First Solo Night

Y'all, I had my first solo night as a NICU RN the other night! I survived it!!! But folks, it was frickin' rough.

Even with them knowing I am a brand-new nurse and had been on orientation the night before... they gave me 3 of the "easier" babies, all with things I have not had to deal with yet with a preceptor and HAD NO FUCKING CLUE HOW TO HANDLE ON MY OWN.

I was talking with a girl who was helping me out, and she asked how my night was going, 2 hours into the shift. I told her good, then explained to her I was given an 8:30 feeder and two 9 o'clock feeders. She legit looked at me and said, "get used to getting terrible assignments for awhile, it happens to everyone."

In a joking matter I laughed and asked, "is it like hazing the new kid?" with a smile and a slight look of fear... to which she responded, "yeah, a little."

Now, I get trying to get me new experiences, and giving me easy babies. Okay, I get it. But if you look at the feeding schedule and avoid giving all of the other, experienced nurses babies that all need to feed at the same time, why the fuck would you give a brand-new nurse all babies that need attention at the same time her first night by herself? Seriously.

For those of you who don't know, feeding times in the NICU are important. Those are the times when you do assessments, get labs, bath, and care for the kid, then feed them. The feeding is supposed to start at their designated feeding time and all cares should be completed before then.

My 8:30 was a kid that was needing to room-in with the parents so that if the parents had any issues during that process, they would have help literally across the hall.

One of my 9:00 feeders was brand new that day, and a train-wreck because not all of her admission labs had been done upon admission, then the NP decided later in the day (like 5 hours later) that hey, maybe getting blood cultures and the other normal admission labs should be collected, just in case. So, day-shift nurse left those for me to do... Now, I'm getting better at regular labs where you just do a heal stick an milk their little foot. The blood culture labs require an IV stick, leaving the catheter in the vein, then aspirating blood drop by drop into a 10 mL syringe to ensure that it is not contaminated with the bacteria from the skin. This is a super scary way to draw labs, and mighty tedious. However, baby veins are so little that you can't just use a butterfly needle or draw blood the way one can on adults or even children. Yes, drawing labs this way is as irritating and tedious as it sounds. Add in the fact that I haven't gotten an IV stick since the very first one I placed on day 2 of orientation, and it stresses me out to no end.

My other 9:00 feeder is truly a feeder-grower. His parents know how to do all cares and he eats really fast. He knows what he's doing and, honestly, I'm not entirely certain why he isn't able to go home yet. But hey, I'm new, so they must be keeping him around for something.

On top of normal cares, me freaking out, and work needing to be completed, we have to get baby weights on night shift. In order to do so, all 20-30 babies are weighed using 1 of 2 scales, unless they happen to be so small that they have a bed with a bed scale.

I had just finished my first assessment when ALL of the parents showed up for ALL of my kids. I needed to do a bunch of paperwork and teaching for the parents who needed to room-in, then get them over to their hospital room for the night. One dad came in with his mom to hold his daughter for the first time since her early birth from emergency c-sections (the kid I still needed to draw labs on...), and the other parents for my second 9:00 feeding showed up and started in on cares and feeding for that baby.

Meanwhile, the charge nurse is asking where I'm at, I had time to only poke my head into each baby's room before I got caught up in the new kids room with a very nervous but sweet dad. The parents waiting to be able to room-in were working on feeding their kid, but ended up having to wait 30 minutes after he was done eating in order for me to get back to help them. And, my sweet parents for my last baby's feeding took care of everything except for weighing their baby, which I put off until the last feeding.

The charge nurse found me, and seemed to get mildly upset with the fact that I wasn't able to be in all three rooms at the same time, but started to help me with delegation and getting other nurses to help with the rooming-in training and whatnot.

Looking back on it now, I can see that feeding the newbie kid should have waited a little bit and I should have gotten labs drawn on the kid when I had a little bit of time before parents showed up. However, I have seen the super-experienced nurses have tons of days like that and I think I handled it pretty fuckin' well. I taught the new dad a lot, and answered all of his questions. I let the parents that knew what they were doing get time with their baby and kept checking in on them instead of just disappearing, and I was able to find a time to sneak away from patient's in order to ask for help. Plus, I was given a difficult assignment that even the day nurse, who has been a NICU nurse for like 15 years, changed as soon as she got in and got report. Now I know I can ask to change it.

