The Roles & Responsibilities Of A NICU Nurse

Becoming a NICU Nurse opens the door to a rewarding and varied career. In this video, newly qualified Paediatric Nurse Alex breaks down the roles and responsibilities of the job, from creating care plans to supporting families.

Hi, everyone, my name is Alex. I'm a newly qualified Paediatric Nurse and I'm going to be talking to you guys today about the roles and responsibilities of a NICU Nurse.

So, I am currently working as a Neonatal Nurse. I graduated from studying paediatric nursing last year and then decided straight after qualifying that I wanted to go straight into working in the NICU.

What Is The NICU?

For those of you who don't know, NICU stands for neonatal intensive care unit. In most cases, that means it'll be a level three unit, sometimes a level two unit, which will consist of- for level three- intensive care nurseries, high dependency nurseries, and special care nurseries. So, there's three different levels of care depending on how sick the babies are.

I work in a level three NICU, which means we do take very, very tiny babies, very, very sick babies, babies who may need a lot of surgical intervention, babies with low birth weights, babies who are born really, really early, who may have some rare congenital conditions, surgical issues, anything like that. We tend to look after those types of babies.

But for now, obviously, as I'm newly qualified, I only work in level two and level one. So, high dependency and special care, which we call SCBU: special care baby unit. We are able to follow our babies along their journey of getting older, getting bigger, and hopefully getting better and on their way home to be with their parents and their families.

Roles And Responsibilities

So today, I'm going to talk about roles and responsibilities. I'm going to try and condense it as much as possible because there are a lot of different roles and responsibilities we have depending on the types of babies we're looking after, or just depending on what day it is and what situations we have to face on different days.

Creating Care Plans & Carrying Out Assessments

But the first one would probably be creating plans of care and carrying out assessments.

Every shift we have to fill out care plans because depending on every ward round, every day, plans may change. The way we are feeding the baby might change. They might increase the amount of feed we're giving. They might change the milk we're giving. They might change medications or just the way that we are having to nurse our babies.

Then there is carrying out assessments. So, this could just be your simple assessment with your hourly obs, assessing your basic saturations, heart rate, work of breathing, respiratory rate, things like that, assessing your IV lines.

A lot of our tiny babies tend to have longline, which are like the equivalent of a PICC line if you're working in paediatrics, which is more of a long-term access for medications and things like TPN, which I won't go into, that's for another video. Assessing your lines, even just your normal peripheral cannulas, making sure that the skin is not red, inflamed, that there's no signs of extravasation, things like that.

Your daily observations are the bread and butter of nursing wherever you are. So, that's a really important role and responsibility that we have. And obviously if we have any concerns, our responsibility is to escalate them to the nurses in charge or to the doctors, things like that.

We are able to follow babies along their journey of getting older, getting bigger, and hopefully getting better and on their way home to be with their parents and their families.

Basic Daily Tasks

We also have other daily basic tasks that we have in the NICU.

One is cleaning the bed spaces. Obviously, infection control is important everywhere, but particularly important with our babies. They're very vulnerable and very prone to infection. So, it's really important that we clean our bed spaces, clean all the equipment, and clean our incubators or cots.

We have other basic care like nappy changing, mouth care, and bathing sometimes. With a tiny baby it could just be a little wipe down or bed bath, or it could be a proper full-on bath.

But a lot of the time we do encourage the parents to get really involved in the care, because it's a good way for them to practice and to bond with their baby.

Multidisciplinary Team Collaboration

And then we also have MDT or multidisciplinary team collaboration. So, in the NICU, as you do everywhere, there's a lot of collaboration with different health professions, but I think it's particularly prevalent in the NICU.

We have to work a lot with the doctors, with the physiotherapists and occupational therapists, speech and language therapists, and the dieticians, because there's so much input that is needed, particularly for our really sick and premature babies.

There's a lot of input that needs to be put in with their positioning, to make sure that their head shape doesn't go flat and that we are positioning them in different ways so that their head shape is equal.

With our premature babies, we try incubators to emulate being in the womb, making sure it's nice and warm, making sure they feel enclosed. So, we tend to make nests for them so they feel enclosed like they would in the womb.

