Ep. 2: NICU Nursing with Nurse Mari: What This Specialty Is Really Like

In this episode of My Nurse Specialty, I talk with Nurse Mari about her journey into NICU nursing and what it really looks like to care for some of the smallest and most vulnerable patients. She shares how she first became interested in working with babies, why she did not get into NICU right away, and how her background in med-surg, adult ICU, and travel nursing helped prepare her for the role she has now.

We also talk about what makes NICU nursing unique, from the emotional connection with families to the high level of critical thinking and teamwork required every day. Nurse Mari gives honest insight into both the rewarding and challenging parts of the specialty, along with advice for nurses who may be thinking about this path for themselves.

In this episode, you'll learn:

• Caring for fragile newborns and their families.
• Taking a longer path into the specialty you want.
• Building skills and staying ready for the right opportunity.

About My Guest: Nurse Mari is a neonatal ICU nurse who cares for babies born as early as 22 weeks gestation, along with infants who have a wide range of medical needs. Before moving into NICU, she worked in med-surg, adult ICU, and other nursing roles that helped build the experience and perspective she now brings to her work. She also creates content online to share more about life as a NICU nurse.

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Instagram: @nurse.mariii

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Transcript

SPEAKER_01 0:02

Welcome to Minor Specialty, a podcast for nurses who want a clearer view of what's possible in this profession. I'm Rebecca, a registered nurse, nurse career strategist, and someone who has spent decades working across different nursing roles. Nursing School teaches us how to pass boards, but when it comes to careers, most of us are introduced to only a handful of specialties. It just depends on who you talk to after you get out of school or while you're in school. And then we're expected to figure it out. The rest of us, that lack of awareness is where confusion and misalignment begin. This podcast exists to expand that awareness. Throughout this podcast, you'll explore your two specialties, some you've likely heard of, and some you may not know it. Along with the insight and helps you understand what is best for your career at any stage. This is my new specialty. Real nurses, real stories, and real possibilities. So today I'm joined by my guest who works as an NICU nurse. And this is Nurse Mari, and I'm so happy that you decided to join us today.

SPEAKER_00 1:20

I am so happy to be here. Thank you so much for having me. It's an honor and a privilege. Thank you.

SPEAKER_01 1:26

So if you can tell us right off, what is it that you do?

SPEAKER_00 1:30

So I am currently a neonatal ICU nurse, and I work with babies that are born 22 weeks of gestation and up. They range from premi babies, babies that have complex medical conditions, and do just basically a summary work of all different types of NICU care. So there is lower acuity, high acuity babies, and I kind of do a mix of all that kind of stuff. I am just getting back from maternity leave, so we're kind of easing our way back into things, and I'm a little rusty at stuff. So I feel like I'm in this second wind of learning. Um, but yeah, that's what I currently do. I have a history of working in adult ICU, medsurge, and under medsurge, I worked in an umbrella of a bunch of other specialties when I work per diem. And so that's what I do now as a NICU nurse, but I have all this added experience in the background as well.

SPEAKER_01 2:21

Okay, so I just I want to kind of like back up a little bit because um we say NICU and then we also say NICU. And so what is what does that stand for?

SPEAKER_00 2:32

So the NICU stands for neonatal ICU, and like I said, it encompasses all these different types of diagnoses, babies that are born um either inborn to a hospital, transferred from another hospital, have either just been born, gone home, and are under 30 days of life old. So it's a big, wide range of babies and different gestational ages, but just basically babies that are born 22 weeks and up, or babies that are under 30 days of life old and have gone home and have now returned to the hospital for medical care.

SPEAKER_01 3:05

So, how is that working with babies? Did you always know that's what you wanted to do?

SPEAKER_00 3:10

Since nursing school and my pediatric rotation, I knew that I wanted to work with babies. However, it is a very intimidating population to go into because just like other nurses can relate, having your patient and their family members is just very intimidating in its own way, let alone it being a baby and their parents. There's this different level of guardianship that someone has over their baby or their child. Um, so I was a little intimidated with that, but I knew one day in my career that's what I wanted to do. And so I geared all these decisions to be made so that one day I would be a neonatal ICU nurse.

SPEAKER_01 3:47

Oh, wow. So that's actually really good for somebody who's trying to see if that's what they want to do, or they just think maybe I might want to do that. That sounds like a really interesting area. What do you mean by you geared towards that? What kind of like shadowing did you do?