I survived my first solo night as a NICU RN. I got done everything I needed to get done, though some was a little bit late. I got a kid a bath, who was in desperate need to be bathed, and he gave me good-smelling baby snuggles with each feeding. I offered help when I had the time, and worked my ass off all night. I organized the beds, talked with all of the parents, and did all that I could, while fending for myself. I was a difficult night and some newbie mistakes were made, but people helped me and went to bat for me once they determined I am willing of their time and effort. I thanked people up one side and down the other to make sure they know I am appreciative of their help. I left in the morning feeling tired, and a little bit defeated, but now that I think back on it, I did an amazing job for a brand-new nurse with only 2 weeks of night time orientation and 12 weeks over-all orientation.

There will be many nights where I will feel way worse because of everything getting crazy busy and hectic all at the same time. There will be days I mess up really bad and need someone to bail me out. There will be difficult parents, babies who are not wanting to fight to live anymore, and times where I feel like a complete failure. For me, I have only had one job where I left and didn't care what happened at work: IT. Working IT left me dreading going to work and counting down the minutes until I left. When I was a cashier in high school, I was so invested in my work that I was constantly trying to improve and do better than I was the day before. In being a CNA, both in the Alzheimer's facility and as a patient sitter in the hospital, I left each day either elated and accomplished or feeling sad/defeated/frustrated/upset. Leaving clinicals was a similar experience for me.

My upset/defeated days come from thinking I could have done something vastly different to lead to a much better outcome than what happened. This can be from interactions with patients, their family, nurses, or any number of the medical staff. It might come from a day when I have no help and the full fuckin' moon is up along with every person with some sore of behavioral issue (both temporary and chronic), or it may come from a day where I am perpetually behind because of something happening at the beginning of the shift.

My happy days come from knowing I did as much as I could. Or from a patient/family member telling me how much I helped them that day. Occasionally, it'll come from a nurse or doctor letting me know how much I helped and how much my presence was required and useful that day (did not happen but once in my 3 years of CNA experience and I didn't believe it when the nurses would tell me that during clinicals because I know I slowed them down). It also came when I had just an amazing learning or teaching experience, like getting to scrub in and assist with a surgery on my first OB clinical night!

For me, I could not handle going to a job where I didn't have emotional connection and attachment to my work. Yes, my heart and emotions are constantly on a roller coaster but, let's be real, I'm on a roller coaster all the time anyway with my bipolar episodes *ba-dum-ts* (that was supposed to be the drum and cymbal sound for when people make a joke). Ha, I made a joke.

You know what, it's true though. My whole heart has been in everything I do, even working IT, and I wouldn't have it any other way. People can tell when you're just there for money or if you actually care about what is happening. I pray my heart stays tender, that I never lose my sense of wonder, and that I am able to continually learn how to be better and care more efficiently so that everyone can feel how much I truly care for them. I never want to get a hard and jaded heart. This means I will have to endure many heartaches and a lot of pain, but I cannot imagine working for 30 years and not feeling anything for my patients or caring about people by the time I retire.


Moral of story for this post: I survived. My babies survived (thought one tried to die on me). And, to top it all off, I was one of the first ones to leave even thought I was able to keep up with all of my work and even help others with their work (as much as possible). I figured I would have been one of the last to leave and super behind all night. Woohoo!

NIghtshift Begins

I worked night shift as a CNA for a year and a half through nursing school. I was a patient sitter, who sat with 1-4 patients on the nights I worked. 12 hours, in a dark, chilly hospital room, trying to get a patient to sleep is difficult work. You may think it's easy or lazy work, which leads me to say: "You do it!" I have had multiple patients grab, kick, punch, and hit me. Yelling doesn't even count as attacks anymore, but some people come up with some nasty things to say when they are on CIWA (edited from AWA, I don't know what AWA is but I wrote this while tired... my bad) (alcohol withdrawal) precautions and need themselves a little buddy for their hospital stay. I have had to stand in the way of elevator doors and hand on for dear life as a dementia patient was pulling me in then pushing me out in hopes that he could get the elevator to work so he could go home.

It may not sound like much, but I have sat with suicidal 15 year-olds, patients suffering from paranoid schizophrenia, CIWA people, dementia sufferers simply wanting to go home, and with so many confused patients that even the nurse refuses to come into the room because of the tension and stress the patient causes for the patient. And yes, they charted that they had done their assessment... I saw it in the charting system but never once saw the damn nurse come into the room (I would know, I was in that stupid room all night, without a break).

