I wanted to thank you for helping me through a tough time. I just read your post about the glass of water and remembering to set it down. I am a new grad who went straight from school to my first nursing position in the NICU. I have only been working on the unit for a few months and already made my first med error. The patient is ok, and I received a lot of support from the staff, but I feel just awful about it and have been beating myself up. Thank you for reminding me to set the glass down.
Thank you so much for writing in and sharing this with me. You have no idea the profound effect your words had on me.
I’m so sorry that you had your first med error. I’m so glad to hear that the patient is okay. And I’m equally relieved that you’re moving past it as well. I had my first med error not too long ago. (You can read about it here.) And it was awful… and everyone, everyone was so understanding and kind and supportive… and I just kept wishing someone would yell at me! Which I know sounds a little crazy but I felt like I deserved to be yelled at.
But the truth is, we’re human. We make mistakes; every single one of us. And in the end, I, much like you probably, beat myself up enough for everyone else.
So, thank you again so much for sharing. I’ll just bet there’s someone else out there who has been through the same thing that will feel a bit better knowing that they’re not alone.
Mushy side note: I wish I could push through the magnitude of my gratitude through these letters and words that appear on your screen. This tumblr is so therapeutic for me as it is. The fact that someone else out there gets some laughter or comfort out of stories shared… gah. It just means so much to me. So thanks.
I don't have a question, but I wanted to give some input on the new grad asking about NICU positions. Here in Anchorage, AK we have a fabulous new grad program where you receive a full year of training in the NICU! They call it an "internship" but you are getting paid like an RN, you are on the unit, and they expect you to continue to work for the unit.
Hey thanks! That’s awesome! Thank you for sharing that with everyone!
Would you provide some NICU specific interview questions? Thank you very much.
So I’m not in the business of hiring in the NICU but here are some things that I would want to know about a future co-worker:
1. anything to do with prioritization of care
2. what is it about the neonatal population that interests you
3. what is it about an icu that interests you
4. what would you do if you saw a well-meaning parent providing inappropriate care for their baby? (i.e. a mother over stimulating her 26-week infant)
5. how do you handle stressful situations
6. give a specific example of how you advocated for a patient who could not speak/do for themselves
You don’t have to know everything about the NICU to be hired into one (trust me, I’m living proof!). Know about the organization - are they big on family centered care? What’s some cool research that’s come out of their unit recently? Maybe they have a really low VAP or CLABSI rate and you admire that…
Know why you want to work in the NICU. “because it seemed cool… like the logical choice… i really love babies…” doesn’t cut it. Be specific, i.e. “I’ve worked with newborns for a year now and want to expand my knowledge base with more critical situations” … or… “I really enjoyed the adult ICU and how it tested my critical thinking and need to be constantly vigilant. I’d love to combine that environment with my love for the neonatal population and learn about their specific needs”.
Have examples of how you used your critical thinking, how you dealt with a bad family, a terrible co-worker, or when you did something wrong. Be prepared to talk about the situation, what you did about it and the result. This shows that you’re able to grasp out farther than just the intervention phase of patient care. Be prepared to talk about good things too! What are you most proud of? When was there a time when you know that your care specifically made a difference to a patient.
I hope this helps! Do a google search too about questions to ask. There’s lots of stuff out there. Good luck!
Thank you so much for your reply regarding new grad friendly hospitals! CA is a great place to work. The major problem is the high volume of applicants. Most hospitals receive 500-1000 applicants. UCSF had around 17000 (that's right 17000!) applicants for their new grad program. Standing out with no previous health care related experience is hard. I have started volunteering though. I highly recommend the American Red cross or local clinics.
Wow. WOW. WOW!I had no idea UCSF was that competitive! Now I know why we had residents from California! I really, really suggest looking at residency programs from all over the US if you don’t have to stay in your current location. I moved over 700 miles for mine!
Best part? I totally fell in love with my hospital and town! Bought a house and am here to stay!
I’m sending good vibes your way! Super glad to hear you’re being smart and proactive by volunteering. It gives back to you and the community and you can’t beat that!
When my older sister was born a little over 5 weeks early with her lungs and other parts not fully developed the doctors told my mom that she may not grow up normally. That was almost 20 years ago, and she has grown up one of the smartest people Ive known. My question is how often do you (as in nurses and doctors) tell parents that there may be a problem in the mental development of a child. Is this often the case with ICU babies?
