How I Started in the NICU
Welcome to neo baby review, your source for all things NICU related! Here on this blog I will post case studies, reviews of new literature, and of course, everything related to the RNC, CCRN, and NNP board exams.
For this inaugural blog, I will talk about my own personal history with neonatology.
I am a fourth generation nurse, although I did not grow up knowing the history in my family nor did I ever think I would become a nurse. In fact, all I can recall from my father is that he worked the night shift a lot and how it important it was for us to wear a helmet while riding our bikes!
I ended up coming to the profession of nursing during my first year in college in 2004. I initially wanted to become a physical therapist, but became less enamored with the profession when I completed some shadowing the summer before I started college. I knew that I still wanted to do something healthcare related and discovered nursing through my research. It seems silly now, but I had no idea that nursing was such a varied field and that there were dozens of “specialties” in nursing. I learned if I did not like one area, I could try another one. In the age of not wanting to limit myself, it felt very appealing.
Armed with this knowledge, I applied and was accepted into my university’s nursing program during my freshman year. I realize now that I was extraordinarily fortunate that my university offered such a program and that I was readily accepted. I now know that many prospective nursing students have a hard time gaining entry despite being qualified.
I went through nursing school receiving good grades, unsure exactly which type of nursing with which I was interested. During my senior year, I worked as a nurse technician at the local level one trauma center on a trauma surgery floor. Enjoying that experience, I decided that I would aim to work in an intensive care unit for a few years and then go to graduate school to become a family nurse practitioner.
It wasn’t until the middle of my senior year that I discovered that there was such a thing as taking care of sick babies in this seemingly miraculous place called the neonatal intensive care unit. I was in my pediatric rotation and had spent one of my clinical days taking care of a three month old with Pierre Robin sequence that required a Haberman nipple for feedings. As I sat in a chair feeding her, my preceptor told me about the NICU. I had always loved taking care of babies and I knew instantly that I wanted to work there. The joy that I felt taking care of that patient and learning that I could do this for a living made me determined to do whatever I could to gain entry into the profession.
Taking a step back, this may be surprising to any veteran NICU nurses reading this. It is common to read on NICU forums and talking with colleagues at work that the public does not understand what we do in neonatology. There is a generalized perception that “all we do” is rock and feed babies. There is a kernel of truth in this- we do spend a lot of time feeding and rocking babies! But we do so much more than that, even with stable feeder/grower premature infants. Even “stable” babies require our expert assessment to monitor for anything from feeding intolerance to signs of infection. This is more obvious with critically ill infants- we are keeping tiny humans alive on a myriad of machines. Drugs are calculated to 0.1 ml for safety (something that would make an adult nurse laugh), resuscitations are regularly run during deliveries, and we are there for parents during birth, the NICU stay, and either discharge or at the end of life.
All of this to say, many prospective NICU nurses are cautioned that the NICU is not always a happy place and that there is more to the unit than feeding babies. I found that while I treasured taking care of babies, I also enjoyed the technical aspects of NICU nursing and being there for families in crisis, making it a good fit for my personality.
After my pediatric rotation was complete, I lobbied my professors for the chance to complete my senior practicum in a NICU. I was lucky enough to be chosen and contentedly spent the next eight weeks taking care of fragile infants under the watchful eye of a generous NICU nurse. Years later I met her again as I worked as a nurse practitioner in the same unit. I am forever grateful to her for giving me my start in neonatology.
As graduation loomed, I did research to determine how I could work in the NICU after graduation. I decided to concentrate my search at large children’s hospitals, which generally have RN residencies. I used the US News and World Report rankings to narrow my search and applied to several hospitals. After a few interviews, I was fortunate enough to receive an offer at Children’s National Medical Center in Washington, D.C. I was thrilled and eagerly awaited my move to the area and the start of my residency.
After passing the NCLEX, I moved to the D.C. area and started my new career. It was an excellent program, 20 weeks long and complete with didactic classes and tests. Although it felt like I was still in school, I loved learning how to take care of fragile infants. It was difficult at times; infant physiology is very different from adults and it took awhile for my brain to wrap around some of the concepts. This was particularly true when it came to cardiology, as the fetal circulatory system is completely different than an adult. I ended up not passing one of the exams on the first go-round, but passed the second time and was able to successfully complete my residency.
Over ten years and several hospitals later, I know I am still working in the right place. The joy that I feel taking care of babies and their families is unparalleled. It is not always a happy place, but knowing that I can make a difference in the lives of these tiny humans and their families gives me meaning and purpose.
Photo: One of my many work badges