Becoming a NICU Nurse Was My Calling

• A registered nurse details how she knew becoming a NICU nurse was the best career path for her. 
• Learning a specialty requires several weeks of orientation and a process of letting go of knowledge that doesn’t fit that setting. 
• NICU nursing is a niche, but most nurses in the specialty say it’s hard to imagine doing anything else. 

I timidly asked the nursery room nurse if it was OK to hold one of the sleeping infants. “Sure,” they replied, as they continued charting. Even though the child wasn’t mine, I was flooded with Oxytocin when I held this adorable, sleeping newborn.

It was the second day of my nursing school Labor and Delivery (L&D) rotation, and I was assigned to the newborn nursery. I always knew I wanted to work in pediatrics, but by the end of the day, I felt for the first time I knew exactly what career I wanted.  

Landing a NICU Nurse Job

At my final evaluation for the L&D rotation, my professor remarked, “I didn’t think I would ever get you out of the nursery!” I smiled, as I had always requested to go there when our other assignments were completed.

Each experience after that in nursing school continued to reaffirm my excitement at the prospect of working in the NICU. I loved doing procedures such as starting IVs, inserting NG tubes, and complex dressing changes. I excelled in my adult ICU rotation. It was exciting to put all the body systems together and see how each affected the other. I was, of course, cautious, but I felt comfortable in a critical care environment.

When I graduated, new graduate nurse positions were scarce. I made sure to network and get contact information of the NICU nurse manager where I did my clinicals. I tried to show enthusiasm, eagerness, and a strong work ethic to all the staff on the unit when I had clinical rotations. On the day of my nursing school graduation, I got the call with a job offer for the NICU. Best. Day. Ever. 

Navigating the NICU Nurse Specialty

There are many specialties in nursing: perioperative nursing, oncology, nuclear medicine, and dialysis, among others. Focusing on a specialty requires several weeks to learn all the nuances and priorities for patient care in that area.

You need to let go of knowledge you worked hard to ingrain because it doesn’t fit that setting. For example, for premature infants on respiratory support, the goal is to keep oxygen saturations low, typically between 82-94%. This is because the fetus maintains low oxygen saturations in utero, and high exposure to oxygen can cause lung and eye damage to a preterm newborn. In any other setting, an oxygen saturation below 94% is cause for concern and often a rapid intervention. 

Different areas of nursing also tend to attract certain personalities and require certain characteristics. Nurses in the Emergency Department and Operating Room need to have a thick skin and the ability to quickly turn over patient after patient. Comparatively, NICU nurses must be meticulous and pay attention to tiny details. For example, a nurse will draw up 0.08 mL of medication and administer it with a 0.5mL flush of normal saline over 10 minutes on a syringe pump. They may also spend much of their shift adjusting the FiO2 setting up and down by only 1% to keep the oxygen saturation within the low range. 

NICU nurses must be delicate when handling neonates that are sometimes one pound or less. It is easy for IVs or ET tubes to dislodge. Voices and lights are kept low to simulate the womb.

All areas of patient care require compassion for families and education — some more than others. Caring for the parents of the infant is also a part of the job. A nurse provides emotional support to a family in a terrifying new environment and reassures them of what to expect. A nurse guides even well-seasoned parents on the best ways to touch, hold, feed, and bathe their child who is attached to wires, tubes, and monitors. Education is provided at each step of the infant’s development during their NICU course. Infants sometimes spend months in the NICU, and a nurse may develop a close bond with a family when assigned to care for that baby regularly. 

Most hospitals have different levels of care for adult or even pediatric patients based on acuity such as ICU, step-down, and med-surg or general floor patients. In many facilities, there’s only one NICU. NICUs are often comprised of babies at different levels of acuity, and staff can be expected to care for patients at all these levels. I personally loved taking care of the high-acuity patients, but in truth, the majority of my shifts were spent taking care of low-acuity patients who simply needed time to develop to term. We call these babies “feeder growers.” 

The Bottom Line

In my experience, neonates are amazingly resilient and there are so many more positive outcomes than sad ones. NICU nursing is definitely a niche. Many nurses in different areas have often said, “I could never do what you do.” And for a NICU nurse, it is hard to imagine doing anything else. 

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