First off, glad to hear your sister is doing well!
There are a couple of things I wanted to address with your question if that’s okay.
First, your direct question of: “how often do you (as in nurses and doctors) tell parents that there may be a problem in the mental development of a child? Is this often the case with ICU babies?”
Speaking personally, unless I have hard evidence, there is rarely a time when I will out and out say that a child will have concerns with mental development. This conversation only occurs when I’ve seen diagnostic data, seen clinical symptoms manifested by the infant, and built enough of a relationship with a family to have such a hard conversation.
There are always the easy ones to say, “Yes, this baby will definitely have some level of mental acuity issues”. This can include a genetic diagnosis such as cri-du-chat syndrome or holoprocencephalies or even such a diagnosis as Trisomy 21 aka Down Syndrome. Other times, we may see something diagnostically on a head ultrasound or MRI.(Click on bold-typed for links to more information.)
Infants born more than 10 weeks early are at high risk for intraventricular hemorrhage of the brain. This brain bleed (graded 1-4 based on severity) cannot be cured. We do everything we can to prevent it. Often times, the less severe bleeds resolve on their own. Sometimes though, these bleeds can be so severe that there is a shift in brain structure. (i.e. A “Grade 4 with a mid-line shift” would prompt a conference between the health care team and the family about the long term outlook of the baby.)
There are other issues including hypoxic events that can lead to seizures or cerebral palsy. Unfortunately, these cases are often a wait-and-see what the infant will do with occupational, physical, and speech therapy. We often tell the parents that until the first two years of age the infant will most likely be behind. For example, if an infant was born three months early, even though they may be 9 months old chronologically, we’d only be expecting them to meet the milestones of a 6 month old.
The other thing I wanted to address was about your sister’s lungs which leads us to talk about respiratory distress syndrome (RDS) and chronic lung disease (CLD) of the newborn. One percent of the newborn population will have RDS. Which doesn’t sound like a lot, and overall it’s not. But when you start talking about the premature population those numbers jump significantly. “About ten percent of premature babies in the United States develop RDS each year. The risk of RDS rises with increasing prematurity. Babies born before 29 weeks gestation have a 60 percent chance of developing RDS.”
So here is where the concern for your sister may have emerged. NICU medicine is still a relatively young science. The first NICU in the United States was back in the 1960’s! And surfactant therapy, commonly used in the NICU now to prevent RDS, was only widely recognized as legitimate therapy in 1980!
If a 35-weeker like your sister came into my NICU I would not be nearly as concerned about her as the staff was 20 years ago. That’s because we’ve come so far in a relatively short amount of time. We’d help her lungs develop if needed, give her rest and medicine to ward off infections and provide nutrition until she was able to feed well on her own.
I hope this helps to give you a peek into why those things might have been told to your family as well as that NICU care has many things to balance out for the neonate. I could go into much further detail but I don’t want anyone to go to sleep out there and start drooling on their keyboard.
Hi Ben, This video is amazing and broke my heart. I am a Development Manager in the Orange Coutny Division of March of Dimes and would love to have your permission in using this video to show our corporate teams on why it is so vitally important why they all fundraise. Thank you so much! Shauna Bradley
This video was shared from the original poster’s vimeo site. I am not Ben; just hugely appreciative of the beautiful message he created. If you’d like to try to get in contact with him, it looks like you can message him through his vimeo account here.
(PLEASE everyone, while the internet is an awesome place to connect and see awesome things like this video, please don’t spam the heck out of this guy. I feel weird enough posting a link to his profile. But since it’s public, I can only assume he’s okay with receiving messages.)
“Nursing is nursing, whether you’re a med/surg nurse, a critical care nurse, ER, telemetry, pediatric, psychiatric, L & D, clinic, ambulatory, home-care or any other of the many disciplines. We’ve all gone through the same pre-requisites and the same core subjects in nursing school, the same despair that is the nursing school experience, and we’ve all passed the same stressful licensing examination (NCLEX). It doesn’t matter if you graduated from a community college or elitist school, or whether it’s an Associates, Bachelor or Masters degree - what matters is that you don’t look down or disrespect your coworkers who have struggled the same as you, achieved the same as you, and maybe even fought battles you probably didn’t know existed. Respect nursing by respecting one another.”—
I'm a nurse in the NICU where Ward Miles was a patient. I'm so proud and happy to be a part of a unit that makes such an impact on the lives of these little ones! Love that you shared the video! :)
Hey that’s fantastic!