Anywho, I predicted that working nights in the NICU would be slightly smoother and a little less difficult to stay awake during. I was correct... for the time-being. I haven't needed mid-shift caffeine boluses (for myself, we started a couple on the kiddos) just yet, nor have I been nodding off while charting. Granted, I just worked my second night shift last night and I'm still working on staying on-time with meds, labs, and feedings, so I stay pretty busy most of my shift.

First Night in NICU: I show up, bright-eyed and bushy tailed for the first day of night orientation. We get report on our two sweet babies and get started. Everything is chugging along with on kid that was admitted a couple hours before we got them (so they required a lot of extra help), and another little punkin that fought feedings with everything the kid had. My gosh, the baby would cry when not being fed, but refuse to eat when we finally gave the bottle. Hahaha, it happens, in my short amount of working, I have seen a few kids do that. So, we got through to about midnight and got notice that we would be getting another child to our assignment. Praise the L-rd I had a preceptor because I didn't even help with our third baby. Then, around 0430, we got a call that our already short-staffed unit would be receiving another little bundle of joy via surprise c-section! Seeing as I'm still learning, and two... one and a quarter nurses are better than none at said delivery... off we ran not even ten minutes later to a delivery that proceeded much more quickly than we were warned about.

When all the day nurses that had been teaching me for  the past several months asked how my first night-shift was, all I could do was allow my eyes to get really wide and say, "Well, I learned a lot." That's it! My gosh, I did learn a lot and the nurses learned that I could be counted on to do their assessments if I happened to not be crazy busy while one of their little patients decided to go meet Jesus as an inopportune time for us. I know it's all about working with the babies and their schedule, but them leaving us to "go towards the light" is not something we take kindly to.

Plus, I realized at about 0200 that it was the Harvest Moon, which is a full moon that packs in EXTRA "excitement" (edited from crazy, because that's a mean word to use), obviously. The labor board was chalked full, our NICU is full to bursting, and all of the babies (both earth-side and those still earth-bound) were in cahoots. The ones we had were mostly trying to die or crying their little lungs out. While the kiddos still cooking in mamas decided that it's about time they join in with our fun. Well, normally I'm all for lots of babies, but when said babies are just a couple weeks over halfway baked, it causes a bit of stress for the medical professionals committed to trying to make sure living humans remains living.

NICU Night #2: We started with two infants and gave report on only those two infants. Oh my gosh, it was glorious. We had time to help other nurses that were crazy busy, and all of us went home and clocked out on time! Charting completed, meds given, learning opportunities utilized, IV placed on child, and teachings done!

When day-shift nurses came on and asked how my shift went, I couldn't help but beam with excitement. I stayed on-timeish (minus getting behind for pulling an umbilical arterial line (scary) and doing labs at 0500. Besides that, the shift went fairly well. My gosh, I have been so incredibly blessed with good preceptors and my night-shift preceptor is no exception. She is a wonderful nurse, a great teacher, and a really sweet lady. I am very glad to be able to get to learn from her and know that I can count on her when I am on my own drowning in the future.



My orientation is technically over in 4 shifts. That completes my 12 weeks of training and preceptorship and the more I work the more under-qualified I feel. I'm not a parent. I've never breastfed. I am a brand-new nurse that has a college degree essentially giving me permission to begin on-the-job training. In a field that is life and death, that is freakin' terrifying. Throw into the mix that the life-or-death circumstances belongs to people's literal babies, and I'm plumb scared off my rocker.

Between being scared of breaking or killing somebody else's child and being terrified that they think I'm gonna be okay to be on my own soon, there is also the worry of the night shift staff. So many of them are girls that are a year or two out of college, but already thinking they should be charge nurse. However, these girls don't even keep up with the responsibilities they have to keep their babies clean, fed, and organized. I'm so sick of my generation thinking that they are better than other, they are entitled, or that they can climb the ladder just by sucking up to those in management positions while degrading and bullying those of us perceived to be "less than" them. Why am I "less than" you might ask? I don't know. These girls won't acknowledge me, look at me, speak to me, help me, or otherwise respect me as a living being. The only thing that shows that they can actually see me, is that us "less than's" tend to be tucked into various jokes. At least I provide comedic relief to somebody! I'm constantly laughing at myself, but it's nice to know somebody else can laugh with me too.