SPEAKER_00 4:04

So when I worked um during my pediatric rotation, they always kind of give you sometimes give you the option do you want to go to the ER? Do you want to go to this area? And during my peas rotation, I always ask if no one volunteered for NICU, I want to get another go-around to go and do that. So each time I was there, I think I did a total of three um days or clinical days there. Every time I was there, I was like, I love this more and more. It has different aspects of medical care. So you have like the really high acuity stuff, and then you have intermediate, and then you have lower acuity. So there's a big mix of skills that you can practice. And it's something that I really encourage for new grads. They're sometimes like, oh, I'm like really scared to jump into that because it's, you know, ICU after all. But my thing is you can just gently ease your way into higher acuity, you know, build your time management skills, build your other skills, and then, you know, go into the high acuity stuff so that you are a well-rounded nurse. So for me, I knew I wanted to do NICU, but I didn't get in right away. So that was my first rejection. I was like, oh, that's okay. And my professor told me that NICU isn't for everybody. And I do think that's true. I think that you have to have this underlying drive to want to care for babies and their families. And I think that sometimes that's a little overwhelming for some people. They just can't quite grasp all the things that encompass that. So for me, I was like, okay, well, I'm gonna start backwards essentially. I'm gonna work on time management, do all these things. So I started off in med surge, then I said I'm gonna do ICU. And I was hoping that in that time I would somehow, you know, land a job in the NICU. So I had my NRP, I redid all these certifications, hoping that I would just be so blessed and get that job at that time, and I didn't. And that's, you know, another thing to add to my failure resumes, so to speak. I said, you know what, it's it's not the time for me to do this. And I think looking back now, had I gotten into the NICU at that time, it would have been just wonderful. But I think I grew so much more as a nurse and individual, having had the experiences I did in ICU land, because then I did travel nursing and I learned how different hospitals work. So I was, you know, getting this added knowledge and experience and just a different view into healthcare. And so, you know, I had all this added experience and I said, okay, well, I think it's time to reapply and do this. But every year I told myself, I'm gonna do something, I'm gonna try and, you know, just keep up my certifications and do all this stuff. And I always did, hoping that one day I would get the opportunity when the time felt right. And it never felt quite right. Like I never felt fully ready. But my husband was is my biggest cheerleader, and he's like, What are you waiting for? And I think through therapy and all these things that I was doing at the time, I told myself, I need to really make this a year I follow my dreams and pursue these things, even if it means failing again, being rejected again. I have to start now doing the hard work of putting myself out there and just hoping it's gonna happen one day.

SPEAKER_01 7:15

You know, I love what you said about like nothing was wasted. So, you know, for nurses that are going from one area to the other and still wanting one area of nursing and it's feedback, it's not wasted at all. Everything is helping you grow in a different way. And sometimes in that path, you decide, oh, maybe I like this one better. But for you, you knew you wanted to go to NICU. So you just kept doing that and going until it was time for you to apply again. And I love that, you know, you could be the nurse here that said, Oh, right away I got in. And it and it does happen for some nurses that way.

SPEAKER_00 7:54

I love that for them too. I love that for them, that they just get it right away because you don't have to do all these things. You don't have to go through this structured process. I tell a lot of new grads that message me and stuff, like, oh, I don't know if I should do this and that. I tell them if you have the opportunity, just try it and go for it because then you don't have to unlearn certain things and you just get trained right then and there, the way that that hospital or facility wants you to be trained.

SPEAKER_02 8:23

Right.

SPEAKER_00 8:23

It is so important that you take the chance, especially as a new grad. That is so, so valuable.

SPEAKER_01 8:28

Yeah, and how valuable for you because I know that not every school allows you to go and make a choice to go into the ER or to the NICU and and shadow for the day and work with the nurse. But if you do have that opportunity, that those are good things to go try because you want that exposure too, to see if that's something that you want to do.

SPEAKER_00 8:48

Yeah, because I do every so often I've had students that are like, oh, I thought I might like this, but I don't think this is for me. So I asked them, what about this, you know, rotation or the shift that you're on with me makes you feel like this isn't for you? And they're just like, I just don't like it. And that's okay. And it's not for everybody. So I do believe that's true.

SPEAKER_01 9:10

Right. And you know, we're fortunate that we are in a career that has all these options to you. You you have you have careers and then you have nursing careers. So we get our own little area of multiple careers within careers. So it's always good to go and try all these different things and see if you like it because sometimes you're right. You get in there and you say, Oh no, I've talked to so many nurses that have told me that they really wanted an area and then they got there and there was, oh no, this isn't what I wanted. So it's good to try. And if you have that opportunity, you're right. As a new grad or as a student, it's good to go and try and see what you think and you know get a little bit of exposure. But sometimes even that isn't it.

unknown 9:56

Yeah.

SPEAKER_01 9:56

So tell me now that you are in it and you love it, what is the best part of being in the NICU?

SPEAKER_00 10:04

I think the best part is seeing a baby go through some of the most hard and challenging things that like even for an adult would be just immensely overwhelming. And you're helping support these families through this long, very long, arduous process sometimes, and they get to go home. And it is the most, I can't, I wish I could bottle that feeling when they're in their little wagon and we're saying goodbye. Like, it is the most rewarding feeling I have ever felt in my life, next to now being a mom myself and you know, holding my daughter and all these things and cheering her on and all that. But it is this sense of full completion in our work because in every other area of healthcare, you see patients for a short amount of time. And granted, when I worked adult ICU, when I worked med surge, we did have the rare occasion of a patient that would be there over 30 days, sometimes 60 days. I think in when I worked in med surge, we had a patient that was there for six months. And then when I worked in adult ICU, there was a patient that was there for eight months. But you don't get that long duration of time where you see this progress going and all your work and efforts, like you get to see it all go into play. But in the NICU, it's a routine thing. We have babies that are there for a month, two, three months, sometimes four, maybe even longer. And you get to get to see them, you know, have these procedures be part of this whole process, and you get to send them home. And it is truly amazing. And I don't really have much of this experience back in adult care, how much positive, how many more positive outcomes there are in NICU when you've seen these devastating conditions sometimes, and they get to go home and you know, have sometimes a medical device or a thing of that sort. But by the time they hit school age, you wouldn't know that they've been through the things they've been through. And, you know, granted, the parents will never forget it. The babies will likely, you know, sometimes have these things that they live with that are lifelong conditions, but overall they live relatively normal lives. And that's something that I didn't have before, and it's just so different, and it's really cool to see.