It’s so easy to get wrapped up in the day to day work of being a nurse and forget that what we do leaves a real, lasting impact on our patients and their families.
This video was such a great reminder of that for me. So thank you, to you and your team, for doing such a great job. He looks like one pretty awesome kid. Which means I know he had one pretty awesome team. =)
Could you recommend hospitals/states that are new grad friendly? I'm a new grad almost six months out (BSN, all my certifications, precepted at a level III NICU) and haven't been able to find a job. I live in CA, so this is a huge reason why. I don't care where I live. I just miss being in the hospital so much.
Nurse residency programs are a great way to get in the door as a new nurse. They typically take nurses with less than 6 months experience. You can search this site by state and specialty:
You can also try travel agencies and recruiting firms. Some universities offer their graduates career services to help them find jobs too. Also, go back and talk with professors and preceptors that you’ve had good experiences with. They may be able to put in a good word for you or give you the jump on a job opening. I know you want to be in a hospital but getting any experience will look good on your resume. So while that doctor’s office or nursing home that’s hiring may not be ideal for you, it would at least position you past the new nurse stage for job applications.
See the registered nurse part of the neonatal, can it be a registered child nurse or adult nurse. I'm going to university hopefully for child nursing then midwifery then my neonatal, would that work.?
Are you from the UK? If so, then this sounds like a question for my UK followers. Can anyone help out?
In the U.S. it’s one type of nursing degree although you can chose a 2 or 4 year option. This degree, which allows you to become licensed, teaches you obstetric, neonatal, pediatric, adult, and gerontological nursing. As such, you can work as a bedside nurse in any of these fields. (i.e. a pediatric floor, a nursing home, labor and delivery, or for me the neonatal ICU)
If you then want to specialize, or get an advanced degree you can then become a midwife or a neonatal nurse practitioner with a Master’s degree or a Doctorate of Nursing Practice.
I’m sorry I don’t have more information on the process for my fellow nurses across the pond! I did a Google search and found these links in response to the question, “how to become a nurse in UK”. I hope they help!
Hello! Does all BSN programs teach Neonatal & Obstetrics as a part of the curriculum ? They may not focus on it because it's not graduate school, but I need to know if they at least go through it.
As far as I am aware, every nursing program (ADN/BSN) is going to cover life to death and everything in between. You should cover mother/baby, pediatrics, medical/surgical, geriatric nursing as well as cultural needs and many BSN programs also cover things like management and leadership.
The exception to this may be a RN to BSN degree. Since you would have already taken courses that covered those basics in the ADN program, the BSN degree would cover advanced patho/pharm concepts, management, and probably a class on how to do research.
If anyone out there has experienced anything else, please feel free to let our anon know!
that is so sweet of you to think of me! I didn't think you'd remember me. gah I bet you are a fantastic nurse and all your families love you. Yes, I do have a preceptor whose schedule I follow but I get my own assignment now. She's very sweet but since it's so hectic she has her own stuff to do and I'm over here taking up her time and I feel bad :( I hope you don't mind, but I'll probably be sending you sporadic anon messages, or maybe even be brave enough to come off anon at some point :)
Well it was sweet of you to reach out and trust me to ask questions to! I don’t know about “fantastic” lol… start throwing around labels like that and my next shift will inevitably have me inserting my foot in my mouth in front of a family who will certainly not love me after that! =)
It’s all a work in progress. I’ve made a fool of myself plenty of times in front of my preceptors, fellow nurses (boy could they tell you some stories!), and families. It’s all a process. And for you and I, who are at the beginning of our careers it’s still all up hill for us. Each shift is going to present its own set of challenges. And, this is an important one, EVERY SINGLE SHIFT I HAVE A QUESTION FOR SOMEONE WHO IS MORE EXPERIENCED THAN I! We all do. Sometimes it’s just to hear, “Yes, that’s right”. Or it’s a new policy. Or just something you’ve never seen/heard before. We’re always learning.