Speech and language help us with feeding, with starting feeding for babies who may have obviously just been on TPN for a while (total parental nutrition), or been on NG (nasogastric feeding) for a while and they haven't had much practice with sucking, and they might be slowly getting old enough to be able to start bottle feeding or breastfeeding.

So, they help us with input with the right teats to use for bottles or for breastfeeding support with dummies and things like that, to help support our babies with their oral development.

Managing Feeding And Treatments

Which leads me on to infant feeding. So, a lot of our input with feeding comes from the medical team, the dieticians and speech and language, trying to figure out based on the nutritional requirements, if a baby needs to be on a specific formula or if they need just extra supplements with their feeding.

Supporting mums with breastfeeding is something that we have to do quite a lot of the time. Obviously, the midwives can do that as well for moms, and breastfeeding specialists as well. But a lot of the time, especially if other people aren't around, we are the ones that are supporting moms with breastfeeding.

We tend to manage a lot of other treatments like phototherapy for our babies that have jaundice, making sure that we're monitoring the bilirubin levels in the blood through taking blood gases, which is just through a heel prick test. Also making sure that our babies are getting treated for jaundice, because if jaundice is not treated, it actually can become quite dangerous in some rare cases.

Medication Rounds And Calculations

Another nursing responsibilities that we do have is obviously medications. So, carrying out our medication rounds, checking that prescriptions are correct, because they're not always corrector they’ve maybe changed the weight that we are using to calculate the doses of these babies when they start to gain weight, and making sure that the doses are changed accordingly.

As well as this, we are always monitoring the effects of the medications that it may have on the babies, especially if you've got things like morphine, monitoring the withdrawal symptoms if we are slowly weaning the doses, and filling up and changing fluids.

Medication rounds can be really time-consuming, but it's obviously a very important part of our day. We have to make sure that we have good time management, so we're able to do that in a timely manner and still be able to carry out our other daily tasks and care for our patients.

Saying that, with medications comes a lot of maths, calculations. And if we have to titrate the rates of our fluids or if we are increasing the feeds, we need to make sure that the total stays the same. So, there's a lot of calculations and checking that we have to do with each other to make sure our rates are correct, because that's really important.

It is our job to try and support families as much as we can, to make sure that their stay with us is as easy as possible.

Educating Parents And Students

We also do a lot of education.

So, a lot of the times we can teach parents how to do nasogastric feeding for babies who aren't fully there yet with their oral feeding. As well as this, we can teach parents with breastfeeding, teach parents how to do the basic tasks like how to clean their baby, how to change a nappy, especially if their baby is in an incubator that can be quite fiddly, how to hold the baby, and how to do different tasks they might ask us for advice with. So, we're always there support them with that.

Alongside parents, we're also educating students. We are responsible for supporting students with their learning when they come to us, to make sure that they have a good experience and that they feel supported with us.

Supporting Families

And the last thing on my list, which could have had so many other things on it, because there's so much stuff that we do in NICU, is supporting families with advice, with their emotions, with admissions and discharge.

It's a very scary time. Having a baby and then having a sick baby is, obviously for a lot of parents, expected, because there might be stuff that they've been told in pregnancy about their child being unwell. But for a lot of people, it is a surprise.

It is very emotional either way and it's quite overwhelming. So, it is obviously our job to try and support families as much as we can, to make sure that their stay with us is as easy as possible.

Make sure that families feel listened to and supported and that they can be as involved as they possibly can; I think is always good to promote that independence with our babies' parents. And not just because that takes the load off us if they're doing the nappy changes or if they're doing the feeding, but it's important to help them to be able to prepare them to go home, so they feel confident in taking over that care role from us, because they're not our children.

We've got to support them to be able to feel confident about looking after their baby for when they eventually go home.

A Great Specialty To Be Involved In

So yeah, that's a whistle-stop of the basic or main roles and responsibilities of NICU nurses, from my perspective. Obviously, there's a lot more that will go into looking after the intensive care babies and a lot more that goes into different people's workdays, depending on whether you work days or nights, or if you work in a different country or a different Trust. It's all completely different.

But these are just a few that I had on my list. I hope that was insightful for you. And if you are interested in neonatal nursing, then go for it, do your research.

It is a really great specialty to be involved in.

That's the end of my video. Thank you for watching and I'll see you in the next one. Bye!

You can find job listings for Neonatal Nurse and NICU Nurse roles on our website.