SPEAKER_01 12:19

Yeah, sometimes you'll talk to adults and they'll tell you, Oh, I was a preemie, you know.

SPEAKER_00 12:24

You're like, I couldn't tell because you're amazing, you're so tall or things like that, you know.

SPEAKER_01 12:28

Right, exactly. I know it's it's very, you know. Um, I know my daughter had some friends and um they she had twins, they were twin friends, right? Uh um, and one of them ended up in the in the NICU. And um, so she's like, Yeah, I was a preemie. And oh, I guess you know, you just when they're all grown up, you're all, oh, you were, you yeah, you're right. They go home and and they're no different, and they get that great start from all the care from all you wonderful people in the NICU, and they grow up and go on with their lives.

SPEAKER_00 13:00

Yeah, and sometimes what we tell our parents is if there's any silver lining in this awful experience, because the NICU really is an awful experience for them. No one thinks in their birth plan, as they're planning their baby shower, the nursery, all these things, I'm gonna be in the NICU one day. Like, let me mentally prepare for that. Some parents do have diagnoses that are, you know, um disclosed prior to, and they know that they'll likely have a NICU admission, or they've had prior um premi babies, so they're at a like a higher risk of that, but no one thinks like this is gonna be part of my journey. So it's very traumatic, really hard. So helping walk these people through that and everything is just a different type of care, but yeah, it's very, very nice to help with that.

SPEAKER_01 13:46

Yeah. And then so you you did mention too you have them for 30 days, maybe longer. And so that means you get to know the parents pretty well too. And going through those times when it's a lot of anxiety for the parent. And how do you help them through that part?

SPEAKER_00 14:06

I just try to be someone to listen, like hear them out, truly, because a lot of times you're doing things very differently in the NICU. Things move very slowly. We're not gonna just jump in and do a ton of interventions in the day. So when I worked in adult care, this was one of the really hard things I had to get used to was learning that there's some things we're just gonna have to wait out and hope that the baby outgrows or give them a chance to recover on their own. Because if we don't do this, like oxygen therapy, we're just gonna go with one of those big things that, you know, if a patient's DSATing in adult care, we give 100% oxygen, we catch them up, we do these things. In Nikki World, we don't do that because you're overexposing them to a lot of oxygen, which can then affect their vision and all these things. So you are now having to coach parents through this different experience that they may be having, and you're like, okay, well, this is why we do this. So having a lot of patience with them, I my big thing with them is if there's something that you're thinking about or something that's like gnawing at you, like, why aren't we doing this? Because we tell people like, don't go on Google, don't go on these things, but it's it's the world we live in now. So there's a lot of anxiety, a lot of stress, and then there's a lot of frustration too. So they're like, why aren't we doing this and why aren't we doing that? So it's just taking this approach of a different type of education with them and also knowing that they're they're just advocating for their baby. So just put trying to put yourself in their shoes for the day. And this is something I did before I had kids. Like, if I had someone that I deeply cared about, you know, my child or something, I'm trying to envision what this would be like for them. So I'm asking them, you know, can you write these questions down? So when the doctor comes in, we can all talk about it. I want you guys to really understand why we're doing and what we're doing, because this is gonna be a a journey. And I we want to build rapport. So it's so important to build rapport. And I think once you have that, a lot of times parents, it just becomes almost like a pseudo friendship almost. I feel like, you know, when I come back, I've cared for this family. You meet the parents, and then you know, you come back again, they're like, Oh, it's you, and we start talking and everything. And a lot of them are my age now because I'm in, you know, childbearing age and everything. So we relate with a lot of things and you know, family stuff. And because they're there for so long, we do talk about some personal things. They're like, Oh, what did you know, how was the weekend with your sister-in-law, and how was it and that? So there's this different camaraderie, I think. So it helps take some level of stress away. But when things start to get, you know, a little complex with the baby, it tightens that. But then they it's a different level of trust than I've never experienced in other areas of healthcare before. They'll ask me, like, they'll just literally one time one was like pull me from the stretch, like, what is going on? What's happening right now? And I'm like, okay, let me, I'm gonna have to step away or you know, have someone take my spot here. And I'm explaining to them in detail, like, okay, we're doing this, this is why we're doing it, you know. And sometimes there's not enough time to do those things, but I'll tell them, like, you know, it's gonna, it's gonna look crazy right now, and people are gonna come in where people are gonna come, we're gonna start doing a lot of things, but you know, I can assure you that we're gonna do our best and all that stuff. And it doesn't always have to be some super crazy situation, but a lot of times if we don't early intervene with these babies, things go south very quickly. So I just tell parents, you know, you're gonna see all these people come in, you're gonna see all this stuff happening, and you know, this is what's going on, and I'll, I'll, I'll debrief with you after. They're like, okay. And sometimes, you know, I'm just like, you I'm gonna have you sit down or, you know, just take a walk sometimes. If we're gonna be doing labs and you know, x-rays and all these things. Some parents choose to stay there, but some parents are like, okay, I'm just gonna wait outside because it's reliving a traumatic event. And some parents have that happen multiple times and yeah, yeah, there's a lot of um trust that's involved in this role.

