Nurses who work in the neonatal intensive care unit, more often called the NICU, care for sick and premature infants, whose medical status can deteriorate in an instant. Working in the NICU involves much more than holding and feeding babies. NICU nurses function as critical care nurses, whose small charges might have multiple intravenous lines and medications as well as ventilators to keep them alive. In the NICU, dealing with parents can also be a major part of your job description and challenge.
A large part of the job description for a NICU nurse is providing respiratory support. If your baby is on a ventilator, making sure the tube is properly placed, that the baby's oxygen saturation remains above a certain level and that blood gasses show good oxygen exchange are all crucial for survival. While respiratory therapists adjust settings on vents, NICU nurses make sure the tubing is patent, tape the tube in place and check it each shift. If your baby is on continuous positive air pressure, or CPAP, keeping the prongs in place and assessing oxygenation levels is part of your job. For a baby on nasal cannula oxygen, nurses adjust the settings, check the prongs for placement and assess the effectiveness of the treatment. Many babies need frequent chest PT or suctioning to keep the lungs clear of secretions.
Some babies in the NICU take bottle feeding, but many get their feedings via naso-gastric, or NG tubes. Some get all their nutrition via IV. Babies in the NICU often bottle feed very slowly; NG feedings run slowly through a tube that goes into the stomach through the nose or, sometimes, the mouth. Intravenous feedings must run at precise amounts; NICU nurses set up IV pumps and maintain feeding rates. Because premature or sick infants are at risk for necrotizing enterocolitis, a potentially deadly gastrointesinal infection, measuring abdominal girth and checking for blood in the stool are frequent NICU nursing tasks.
Most babies sick enough to be in the NICU are on multiple medications, which must be given at precise times. Blood transfusions are also common treatments in the NICU. A NICU nurse must run blood at a precise rate via a pump and verify the blood type, in addition to watching for signs of a transfusion reaction. Starting IVs -- a challenging skill on these tiny infants -- and drawing blood are also part of the NICU nurse's job description. Assessing IV sites for skin breakdown or other skin damage is also done frequently, since newborns, particularly premature newborns, have very delicate skin.
Both the baby in the NICU and the family need psychological support from their NICU nurse. A NICU nurse plans her care so as to disturb the baby as infrequently as possible. Many NICUs also foster the quiet times necessary for infant growth and development as well as healing in sick newborns by dimming lights or covering the isolette to reduce stimulation, if possible. Unlike well babies, sick infants need less stimulation, not more. Stimulation causes stress, which uses up energy needed for healing.
As with any nursing position, keeping the oncoming shift, physicians and other professionals apprised of any changes in the baby's condition is also part of your job. Writing concise and accurate notes and giving a comprehensive report help keep everyone in the loop so that care can be customized and changed as needed.
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