Struggle of This New Nurse

As my orientation season begins to wrap up, I can't help but think about how I felt when I started, and also how I'm not sure I can do it on my own. So far I can get the basics down, but there is always someone watching me and right next to me.

When I need another syringe, they are right there supervising and will run and get it. They are there to answer my millions of questions, without me ever having to leave the baby's bedside. They help one mom breastfeed as I assess and situate the next baby on my assignment list. They make milk, give baths, and do all of the cares that I cannot seem to fit into my work list because I am still slow in the tasks I do as I begin to figure out my muscle memory and routines. They help remind me when I have a med to give, I need to look at labs, and they help me be able to talk to the providers (NNP and neonatalogists) so that I do not get eaten alive just yet.

As I begin to get down the basics, I'm finding more and more that I am so far from knowing how to be a nurse on my own. Orientation for me ends at the end of September. I finished my last day shift orientation yesterday and I begin night shift orientation on Sunday...

To say "the struggle is real" is an understatement.

As I go about learning the ins and outs of a "typical" day, I have found some serious things I struggle with:

1. Breastfeeding. I don't have children. I don't know what it is like to breastfeed. I try to learn what I can from the nurses I am precepting under, but I feel terribly unqualified. When parents and grandparents of the babies ask if I have kids, I have to shamefully respond that I do not. That is followed with them asking how old I am and how much schooling I have left... Apparently the make-up I decided to start wearing so parents wouldn't be freaked out with how young I am, isn't working at all.
2. Families. The baby's families scare me. For every sweet, loving, adoring, easy family, there is an equally "different" family just down the hall. The kind of family that tells you they were a NICU nurse at the hospital I work at, but after further investigation you learn they were in the float pool and only floated the NICU one night to act as our unit secretary because we were severely short-staffed. There are families where we worry if the parents are on too many pain killers because they are falling asleep holding their 3 pound baby and asking the same question over and over. There are the families that we wonder about the safety of the mom because the dad is overbearing and there are signs of domestic violence. Parents who don't seem interested in the child. Women who tell the staff they will be adopting a baby that is in our NICU, throw a fit when they are not allowed to see said baby because we have no paperwork to say they will be the kid's guardian, and then we find out later there was never a plan for this lady to ever be involved in the care of the kid. Now, many of these situations are simply the stories from the nurses I've worked with, but I have experienced some of them between the few hospitals I worked at in Home State and now Small Town Hospital. Parents/family members scare me!  They blame us for what has happened to the baby even when the kid would have died if we didn't come help. They get upset with us for a positive drug screen in a 2 hour old infant, but I know we aren't the ones doing drugs through the pregnancy... I get that many of them are scare, and coping (though not always effectively coping), and they are in a situation that was unexpected and stressful. I get that. But I need serious practice with the parents and family members.
3. Time management. As soon as I feel like I get caught up, a kid pukes, poops, pees, or the family comes in and puts me right back to being behind. Through in a child needing a bath and bed change and I don't know how I will ever do it without having my preceptor there to help me out.
4. Remembering all of the "little" things. Little things like checking the med list for the babies every time I do an assessment so that I'm not late with antibiotics. Knowing how to give certain medications... Knowing who to ask for, how to ask, and what to do when I am needing a certain supply. Remembering the normal vital ranges and care tasks for babies when I am still so used to adult numbers and cares. 
5. Staying out of the cliques. Now, this one is a little different for me because I already have a target on my back. My grandmother (Mema) works in the NICU at my hospital. She has been there for years and years and years. My great aunt (Mema's sister) is the DON of the floor containing the NICU, L&D, the women's med/surg specialty floor, newborn nursery, and other various similar care departments. She is also the one who does the hiring and runs the meetings... So, you can see how many of the girls on the floor could be concerned and upset with me working there. Throw in the fact that night-shift NICU crew is known throughout the hospital for being ridiculously "cliquey" and I already starting with a handful of major disadvantages. So, while I need to work on time-management and all of these other things so that I can be "on-time" with all of the tasks I need to do, I am so very grateful that I am slow and always having something to do to stay busy because it keeps me from even being in a place where I could have downtime to have to talk with the girls. Maybe, by the time I get to a place where I am okay at being a NICU nurse, I will be so used to being busy that I will remain out of the clique scene all-together and nobody will ever know that there is another way for it to be.

So, here I am, about to be pushed off a cliff. Time to see if I will sink or swim.