Challenges Of NICU As A NRN

In this video, Children’s Nurse Alex discusses the challenges of being a Newly Qualified Nurse working in a neonatal intensive care unit, or NICU.

Hi guys. For those of you who do not know me, my name is Alex. I am a qualifying Children's Nurse, currently working in a neonatal intensive care unit. Today's video is going to be all about the challenges of working in NICU as a Newly Qualified Nurse.

I myself finished my nurse training in July 2022, got my pin in September, and started working in the October. I'm still quite fresh still because as an NQN, some of these points that I'll be making will be based on personal experience and just some challenges that I think would be quite commonly shared by Newly Qualified Nurses starting straight in the NICU.

Extra Training

First of all, I think one of the biggest challenges would be that there is a lot of extra training that you have to complete when you start. Obviously wherever you work, you're going to have a local induction on your ward or your unit. They're going to show you around, they're going to give you little teaching sessions about common things that you need to learn, common conditions that you'll see with your patients, and equipment.

There was a lot of equipment training that you have to do in NICU, which I assume is the same in all kinds of intensive care areas and in all wards, but particularly in intensive care areas. There are a lot of different equipment’s that you need to learn how to set up and use.

For example, using simple things like emergency equipment, suction, oxygen cylinders, how to set up optive flow- which is for those who don't know, it's just high flow humidified oxygen deliverance. Using simple things that you use as a student, like the observation monitors, blood pressure machine, things like that, which is obviously stuff that you should know already from being a student.

Then you've got the added things of learning how the incubators work, how to set up the humidification, how to adjust the temperature, the height. On our incubators where I work, they also have built in scales, so how to weigh the babies, how to clean it. There's a lot that goes into that. How to use the Neopuffs, which we use for resuscitation and emergencies in NICU.

There’re so many things like that. The list goes on and on and on, and you always have to have your training updated. So there's a lot of different machines and contraptions and things that you have to learn how to use, and you're always renewing that training. And obviously if you are not sure, you can always ask somebody, even after you've done the training. Because if you haven't done something for a while, it's easy to forget even if you are years down the line in being qualified. Yeah, that's probably a big thing. That can be a challenge.

It's a lot to learn all at once when you first start, but you're not expected to learn and retain everything straight away. There’re always people that you can ask questions to.

New Environment

Secondly, obviously, it's a new environment, especially if you've never worked in NICU at all as a student, or if you've just never worked in that specific NICU before that you're starting at. If you're in a new Trust, new hospital, new part of the country, a different country, it is a lot of change, especially if you're a paediatric trained nurse, if you're very used to working with different ages of children; if you're an Adult Nurse that's coming straight into NICU, because you can work in NICU as an Adult Nurse.

It will be a massive change to what you're used to and the type of patients you're used are caring for. But obviously you will have the relevant training and inductions and things like that to help you feel as competent as possible. But obviously you’ll develop skills over time and things take time to get used to.

That leads into just how specialized NICU is. You are only looking after one specific type of patient group. Obviously, they vary with different conditions, born at different gestational ages, different levels of sickness, different needs, but you are looking after the same patient group essentially. You're not looking after a one year old, a two month old, a 17 year old. You've got one type of caseload.

We do actually get a few paediatric patients, but obviously normally your patient group is tiny humans, neonates. That can be a big change for people that are used to looking after a range of ages, whether that be adults or children.

You'll have good days and bad days... but you just have to power through it and know your strengths and your weaknesses, and how to build on them.

Being Asked Questions & Supporting Parents

Also, a big challenge for being newly qualified can also be being asked questions. This could be maybe specifically by family members, parents. Especially if you have quite anxious parents or first-time parents, there might be a lot of things they've never done before, even things that we could consider quite simple, like giving a baby a bottle or changing a nappy.

But these things are actually quite big steps for parents, and especially if their baby's in an incubator, changing a nappy can be quite fiddly, so adjusting to learning how to support them, learning how to answer their questions properly.

There's a lot of things that when I started, I didn't feel like I would actually need to be. I thought I would be the person giving support on certain things. For example, a lot of the time mums come to us about questions with breastfeeding, questions about expressing, about safe sleeping for when they go home. And especially if you are newly qualified, you will start working in special care most of the time, if not all of the time.

That's obviously the place where you'll have a lot of discharges, so it's important that you develop your knowledge on being able to educate parents about safe sleeping so that they feel confident about taking the baby home.

Breastfeeding support, which you'll actually eventually get training for, is really, really important because especially if your mum is spending a lot of time on the unit with her baby, the midwives aren't there, or they may be discharged from the postnatal ward, so they've got a bit less support for breastfeeding. A lot of the time it is actually us that are able to help because we get taught how to learn what is a good latch, what does a good latch look like, is baby sucking well, things like that.

That's one thing I didn't actually expect to have so much involvement in when I started, but it's actually really nice skill to have, and I think it's quite an important role as a Neonatal Nurse to get involved with that and to empower parents with their feeding choices as well. Because some parents decide not to breastfeed, and that's completely okay. Fed is best.

Sometimes when you get asked a lot of questions, or you need to provide a lot of support to parents. At the start when you first qualify, it can be quite daunting and you might not know the answers, but that's okay because there's always people that you can ask to help you to answer those questions. It's not stupid to be like, "Oh, I'm not actually quite sure, but I will find out for you." At least you are making the effort to find out even if you don't know yourself.

Also, it can be quite difficult as well answering these questions if you are someone like me who is quite young. I went straight into studying nursing from leaving school, and then I went straight into my qualified Registered Nurse job after I finished my degree. So, I am quite young. I'm one of the youngest nurses on my unit. I don't have any children. It's all quite new to me teaching parents how to be a parent when I am quite young myself. I don't have any children. It is quite interesting. But once you develop your knowledge and your skillset, you'll get used to it and you'll feel confident in supporting them with their child.

Working In A Large Team

The last thing on my list about challenges of joining NICU as an NQN would be just how large the team is. On the ward your team is quite small. On a day-to-day basis on a day shift, you'll probably have a few doctors that are in and out of the ward, there may be three or four nurses on shift, your ward manager might be there, the matron will be in and out.

But on the NICU, there's so many staff. Even though we're still short staffed quite a lot, as a lot of places are, there's way more staff that are there. There's management, there's senior nurses, there's matron, and there's physios, occupational therapists, doctors around all the time. There’re always people you can refer to for support, breastfeeding specialists, we work closely with the midwives as well. There’re so many people that form the team.

It's important that you utilize that and then you develop your confidence to be able to escalate your concerns or to even correct people sometimes or make suggestions and really advocate for your patients because there's a lot of people that you can get input from and that you can give input to. Even if you are new, that doesn't mean that your opinion's invalid. You could actually provide some really beneficial input to help improve your baby's care.

Challenging Emotions

There's so many challenges and individual things that people will struggle with when they come into NICU as a Newly Qualified Nurse. It is very different. It can be very difficult. Emotionally, it's very challenging. Some of the things we see aren't very nice. It's not nice to see anybody sick, let alone a baby, so it can be really challenging.

But you just have to be able to speak up if you are struggling, know your limits, know your boundaries, be willing to learn, and that's kind of all you can really do.

It's challenging in general being an NQN, because it's a massive transition from being a student. But as long as you've got good enough support, both internally and externally, in and out of work, then you should be okay. But you'll have good days and bad days, that's a given.

But you just have to power through it and know your strengths and your weaknesses, and how to build on them.

That's it for me. I hope the video was useful, and I will see you in my next one. Bye.