Comparing NICU & Paediatric Placements

Alex, a third year student nurse gives an insight into her experiences on placement in NICU and Paediatrics, the differences between the two areas, how she adapted and how rewarding the experience was.

Introduction

Hi, guys,

For those of you who do not know me, my name is Alex, and I am a third year student studying Children's Nursing.

Today's video is just gonna be about me comparing some differences that I noticed between NICU Nursing and Paediatric Nursing and the kind of transition that I made when I was in placement there.

I just recently completed a six-week placement on the Neonatal Intensive Care Unit, and the one that I went to was a level three unit, so it had SCBU, which is a Special Care Baby Unit, HDU, which is high-dependency, and obviously NICU, which is Intensive Care. That was my penultimate placement of the whole course, so I'm now on my final placement.

For those of you who may be having an upcoming NICU placement or are interested in working in NICU and are doing the Child Nursing route, 'cause I know adult nurses can also work in NICU, but I just wanted to, yeah, shed some light for you guys on some of the differences that I noticed from general paediatric nursing to neonatal nursing.

Adapting To Different Ways Of Doing Things

The first one that I noticed was kind of like a big one, was just documentation. Documentation was so, so different in so many aspects, for example, the observation charts are these massive charts that are by the bedside, they have all sorts on them, obviously your general observations, which you have to do hourly, which is obviously different in Paediatrics because depending on how sick the child is, it's generally four hourly unless they're on some sort of oxygen support or they've come out of surgery or something like that.

Obviously writing down observations, if you're working in the intensive care unit you're writing down all the numbers that are on the ventilator, half of them, when I first saw it, I was like I have no idea what any of this means, and obviously you're not meant to know everything and you won't really learn everything whilst you're there because it's very specialist and you have to do a course anyway to be able to work in the intensive care nurseries. But that was very different, making sure that I wrote all the numbers in the right place even the way that they documented input and output with like TPN, IV fluids, even just with bowel movements and like nappy changes and stuff, it was all laid out very differently.

So my first couple of shifts I had to really get used to that. And it was explained to me very well just getting used to the change, 'cause I was just used to the same BPEWS charts that we use across all the Paediatric awards in my Trust and that's all on paper.

So I was still used to the whole paper thing 'cause it's in paper in NICU and it was on paper in all the Paediatric wards in my Trust. But I know some other Trusts, the OBS they fill out online. But yeah, the chart was completely different, so that was something I had to get used to.

Then I had to get back used to BPEWS charts on the current placement I'm on 'cause I'm in general Paediatric’s. So that was like a big change. Another thing to do with documentation was note taking. So normally in Paediatrics in my Trust we write notes on EPR online. So you can edit it when you want, you can add things when you want, backspace if you made a mistake with a spelling error or whatever, but in NICU it's all handwritten which was very different for me, and it was weird to get used to making sure, I think

it was good 'cause I had to really think about what I was saying, making sure I was keeping it concise and making sure that I was not just writing for the sake of it,

so that I didn't have to make it look messy by crossing stuff out or having to start again.

Learning To Take Concise and Accurate Notes

That was another thing that took a lot of getting used to but it was good in a way, 'cause it really makes you think about the notes that you're writing, and what is relevant to document. Another thing, medications, that was a massive difference because I feel like in Paediatrics, whenever the medication is due, it's due whether it's at one o'clock, five o'clock, six o'clock, 10 o'clock whenever, but in NICU it was like very set times that all the babies medications would be due.

It's not like a random time. It was all very regimented and set out, and the process of drawing up the medications and doing the calculations and the checks was very, very calculated and very well observed between, obviously with students 'cause we had to do it supervised, but with the nurses as well and the way that all the medications were checked because it is very common in NICU to have medication errors because the dosages are so tiny.

Administering Medication

So it was really important, especially in ICU when you're dealing with a lot of controlled drugs, it was very important for the Nurses that they do that properly.

And then obviously with IVs and even just simple oral NG meds like making sure you get that right and that everyone's properly checked each other's medications was like super, super important. Whereas in Paediatric’s, I think it's a little bit more relaxed like the process of actually drawing up the medication and checking because the dosages are bigger. And then obviously in general you're dealing with, and looking after patients that can't talk to you, they can't move for themselves, and obviously you do get older patients in adults and children that can't talk, can't walk can't move for themselves. But obviously very different with babies, you have to understand their cues, it's a lot of personal care, obviously changing nappies, cleaning them and stuff like that. Whereas you don't really get as much personal care in Children's Nursing, and even if you do a lot of the time, it will be the parents that do it. So it's a lot of that, you know, bottle feeding, NG feeding.

I feel like I did like 10,000 NG feeds a day, it's like the bread and butter of NICU Nursing I feel like. Understanding TPN, all the different lines that they have. It's not just like your normal cannula, peripheral cannula, they have long lines, they have umbilical lines which was so interesting to see. And also just getting used to seeing patients that are intubated and ventilated because I'd never to PICU, because I didn't have an Intensive Care background, it was a bit of a shock to me to see sedated patients.

Understanding The Importance Of Clustered Care

It all took a lot of adjusting and especially with the premature babies, there's very minimal handling, so it's like making sure you cluster your care doing a lot of things at once so you're not disturbing the babies as much 'cause they need time to rest and grow.

Adapting quickly

Those are kind of the main differences that I noticed which are all kind of big changes that I had to get used to but I did get used to it quite quickly I feel like, and

I absolutely loved it and I'm going to be a NICU nurse

which I'm really excited about for when after I qualify.

Nurses Need to be teachers too!

If you are having a NICU placement soon or you are interested in maybe pursuing a career in Neonatal Nursing those are the kind of things that you could probably expect, and obviously you have to be someone that has a lot of patience and enjoys interacting and teaching because you're gonna be teaching parents a lot of things like how to handle a premature baby, changing nappies all that stuff, especially with the new parents you're gonna be just reassuring them because they're gonna be very anxious. It's a lot of family centered care.

The Rewards Of Neonatal And Paediatrics Nursing

That's like really reiterated in Neonatal. It's not just a patient you're focusing on, you're looking after the family as a whole which you do generally in Paediatrics, but I feel like there's a much more of a focus of it in Neonatal. So that is probably another difference as well but it is amazing.

I think if you get the chance to work there or do a placement there, take the chance and just embrace it 'cause it is very specialized and I think it is very much like Marmite, but I loved it and it is such a rewarding experience to kind of go through.

So yeah, that's kind of my little insight into the kind of main differences I noticed between Neonates and Pediatrics.

I hope you enjoyed the video and I'll see you in my next one.

Bye.