Picture this: you walk into work and grab a mask at the front door (because, COVID) and head up to your unit. You buzz yourself in with your badge because the unit is locked. Inside it holds life’s most fragile possessions. Walking inside, the dim lights, familiar beep of the machines, and hum of ventilators surround you.
Your first task is to make a report on the baby you’ve been attending for the past three shifts. The tiny baby is in a clear box, known as an isolette, which is intended to mimic her mother’s womb. This will be home to the baby for the next few months. This baby was born barely viable at 23 weeks gestation. Her translucent skin glows under the lights, and she is barely the size of your hand. She is covered in tubes and wires to help keep her alive.
For the next twelve hours, your job will be to monitor and assess every tiny change in this baby’s condition and manage all medications, machines, tubes, and wires to keep her alive. This is your job as a Neonatal Intensive Care Nurse, also known as a NICU nurse.
What is the NICU?
You may have never heard of the NICU. And if you haven’t, that’s okay! The NICU is a specialized unit in the hospital that cares strictly for sick newborn babies. NICUs can range from Level 1 to Level 4. The higher the level, the more critical the newborns tend to be. The higher-level NICUs can care for the most complex and critically ill newborns in the world.
What Kind of Babies Does a NICU Nurse Care For?
NICU nurses specialize in the care of sick and critically ill newborns. That means that we only care for babies from birth until they are discharged home or transferred to a different hospital. NICUs rarely accept babies who have already gone home. For instance, if your baby was home and got sick at 5 weeks old, they wouldn’t come to the NICU but would instead go to a pediatric unit. Some common diagnoses seen in newborns who need NICU include:
- Prematurity (newborns born between 22-36 weeks)
- Hypoglycemia (low blood sugar)
- Congenital heart defects
- Respiratory distress (difficulty or lack of breathing)
- Meconium or fluid aspiration (getting stool or fluid trapped in the lungs)
- Birth trauma including asphyxiation (getting “stuck”)
- Low blood pressure
- Issues with the stomach, including gastroschisis
- Feeding difficulty
- Jaundice
- IUGR (growth restriction during pregnancy)
- Pneumothorax
- PPHN
- Seizures
- Sepsis
What Duties Do NICU Nurses Perform?
NICU nurses have a wide range of duties! Depending on which level NICU a nurse works in, duties may include:
- Assessing critically ill newborns
- Taking vital signs
- Equipment management
- Handling numerous mechanisms of respiratory and cardiac support, including a nasal cannula, CPAP, ventilators, and ECMO
- Changing, bathing, and feeding infants
- Handling feeding tubes including nasogastric, nasojejunal, and gastrostomy tubes (g-tubes)
- Neonatal resuscitation
- Administration of life-saving medications
- Handling intravenous and central lines
- Scrubbing into surgical procedures and assisting the doctors
- Documenting
- Attending high-risk deliveries
- Serving as a support for your patient’s parents and families
- Patient advocate
- Running tests and obtaining bloodwork
- End of life care of the newborn
There are so many other skills too! When you are a NICU nurse, in a way, the baby you are caring for isn’t your only patient. A large part of being a NICU nurse includes incorporating and educating the newborns’ parents and family on their condition and cares.
What Certifications Do NICU Nurses Hold?
Not anyone can become a NICU nurse. To become a NICU nurse, you must obtain the following:
- Bachelors of Science in Nursing Degree (some hospitals will accept an associate of science in nursing degree)
- State Registered Nurse License (must be licensed in the state of the hospital they are working for)
- CPR Certification
- Neonatal Resuscitation Certification
Many NICU nurses also have specialty certifications that are geared towards the NICU. For example, a NICU nurse can be certified specifically to care for cardiac babies or certified specifically to care for “micro-preemies” or babies born very, very small.
What is the Best Part of Being a NICU Nurse?
Being a NICU nurse is one of the most difficult but rewarding careers in healthcare. We get to see the tiniest and most fragile babies fight to survive. And we get to play a large part in their survival. Many NICU nurses will tell you that the best part of being a NICU nurse is the bond you create with the families. There is no better feeling than watching a baby who fought for their life for five months walk out of the NICU doors happy and healthy!