SPEAKER_01 18:11

And um, you know, we know as nurses too that when people explain to you that helps with anxiety. So it's nice that you can have that, you know, that they have that trust with you and that they ask you what's what's happening, and they know that even you know what you're saying is calming them down, even though they're still anxious and worried about everything.

SPEAKER_00 18:32

Yeah. Or if it's not me, are the doctors and the providers that I work with are next level. Like I've never seen this kind of delivery of situation that's going on like they do. They're so they're so good at delivering this information, and sometimes they'll sit them down, they'll be there with them for like an hour. And I feel like when I worked in adult care, I used to have to call a conference for this kind of care delivery to be done, where you know, I'm like, you know, there's so many moving parts. This family's been here sometime. Like they just they they have every right to know exactly what we're doing and everyone be on the same page and talk to them. But in the NICU, this is like a regular occurrence. The doctors now have this good rapport with these families because they have sat there countless times with them talking about what we're doing, what we're expecting to happen the next few days, what the future looks like perhaps, and you know, just reassuring them and the things we can reassure them on, and also telling them, like, okay, well, we're gonna have to do, you know, A, B, and C. It's gonna be hard, but we're gonna all do this together. And, you know, they have this sense of strength that they get from us too. And the doctors and providers are right there with us. And I've never seen, I've never seen anything like it before. And it's been the most refreshing thing that I've ever experienced in healthcare because it really feels like we're on the same team and we're doing the same work and doing this stewardship together.

SPEAKER_01 20:01

So it definitely teamwork, and that makes a difference.

SPEAKER_00 20:04

Oh, yeah. Like real good teamwork, like the kind of team that like you want to go and have, you know, eat with later and all that stuff, but where the doctors are included too.

SPEAKER_02 20:13

Right, right.

SPEAKER_00 20:13

This is like so many of them versus I feel like in adult care, I'd have like a sprinkle of doctors that I'm just like, oh my gosh, you're so cool and you're so kind and caring. But I feel like you have to have that to be a neonatal doctor, like a neonatologist or a NICU uh PA or a NICU NP, that kind of stuff, because you do have to have just a little extra, I feel, to be that person for these families.

SPEAKER_01 20:42

Yes, and I I do like that, you know, when we talk about nursing, there's when you're on the floor and who is on your team, it's more your colleagues and them helping you. And yes, the doctor's part of the team, but here because everybody's there on the unit pretty much, and you can call them they're all part of the team.

SPEAKER_00 21:03

Yeah. I mean, I've had a doctor one time during rounds put a baby in this in a stroller and like rock them back and forth in their room and give them their pacifier and like hold them to calm them as I give them report for like our rounding time. And I was kind of like, Do you want me to because you feel awkward sometimes when a doctor's doing things that you don't think are in their scope, like getting a patient a blanket or things like that. And the doctor's like, no, we do this every round. I hold the baby and we just talk. And the baby's like, just I know you. And I'm just like, okay, this is this is different. Different environment. It's very different, very different. You know, I feel like there's just this barrier that doesn't exist there, I think, too, because I feel like the same way with my colleagues, you know, back when I worked adult care, sometimes I would get that occasional, oh, that's not my patient kind of vibe. And You know, it's hard. You know, there's a lot of people that you don't have that with. There's a lot of people you can count on on your unit and all that stuff. But in the NICU, I never see that. The baby's crying. My my coworker's going to reswaddle them for me, give them their pacifier, hold them, do something, call a volunteer to come hold the baby for us, or do something like that. Which I was like, at first I thought, like, oh, do they think I'm not like doing a good job? Or, you know, do they think I need more help? Which is fine. You know, at the time I did need some added help and all that. But they're like, oh no, I had this baby the other day, and they like this, and then they love when they're getting turned this way, and then when you broke them this way, and all that stuff. And I'm like, okay. And I found that that was just a regular thing that people are more willing to, you know, add a little more work to their day to help keep all the babies happy, all the babies healthy, and everyone just, you know, things going smoothly. And I love that.

SPEAKER_01 22:54

Sounds so supportive, such a supportive environment.

SPEAKER_00 22:57

Yes.

SPEAKER_01 22:58

Yeah. So tell me, like, who, what nurse do you think would be you, I well, you'd probably say everyone should go into the Nikki.

