally just got report and now the doctor and everybody is looking at you. Your case manager would be like, "Tell us about this patient." And I'm like, "Uh." It's hard, right? And--

KENYA: Yeah. It's one of the hardest parts.

CATHY: And I felt like in the beginning, I had a lot of pressure on myself to know all my stuff. But over time, I've learned that it's okay to be like, "I just got this patient for the first time this morning and I don't know. I'm not sure about these things. I need to get into that." I think when I was a new grad, I was afraid to say, "I don't know." But now, if I don't know, it's-- just I don't know yet. Uh-oh. I think we've lost you. There you are.

KENYA: There we go.

CATHY: Yeah. You said your team is really good about lending support and helping you when you need help. Are you good about asking for help? I know for me when I was a new grad, sometimes I would be reluctant to ask for help. I felt like I need to manage it all myself and show that I can handle it all. And so one of the pieces of advice that I give for new grads is, "Don't be afraid to ask for help. Definitely ask questions and don't be there drowning. Make sure you ask for help before it gets too bad." Your experience with that? You feel comfortable asking for help? Was it hard?

KENYA: Well, I always like to ask a lot of questions because I'm terrified to mess something up in the first place. So I always go ahead-- if it's something I'm not sure about, I always go ahead and ask because I'd rather, possibly--

CATHY: For sure.

KENYA: I mean, nobody makes me feel dumb. Nobody's ever done that there. But I'd rather seem-- ask a dumb question than do something wrong and possibly hurt the patient. I'd rather just ask. And even if I know the answer, but I'm not super sure of the answer, always check. Even if it's something I know I've asked them before, I'm like, "Well, I'm going to ask again just to be sure." So I always ask for help, especially when it's something I haven't done before. Like if I have a patient that's intubated, I always will ask for help. "Hey, will you help me turn them?" Or if they have a fresh trach or something, "Hey, will you help me reposition?" Stuff like that. Especially when it comes to safety or like a question about a medicine, yeah, I always ask. And normally, people are really good about-- if they have downtime or other people that have orientees-- so this is the kind of new hire season after; some are fresh out of school. A lot of people have orientees, so a lot of people are available to help, so.

CATHY: Nice.

KENYA: And I think that's one thing that preceptors and your educator looks for too, is do you know how to ask for help? Do you know when you're drowning, that it's okay? So they like for you to do that.

CATHY: Okay. Yeah. For sure. And that's a really good thing. So I just want to make sure when people who are listening and they're getting ready to start their new position, don't be afraid to ask for help. Don't go around and feeling like you can't ask for help. They want you to. They're looking for that. They don't want you to go off and be doing stuff without asking when you're not comfortable.

KENYA: Especially, if it's going to put patients in jeopardy. Definitely ask for help if you need it.

CATHY: Sure. And just give yourself a lot of grace and a lot of patience because it's just so much to learn. Especially, that whole first year, it just feels like a lot. At least it did for me.

KENYA: Yes. So much. Everyday.

CATHY: What's your ratio, Kenya? Is it two to one or is it how many babies?

KENYA: It's normally two to one. So normally, two. If it's a really, really sick patient, which I mean, I'm sure I wouldn't have for a long time being there, it would be one to one. Or sometimes if the staffing is really bad, you might have three or two and a half, but I've never had that happen during my preceptorship, so.

CATHY: Okay. What's been a good day? What's a recent day that you've had that you just felt really good, you had a really great day? Can you think of a day where you came home you're like, "I've got this. I'm doing good," you felt really good about your day?

KENYA: Yeah. Probably a day when I got to have a lot of interaction with the family because I really haven't gotten to do that much up until that point. And I felt really comfortable talking to them and answering their questions. My preceptor was really supportive of it. And so I felt really good that day, and I was like, "Wow. I was actually able to kind of build a relationship with this family, kind of help them understand what was going on with their child and kind of help them feel better." So because that was one of the biggest parts that I was kind of scared about. I was like, "Okay. So you don't only have your patient, but then you have to deal with their families too." But that's overall been a really positive experience. So that was probably one of the best days I've had.

CATHY: That's awesome. Well, how about on the flip side? Is there been a really hard day where you came home and like, "Oh, that was a rough day," just a hard day for you?

KENYA: Yeah. Probably when patients pass away. That's hard for anybody. But I feel like it's just harder when you're in peds. So I mean, that's just rough in general. And then really busy days where there's a lot of moving around, a lot of field trips off of the unit. Those are really hard days or the days where I just don't-- even though my preceptor is helping me, she's running too. You just don't even sit down, and you don't feel like you're caught up at all that day because I love being caught up on charting. Sometimes I'm really not caught up. So days like that, where I just fall behind all day, those are the worst to me.

CATHY: Okay. Yeah. No, I hear you on that. When you would feel like you're charting at 4:00 PM for the whole day because it's just been fighting fires and stuff like that. And I can't imagine what that would be like. I know during my new-grad period, I lost a patient who was full code, and that was rough. And so I can't even imagine how difficult that would be in a peds environment. Hats off to you and to everybody who wants to be a peds nurse. I don't think that's-- that wasn't the path that I considered just because I think, I have my own kids and I didn't want some of that stuff in my head. And so I really appreciate and admire and respect people who want to be peds nurses. And I'm so glad that there's people who want to do it because I think I'm not sure that I'm strong enough to do that, right? It's hard enough with adults. Like I said, I had that one patient pass and that was that was rough. I still think about her sometimes, and it's hard. So let's see what other questions we got here. We talked about some of your career goals. Have you had to start an IV on a teeny tiny baby? Have you done that? I can't even imagine. I have a hard time doing it on adults, so.