I know it’s hard to interrupt your preceptor or another nurse with a question but eventually you won’t have that question again and before you know it there will be another nurse, even newer than you, asking the same question when you’re busy with your own patients. And the answer will come right to you and you’ll get to make a new nurse feel a little bit better about his/her work.
Just remember to be kind to yourself! And ALWAYS feel free to send questions/vents/concerns my way! I’ll do what I can.
Oh, and as a side note to you and everyone else who submits questions. If you submit it as “anonymous” the only choice I have is to publish your answer on the blog. If, however, you submit it from your Tumblr account I have the option, at your request, to answer just you. It’s a good option for people wanting an answer to something more specific, or if there needs to be a continuing dialogue.
I just wanted to say - thank you for posting that video. I don't know how you did it, but it was perfect timing. I just wrapped up 3 nights in a row for this week and it has been ridiculously busy and crazy and there were many times I found myself questioning why I even chose to go into this field in the first place. That video reminded me why I did. (not sure if you remember me, but I'm in that nurse residency program! s'been kinda rough, but. just keep swimming, right?)
The universe is such a funny place! I just logged back onto Tumblr because I was going to do a shout-out for you, anon! I was wondering how things were going for you… I’m so glad that you enjoyed the video! It absolutely brings me the utmost thrill to think that I can help or encourage any of my fellow nurses out there.
I’m glad that you’re sticking with it, too. I remember so vividly what it was like to be a nurse resident and navigating being a new nurse. I do hope you’re finding your rhythm and your place within the unit. If it makes you feel any better I just finished up a crazy 3-in-a-row round myself where there were several times that I just felt like I was a pee-wee football player in the NFL. (we like football in my house so sorry for the analogy!) I was literally dragging my feet walking out of the hospital I was so exhausted. But at the end of the day, (or maybe the next day when my brain had finally rebooted) I know I made a difference in my patients’ lives and that of their families. And you do too! Don’t ever forget that!
I meant to ask if you had found anyone that you’ve been able to talk to yet within your unit that is helping you adjust to nursing. I hope so!
How many years did you go to school to become a neonatal nurse? and where the courses hard?. I love science but chemistry wasn't all that nice to me..I think I want to become a neonatal nurse.
Everyone has their own path to nursing. Since I am an Associate’s Degree trained nurse, I had two solid years of just nursing courses. There were prerequisites that I took while also working on my Associate of Arts - General Education degree. All in all, from my first semester to walking across the stage to receive my pin I was in school for about 5 years. But I also was doing school part time and working full time.
Many of my friends followed similar paths as nursing was their second degree choice. And then I have friends who went straight to university after high school, did their four years and earned their Bachelor’s of Science in Nursing (BSN).
As far as the science goes, if I remember correctly my nursing school required 2 semesters of Anatomy and Physiology and 1 semester of Microbiology. If you do a BSN, you will most likely need a Chemistry class as well. I took one as a part of the pre-requisites and it was probably the easiest class I took. It was the bare-bones, basic of the basic course. I think my high school chemistry class was harder.
You might want to research what schools you’re thinking about attending and seeing what their science requirements are. If you’re still worried about it, most college/university systems have free tutoring available if you’re struggling with a course.
Click here and here for more information on what makes a RN a neonatal nurse.
I hope you decide to be a neonatal nurse as well! It’s pretty awesome if I do say so myself.
A medical helicopter crashed on its way to pick up a child in Tennessee Tuesday morning, killing the pilot and two Memphis children’s hospital workers.
My sincerest condolences to the Le Bonheur team from Memphis, TN today as they lost three of their own. A pilot, a RN, and a RRT were lost when their helicopter went down in TN on the way to pick up a patient.
Every day I watch our own Neonatal and Pediatric Transport Teams go out via ambulance or flight to pick up the sickest of the sick who need our help. For them, as for so many of us, this is not “just a job”. It is a calling… an innate desire and drive to push to be the best because that is what is needed of us from those whom we serve.
For all of my followers in the TN area… for the families Pilot Charlie Smith, Carrie Barlow, RN, and Denise Adams, RRT, and the entire health care family: my love and thoughts are with you all today. To Carrie and Denise and Charlie: thank you for your ultimate sacrifice. Rest in peace.