SPEAKER_00 23:06

I don't, I don't, I do, and I don't. I think that, you know, if you are a nurse that wants to have your hands in a mix, like a mix of skills, so really high acuity, but also the opportunity to like have chill days and intermediate days and are really driven by evidence-based practice, new research, um, pathophysiology is very, you know, huge in all these babies because there is a rhyme and reason why we do certain things. And um just having sometimes constantly changing procedures because of new data. I think that's the kind of nurse that would like NICU, someone that's wanted learning all the time and improving and mastering really niche, high-level skills, um, but also having the opportunity to, you know, hang out with babies. Because we're gonna have days like that. There's there's days where I'm just in a recliner with the baby, my other baby's fine, and I'm bottle feeding them, I'm holding them, just you know, we're chilling. And my co work my coworker came up to me one time and she's like, We get paid to do this. And I'm like, Yeah, we do. This is so awesome. But there's days where you don't sit down, you have a ton of drips and all these things, and you know, you know, vital instability. We have, you know, our A-lines, our devices, our events, and all these things. So you're having to do this mass mental gymnastics of critical thinking skills, learning to advocate with, you know, for your patients, calling the doctor, escalating care, coordinating all this crazy stuff that you have to do and having that adrenaline, you have a balance and mix of all that. So I think if any of those things sound appealing, then NICU is for you. And obviously, there has to be some sort of enjoyment of caring for small, tiny children.

SPEAKER_01 24:51

Right. And you know what I like about your story, Mari, is that um you started with adults. And so, you know, sometimes you're with adults, you're like, oh, I could never go to the babies. How, you know, I've been putting IVs in adults, doing everything, calculating for adults. How in the world do I transfer that into now working with babies? So, what advice do you have for that nurse? Because a lot of nurses that I talk to feel that way, and they feel like they're at the bedside and being with adults. How can they become a NICU nurse? And did they make a mistake by not starting with kids?

SPEAKER_00 25:28

I think we go into our nursing journeys however we go into, and it's up to us to decide where that lands us and where it leads us to. So I think never giving up if it's NICU that you want to do. And what I found is that my experience in adult ICU wasn't in vain. Granted, I did have to unlearn a lot of things and retrain my brain in certain ways. But sometimes when I'm caring for these small tiny babies, I think of caring for my very frail elderly population, like the IV stuff, like there's certain things you're just not gonna do with an elderly person. Their skin is so sensitive, all those things are so delicate, they're they become very hemodynamically unstable very quickly. So you're having to do all this stuff. And a lot of times when we get to a certain age, we can't advocate for ourselves. And some of my patients, you know, they're at in adult care were unable to speak and you know had all these other conditions, and some of them, you know, were now um had medical devices where, you know, like they're intubated and all that kind of stuff, so they can't speak for themselves. So we have to rely on our other other critical thinking skills and you know, seeing um information from their vitals, their labs, and all that kind of stuff. So those things will apply greatly in the NICU. So there are skills that you are practicing, there are skills that you are learning if you're an adult care and want to go into NICU and think, like, how am I gonna make this shift? I sometimes say, like, NICU is adult ICU adjacent, just smaller in some ways, not every way, but there are some ways with how you approach care too. Like you're gonna be telling the doctor, I'm seeing a trend happening now. Like this has been not their baseline, and we're having increased need in oxygen, we're having, you know, a slight bit of tachycardia, we're having, you know, dips in our blood pressure, all these things. So you're practicing this level of advocating for your patient when you're an adult ICU that will transfer into Nikki world. And I think that's one of the first things my preceptor said is like you're very comfortable with talking to the doctors. And I felt like, of course, because I they're they're my leader, they're my captain. So I need to be able to tell them exactly what I need and also tell them what I don't know. I'm gonna say, like, hey, why are we doing this instead of that? I was very comfortable with saying those things because one big thing I learned working in adult ICU is that you're not gonna know everything. And that needs to be something that's ingrained in every nurse, pretty much, that you're not gonna know everything. And if there's something that you are slightly hesitant on or unsure, you need to clarify that with whoever. And if you think you look dumb or stupid, like that needs to be the last thing and something you learn to suppress because you need to just be comfortable with asking for help or clarification of things. So I think those skills that I learned um working in adult care have translated very well into NICU world, but there are some skills that you're just gonna have to relearn. So that's just something that comes with the territory of NICU, and I think it's one wealth do worth doing if that's something that they're interested in.

SPEAKER_01 28:31

So, like you had a good orientation, it sounds like too. Is that normal for somebody who wants to go into the NICU or do they open up like openings for people who want to come, or are they always looking for nurses that have the experience first?

SPEAKER_00 28:43

I think they look for different types of experience. So I know a few hospitals, because I'm connected with a few other NICU nurses in Southern California and then up in the Bay that tell me that they have like different um fellowship programs. Sometimes there's like an intermediate program, like you're a nurse that has nursing experience but not NICU, and they'll help train you in that. The duration of that orientation is very different. Um, and some people have like a few weeks, sometimes people have a long orientation period. And then there's like new grad residency programs that have, you know, NICU-specific stuff. And I think one of my friends, she did LD, but she got cross-trained in NICU. So she would be able to float to NICU and she said, like, oh, I would like to float to NICU, but it wasn't really my thing because she would only float every so often. And when she would go, she would just be so anxious that she didn't really enjoy it too much. Because it is, it is really intimidating. It's nerve-wracking when you don't know all these different things and you're having to learn all this stuff that or relearn these things that you once learned and practiced, but you don't do regularly. It can be a little apprehensive when you're having to do those things on the fly. Um, but yeah, I think there's different um types of programs out there. There's some for new grads, there's some for intermediate nurses, there's some for nurses that have been into NICU, um, did something else, and they just need a refresher. Um, but there's many different types of um NICU nurse programs that exist at different hospitals. Just depends what you're looking for, whether it's a level two, three, or four NICU, that's also important into the type of acuity you're gonna get. So I always tell people that message me, do your homework on the type of NICU you want to do. And, you know, sometimes there's people that don't have the availability of having many hospitals that have all these different types of NICUs or opportunities. So, I mean, at some point, you know, if you want to do it, you're just gonna go for it.

