Welcome to the NICU! Whether you are a brand new nurse or a nurse with years of experience in other areas, the NICU will be a new world to you. Prepare yourself for a most exciting career! In my previous post, I gave a little insight and tips to carry you through your first days, weeks, months in the NICU. This week, I thought I would focus a bit more on the environment of the NICU and what to expect.
Our sick and tiny babies are sensitive to bright lights so you may notice immediately that the lighting is softer than other units. Exposure of the tiniest patients to bright lights can affect brain and nervous system development. In an emergency, the lights will be up, but otherwise we try to shield the babes by covering each isolette with a heavy cover as well as covering the baby’s eyes during care. Dim and low lighting are thought to be optimal for the growing infant’s needs.
NICU babies are equally sensitive to sound. According to a 2015 Cochraine study, “the sound levels in NICUs range from 7 dB to 120 dB, often exceeding the maximum acceptable level of 45 dB, recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants versus 0.1% of the general pediatric population.” Speaking or laughing too loud can also affect our patients adversely. The constant sounds of ventilators, pumps beeping, and monitors alarming all contribute further to stress on the infant. The extremely premature infant’s brain cannot process the way a full term baby does. It can be reflected in the decompensation of a baby’s vital signs- whether through desaturation or even bradycardia.
The machines, pumps, monitors, isolettes, and phototherapy lamps are an intricate part of our daily work and sustain our tiny patients. It is our job to be sure that each piece of equipment is functioning properly at all times. There is an alarm for essentially every piece of equipment that can sometimes drive one mad by the end of a twelve-hour shift. You know you have arrived in your career the night you wake at home in your bed to the sound of a baby desaturating.
The life of a NICU parent is like stepping on a roller coaster to find that there is no getting off. The tiniest babies have good and bad days and a parent’s emotions will reflect this. Sometimes this can be the most challenging part of the job. We feel helpless and want to give the parent hope on the days that seem hopeless. All we can do is be honest and supportive. Be empathetic. Listen. Allow the parent to express their feelings.
As you step on the unit for your very first time, you may feel both nervous anticipation and excitement. You yourself will be exposed to constant beeping of pumps and machines and may find you are completely exhausted when you get home. Be sure to get plenty of rest those first days and find a way to decompress on your days off. You will be learning on so many levels both theoretically and clinically all while being exposed to this strange new world. Take it in stride. One day at a time.
Lori is an American nurse and yogini living in Gothenburg, Sweden. She contributes regularly to Mighty Nurse, AWHONN, American Nurse Today, and has been featured in The Huffington Post. Follow her adventures through her blog, Neonurse, or on Instagram.
- Sound reduction management in the neonatal intensive care unit for preterm or very low birthweight infants