KENYA: I've not had to start an IV on a little baby because most of ours, if they need an IV, we need that access. So most of the time, we just let someone who knows they can get it. So there hasn't been a time where it's like, "Oh, well, they have plenty of great veins. Just go ahead and stick!" I'm actually stuck for labs though. We do a lot of little sticks which seem really easy. But there's actually a specific way to do it, and they're a lot trickier than they look. So that was interesting. But I've done some venous sticks too. So those are cool. But no, I have not started an IV on a little teeny baby. I have a second PRN job at an IV therapy, like medical Spa. So I stick adults all the time, and it's just so different comparing that to babies. Because the first time I've ever stuck a baby for venous stick-- like on an adult, when you get that flash, you just go a little further to be sure you're in there then you thread. Well, on a baby, as soon as you get that flash, don't go any further with your needle. Just thread because it could go a teeny bit more. You're through the vein. So that was hard. That was really hard to get used to. But yeah. yeah. We'll see.

CATHY: I'll see what else-- some other specific questions people ask. Do you require parents to be CPR-ready when they leave?

KENYA: I'm pretty sure, I'm not entirely sure. We have discharge planners on the floor. Our unit's really really big, so we have Discharge planners that coordinate all the discharge, teaching, and education. So I'm not entirely sure. But I feel like that would be something that we would provide. I know the hospital has the resources to do it. So I'm sure that's something that they require.

CATHY: They probably do.

KENYA: Or we at least highly, strongly suggest it.

CATHY: And then someone else has asked about drug calculations, formulas for babies. But I'm guessing they have it all calculated, the pharmacy exact dosages for you, right?

KENYA: Yeah. Everything comes up from pharmacy. If it doesn't come up, already pulled up in the syringe from pharmacy and it comes from the Pyxis, it tells us the amount to get. There's been times where I've had to do the calculation like reconstituting antibiotics. But it is straightforward calculation. You would follow your mark or the milligrams they want them to have. And then it's just your desired, over have, times your volume, so it's just sometimes you'd have to be sure to know your milligrams. And whenever I have to calculate something myself like that, even though it's not required, I always get another nurse to check to be sure.

CATHY: Super smart, right? So no crazy calculations like nursing school. Sometimes, they have you do really crazy stuff. You got to get through it in nursing school. But then they really try to make it easier and less prone to error when you get out.

KENYA: Yeah. Yeah. At my school, we had a medication calculation exam every single semester, every semester. And we had to get a 90 or higher. A validation exam, three exams or you failed that, you got to retake the class. But--

CATHY: We had the same thing except for I think they made us get 100. If you missed one question, you--

KENYA: [crosstalk].

CATHY: I think you get one retake and then-- yeah. Then you don't pass the class.

KENYA: Oh, that's intense! oh, that's even more intense! I thought we had it bad.

CATHY: No. No. Math. And I'm fine with math. My previous degree was engineering. I love the math, but for people who didn't like math, that was way, way stressful. So for sure.

KENYA: I think a lot of it, too, was just-- it wasn't hard math. It was just so much was riding on it, that it was just you would miss little stuff. So I don't know. I guess, my suggestion for people with that, practice, ask questions, just take a deep breath. And I would use almost the entire time that we had to take it, and I would go through and calculate everything a second time or even a third time, just to be sure. So I say [crosstalk].

CATHY: So smart. So smart. Don't just bang it out and throw it in, right? [crosstalk] Well, let's open it up to questions. I think there's like 22 people watching now and if you guys want to put any questions over there on the side, we can try to answer those. Or Kenya, is there anything else you want to share? Just advice for students getting ready to start as a new grad or they're graduating. Anything else you want to share with the students who are watching?

KENYA: I guess, I mean there was times where-- last semester of nursing school was amazing. But there was times where I was super sad. Not sure where I want to work. Not getting called back for stuff that I applied for. Just being unsure. I'm like, well this is supposed to be a really happy time. So I mean, just allow yourself to be happy even though you might not get where you think you really want to be. I mean, I know everybody's not spiritual or religious but I know that where I am right now is where God wants me right now. So just keep stuff like that in mind. Everything that you go through has something to learn from it. So if you look at stuff that way, like, there's something that can be learned from this experience, even in your patient assignments and stuff. If it's something like, "Oh my God, this assignment's so boring," or "This assignment's horrible." I mean, it's hard to think of it right then in that moment but I try to think later on like, "Okay, well I at least learned this from that situation."

CATHY: Totally. I'm real worried that--

KENYA: Oh, sorry.

CATHY: I'm sorry. No, I just say along the way, I definitely had moments like, "What am I doing?" Like when night shift, and when I was working as a transporter while going to an accelerated bachelor's program. And there was definitely moments like, "Oh my God. I want to be a nurse but this is so hard." It will get better. As you get through these steps, it will get easier. It will get better. Just got to give yourself a lot of grace. Give yourself a lot of patience. Yeah.

KENYA: That and I think have, if you can, a good support system. I'm blessed enough to know a lot of nurses. So having people who I would consider really, really close friends who've been nurses for 15 years and kind of can be my mentor, I think has been great. And then, just find that good group of friends in your cohort that you can study together even if it's just talk about stuff. Because I mean, that was helpful. I'm a really social person. I don't have any siblings. So my best friends are like my sisters. Those are my siblings.

CATHY: That's awesome.

KENYA: And then if you have a significant other, love them through it. Let them love you through it. I wouldn't be able to do any of it wit