SPEAKER_01 30:40

Yeah. And so it would be helpful to maybe have some certifications that even in areas that you're not working in, you would get the certifications more for the nurse that would be going into the NICU. What certifications are those?

SPEAKER_00 30:51

NRP, which is the neonatal resuscitation um certification, PALS, because most NICUs are bridged with some sort of children's hospital or will transfer into some kind of pediatric care. Um, and then there was peers. I don't know if that's super high on the list, but uh, that's one I took um when I started my NICU journey to have on my resume. When I started my job, they didn't require it, but my professor told me that that was something good to have because he's like, you don't know which NICU you're gonna go and apply to. So just have one for anyone that's gonna have that, because some NICUs in the US do require peers. Um, so NRP, PALs, and peers are good things to have, along with ACLS, because you know, if you're gonna do NICU and say you don't get in there right away, um, ICU is another next adjacent or PICU even, um, and that's something that would be beneficial to have um as part of your certifications before you start a job.

SPEAKER_01 31:48

Yeah, or even yes, start applying for the jobs too, so that you can have them on your resume and say why you got it and what your goal was.

SPEAKER_00 31:55

Yeah. I think that to me, like if I were a hiring manager, that to me would show like I this person has incentive and commitment to want to do these things. Although there's some places that give a different mixed review on that. They're like, oh, you know, you'll get it once you start the job. That way, you know, it's it lands when you're hired and you just renew it every so often, especially if like the hospital's paying for those kind of certifications. I'm not sure. I mean, I feel like I'd be like, oh, you already did it, so we have to pay for that. Um, but I think for me would show that there's like this um driven commitment to want to do this specific population. That for me, I'd see that on a resume and be like, okay, that's really good that you're doing this and you know, you're trying to get a leg up on your competition essentially, which I hate to think that, think that way, but when you don't have your job yet, you want to stand out um as an applicant on paper and try to get in there. And if that's one of those things that's gonna help, I think that's very beneficial to have.

SPEAKER_01 32:54

Right. No, in being on both sides of the hiring table, I do know that that's important no matter what area you go into. So researching where you want to go and then getting those certifications because they do look at it and then even speak to it in your interview so that you say, you know, this is why I went and got this, and I learned so much during that. And it it's helpful even in shining through your interview.

SPEAKER_00 33:17

Yeah. And when I returned back to work, I had the opportunity to sit in a few interviews because I went back to work modified from a wrist surgery that I had. So I was seeing this different take on, you know, um, other aspects of my hospital. So I was able to help with some of these interviews and be some sort of insight into these um applicant interviews. But one of the biggest takeaways that I learned from sitting in these interviews was they want to know why NICU, not just babies. I like babies, and sometimes you like hear this and you're like, oh my God, I need to help this person. But you have to know why NICU. Like there has to be a drive in you because this is such a small population. There's only so many open spots, and you have to know you have to know why.

SPEAKER_02 34:03

So is that why? Yes.

SPEAKER_00 34:05

Yeah, that has to be a big, a big thing that you really think about, and then why that hospital? So that's sometimes people like, oh, they have the Nikki one down, but then why this hospital? Why should we hire you of about you know, over all these candidates? Why you? So you have to just have that in the back of your mind. Um, actually, no, in the forefront of your mind of this is how I'm gonna land this job. Why I want why NICU, and then why this hospital? Because that is so important as a hiring manager to hear, because that's just gonna say to them, like, how committed are you to this? And is this just something that you think is cute? Because I do get that sometimes. Some people are like, Oh, I think it's cute, and you know, NICU's so cute, and they tell me this, and I'm like, girl, NICU is I see you too. Like NICU is serious, it's serious, and it's a lot of um, there's a lot of things in the background that you carry because you work in the NICU, and it's it's can be really heavy. I'm gonna just throw that out there.

SPEAKER_01 35:01

It's not yeah, that's like one of the hard parts of it because we're talking about you know all the great things too, but the hard parts, yes, is um there are some heavy things that happen there.

SPEAKER_00 35:10

Yes, so I don't want to glamorize NICU either. I think I sometimes focus a lot on the positives on things, um, but I don't want to glamorize NICU. There are some really heavy things. There is times where you you have to, you know, stand on your two feet and say, hey, I need this, this, and this, this is what's happening. You know, you're conditioning yourself to um escalate stuff and really hone in on those critical thinking skills and and put them into practice. So you have to know how all this comes together in your head for your life and say, you know, NICU is where I want to be because I want to work in a fast-paced environment. I want to advocate for patients in this specific population. I want to work with educating parents on how to care for these different babies with these different diagnoses, and also as yourself, you know, are you the kind of person that is okay with constant change? It feels like, you know, every year there's a new article that comes out with new amazing data that says, okay, we're gonna everything that we're doing, we're gonna change all of it, all of it, forget everything. We're gonna start brand new, we're gonna do this, this, and this. And you're like, oh, okay. And for that kind of change for me was kind of hard at first because I came from a land where it's very standardized. We do A, B, and C, you know, like your DK protocols, your post-strokes, all these things. Um, your comma, you're doing A, B, and C and it's all that. But if that was changing all the time, I'd be like, oh my gosh. And it was like that at first. I was like, oh my gosh. Uh so I have to keep tabs on all these things, but I like that. I like that there's new data that's showing that there's better outcomes if we do it this way, if we change this, and it just feels like you're being part of this amazing historic stuff that's happening. Right, right. So I think things like that, you know, if you have that drive and you have that interest in that kind of stuff, then, you know, that's good to talk about in your interview. If you want to do NICU and say, you know, I like this, you know, evidence-based practice that's, you know, ever changing in this population. I want to do more learning and all that kind of stuff. I think it speaks volumes when you talk about these things in an interview.

SPEAKER_01 37:16

Right. And that's fascinating. Yes, we all want positive outcomes. So if there's research that's showing that it's a better way to do it or what we were doing it the old way isn't the best way, it's good to have that new information. I remember one time, I think I went off maternity leave and I come back to work at the hospital and I'm looking for something. And they're like, oh no, we got rid of those. We found out those don't work well for patients, so we got rid of them. Oh, okay. You know, things do change. You just go on maturity leave, come back, and things have changed. So yes, having to stay, that's important. So, what kind of career growth is actually within the NICU? Because I know that when nurses do find an area that that they love, um, they can find growth within. So, what what would be like a moving up in the NICU?

SPEAKER_00 38:06

So, moving up in the NICU, obviously, after getting your bases covered and feeling confident and capable as a nurse um comes preceptorship. So that's one of my lovely things I love to do. I love to precept a new nurse or an experienced one and say, like, okay, this is how we do things here, and how did they do things at your old facility? And sometimes that kind of insight gives us new information on, like, oh, maybe we can try this at our hospital. Um, but yeah, being a preceptor um in the NICU, you can also be cross-trained for LD or other units depending on the hospital that you work at. So you can have um experience to go be the OR nurse essentially, or help with the OR nurse or the delivery nurse and um go and do this um first assessment of babies and see if they are gonna meet NICU criteria, if you're gonna transport them, so you become a LD and transport nurse, which is kind of cool if you ever want to do transport later. Um, so there is the opportunity. There's also um, you know, if you work at a children's hospital or one that does have capabilities for other um care for children. So some hospitals don't all have a PICU or a NICU. Um, but where there is a NICU, there's usually a PICU and a C V I C U of sort, um, and other type of patient, um, child patient care. You can be cross-trained to work in those units. Um, so that's just you know another one of those things to move up. There's every unit has the availability to be a charge nurse and those kind of things. So um that's moving up in the NICU.

SPEAKER_01 39:32

Family educators, I think too.

SPEAKER_00 39:34

I've seen educators and CNSs, um, so clinical nurse specialists. Um, but yeah, the NICU has a lot of opportunity for educators and that kind of stuff. And then with every hospital, whenever there's a new rollout or um skills that you have to do, there's like the superusers or the um unit expert on those things and stuff. So in the NICU, there's so many different skills and things that you have to keep up. And so there's the opportunity to be a nurse leader in that way, where you are, you know, you say, I'm gonna be a nurse expert in this, and then do the certifications or the added training to do those things so that you're a resource on the unit. Um, there is resource nurses too. Um, and I think in some ways, becoming a break nurse too, that's like a very wide skill mix because you have to be able to just jump into any patients' go at any time. So, you know, sometimes people don't think of resource nurses or break nurses being a way of moving up in the NICU or working or moving up in their current role. But I think that, you know, you become a very proficient skilled nurse. That is one of those things that you can do that you don't just do as soon as you get hired. So anything that you can do outside of when you're first hired, I think is a way of scaling up in NICU. So yeah, becoming a charge nurse, educator, resource nurse, LND, transport nurse, um, break nurse, all those things are different modes of um or preceptors are different ways of moving up in the NICU.

SPEAKER_01 40:56

Yeah, so you have a lot of growth from from within.

SPEAKER_00 40:59

Yeah.

SPEAKER_01 41:00

So if you could give one piece of advice to a nurse who feels unsure about this specialty choice, what would you tell them?

SPEAKER_00 41:07

If they feel unsure, I think sometimes we are unsure because we don't want to admit that it's just it's fear that's holding us back. Like you know deep down in your heart what you really want, and you just have to proclaim it that it's gonna happen for you one day. So I think sometimes we say, like, oh, I'm not sure because when you say this is what I want to do, there's a different expectation of you now. People are gonna ask, Oh, did you do that after all? Did you do this? Or did you said you wanted to do that? That ever happened for you. So it adds this like added stressor, I think, in some ways, because I said that to myself, like, I want to do NICU, and people were like, Oh, you know, do you ever I did you ever get in, did you ever hear back from the NICU position or did you ever this? And it's like it sucks because you're like, oh no, I didn't, and you know, it sucks that I didn't, but you know, it's okay. But I think if you're unsure, you have to just come to the realization, is this really uncertainty or is it just fear that's holding me back? And I think a lot of times, nine out of ten, I talk to people and I ask them, what's holding you back? And they said, I don't know. And I tell them, Well, I'm gonna give you permission to um follow your dreams and just start, just start looking. And that's how it happened for me. I was like, okay, you know what? My husband and I were talking, and I was like, I can't do adult ICU another day. I had a very um intense last shift, and um, there was just a lot of moving parts that I was just like, I don't think I can do this anymore, like not forever. And I I have to just find a way to get out of this because it's not it's not feed feeding my um my soul anymore, like it used to. I don't feel I I have so much anxiety going into work and all this stuff. So I told myself, I my husband's like, you I don't know what you're waiting for. What are you waiting for? And he asked me that point blank, and I said, I don't know. I don't know. He's like, Well, I'm gonna tell you right now. You need to just go online and apply. And as I did that, the job had posted zero hours ago. I had just posted, and I was like, Oh my gosh, this is a sign from God. I'm gonna do this right now. And then I got a call and everything. So I'm gonna tell whoever's watching this and who stayed on this long to watch my um discussion about the NICU. If you are scared and you don't know for sure, but you know, deep down you want to do it. I give you permission. I'm telling you right now, get on the computer, start looking on your phone for job postings and keep doing that every week at the end of the week. Say, I'm gonna look for job postings, I'm gonna look for job postings and apply. Get that resume ready and just start applying. Have those cover letters ready and just start to mentally visualize yourself doing this because it's gonna happen. It has to happen one day if you don't give up.

SPEAKER_01 43:52

Right. No, you're saying all the good points that I tell nurses as well. You know, be ready, have your resume ready, that zero hours, you know, be one of the first ones. To apply, that's all really good information for nurses that are out there applying to jobs. So there's a lot of nurses right now, as you know, um, just getting their foot in the door. And so I really want to help those nurses that, okay, you got your foot in the door, but that doesn't mean you have to stay here. You can go to wherever you want to go. And if Nikki was one of them, you know, start going in that direction and start doing the things that we talked about today.

SPEAKER_00 44:24

Yeah, you're not married to your job. That's right. You're not married to it here. You've you people used to make nurses feel like, oh, this place is invested in you. You used to have to stay. You have to stay, you have to make it worth the investment that they trained you and all that stuff. Right, right. Miserable and unhappy, just just go. You don't have to stay. Right. Don't, don't, don't make that.

SPEAKER_01 44:46

It's it is scary to move, though. I mean, I know.

SPEAKER_00 44:49

I was terrified. I was terrified. I was like, I don't know what I'm doing, and I don't know how this is gonna pan out. I hope it works out. I hope I really love it. Like, I think I'm going to. But God, it felt good. It felt good to have that validation. Like, this is, and I I say that now to many people, this is where I felt like I was always meant to be.

SPEAKER_01 45:07

Yeah. So well, I definitely love you sharing this story and all that information and insight. And you want anything else you want to share about what you do, you also do?

SPEAKER_00 45:17

Um, I do content creation on the side. It's my fun passion hobby where I share more about my experience as a NICU nurse. I just launched a series of my day in the life in the NICU. So you're seeing a visual little snippets of things that I do because sometimes I I told myself if I had my account, if I saw my account before I started into the NICU, I would be less scared, I think. I would see like, oh, okay, there's all these different moving parts. Um, but yeah, so if you want to follow me at Nurse Motty, um, nurse.motty with three eyes. Um, I can share more about what I do. Um, and I'm always open to my comments and my DMs. If there's anyone out there that has any more questions that needs any more insight or anything, I'm right there for you.

unknown 46:00

Great.

SPEAKER_01 46:00

I'll have that in the show notes for you for anybody who wants to see it so they can find it and then they'll find you.

SPEAKER_00 46:06

Perfect.

SPEAKER_01 46:06

Okay, thank you so much again. I really enjoyed talking with you today, and I love your journey, and um, it does definitely show that you are in the right place. And but if you ever want to move again, you know you're okay to do that.

SPEAKER_00 46:19

Yeah. Well, thank you so much for having me. It's been a pleasure.

SPEAKER_01 46:24

Thank you for listening to my nurse specialty. I hope what you heard today gave you real insight into this specialty and helped you see what's possible for your nursing path. If you're watching this on YouTube, please subscribe. And if you're listening on audio, follow the show so you don't miss what's next. If you know a nurse or even a student nurse who's learning about their next steps, tell them about the show or send them this episode. And tell me, what specialty should we feature next? If you're a nurse in a unique specialty that you'd love to share, apply to be a guest on my website. I'm Coach Rebecca. Until next time, keep exploring.