Anyone else hate the NICU?

[megacolon]

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Not to offend any budding neonatologists in the forum, but my NICU month is driving me crazy. All I can do is count the days until it's over. Anyone else with me?

I think the most frustrating part is that I have to spend 3 months of my life learning medicine that will be utterly useless to me when I am finished (I am med/peds)....well maybe someday I'll get to put that UAC into an adult. I really feel like the only reason we're stuck in there is to just do work.

Another thing that's frustrating is the fact it's a completely different world and since I don't really know that much, I can't communicate effectively with the parents, and then you have the NICU nurses treating you like you don't know anything (which I can partly understand) but doesn't make for a satisfying day...day after day after day....and then cross-covering 50 kids...ughhh. At least I'm switching over to adults in a couple weeks. I need a break.

And to preempt any comments, I do like taking care of kids, just not when they weigh less than 2 pounds.

 

[BPD]

No offense to any budding med-peds folks here, but I really dont understand why people like you do medicine pediatrics, where medicine is always before pediatrics. When you are going to end up managing adults, arent you wasting your time? The NICU is NOT the favorite rotation of many Pediatric residents either, but your insinuation that just because you are med-peds, you are entitled to a special exemption is offensive to me as a pediatric resident!
Anyway, maybe you can request your PD to substitute one of you NICU months with a PICU month (med-peds resident at my program can do this).
All the best!

 

[TexasRose]

I dunno, there are many peds residents who don't care for the NICU either. I don't think it's strictly a med-peds thing.

MC, I do understand your frustration with feeling like you do a whole lot of work that isn't very satisfying to you. It's a sometimes annoying part of medical training.

But hey, you can do anything for a month, right?

 

[kickazzz2000]

I HATED my first NICU month.

Nurses treated me like sht.
I didnt know anything.
My senior was a slave driver.
Cross covering 50 babies was overwhelming.
Paperwork upon paperwork.



I start my fellowship in July.

 

[oldbearprofessor]

Everyone has a right to hate some of their internship. What would SDN be without them expressing it? I hate to think what I would have written about adolescent medicine rotations/clinics if I'd had SDN back in those days (of using my Apple IIc).

You have two different issues you've expressed. If your post was just to vent, feel free to stop reading, I'm not offended at all and you'll still make a fine pedi or med-pedi or whatever even if you hate the NICU.

But, to look at your two issues a bit. The first is that you think the experience in the NICU won't be useful in your future career. Certainly that depends on your career, and it's quite possible you won't put UAC's into anyone after your residency (or during it), but almost any career that includes pediatrics includes a substantial amount of time around babies. You may not take care of 600 g babies with NEC in your career, but you will use a lot of what you are learning, especially in your level 1 and level 2 months. If all of your neonatal training is in a level 3 NICU with no transitional babies, then you should complain to your program chief.

The second issue is the feeling of not knowing anything, etc. Although I haven't particularly seen this as a bigger problem for med-peds residents compared to pedi residents, it is certainly true that you are a lower animal on the totem pole as an NICU intern compared to a MICU intern (or so I've been told repeatedly). Nurses and others don't trust you, often don't like you, and you can't answer the questions they want to have answered. But, like all internship rotations, there is a lot to learn if you can get over these little details.😉 The physiology of neonates is very different than adults and if you are interested in that sort of thing you can get a lot out of the month. For example, think about how you treat acute hypercalcemia in an adult and then think about whether lasix, fluid boluses and anti-bone resorptive therapy is a good idea for a 600 g baby with BPD?

Bottom line is that you can make it a good learning experience, even if you don't feel competent or like the NICU environment.

Or you can just survive the month and curse neonatologists forever.🙄

Regards

OBP

 

[megacolon]

It's always interesting to see what people end up posting in response to stuff on here. The comments were interesting to read...well all of them except the first reply. I love how people make all sorts of assumptions about me based on 3 sentences.

1. I don't believe I deserve an exemption. I do plan on seeing children and taking care of them when I finish my training. To assume that peds/med people just take care of adults when they're done is not a well thought through argument. All I'm commenting on in my post is that I will look forward to my first switch of the year, when I'll finally get to take care of adults (I did sign up to do both)

The discussion about the necessity of 3 months of NICU training for those in combined pediatrics/internal medicine training or even categorical training would be great for debate in a separate thread. One of my neonatal attendings actually did med/peds residency training.

2. The last poster is correct, the value of taking care of transitional babies to me is much higher than taking care of level 3 kiddos. And in the day to day workload, those level 3 kiddos take up much more time, energy, and management than my simple feeders and growers and doesn't leave me as much time as I would like to focus more on them.

3. The discussions I have had with many graduates of med/peds over the last month that work at my institution have told me that there isn't really anything they use that they learned in their NICU rotation.

4. I don't really feel that my feeling of lack of knowledge in the NICU is a med/peds thing. I would argue that it's common for most interns in categorical or combined programs because in talking with other residents, many do not receive any NICU training or exposure unless they electively choose to do so. Thus adapting to the new environment of the NICU can be very overwhelming, especially when thrown in to do the intern level of work and cross-coverage at night.

5. I was venting a little bit, something we all need to do. The NICU is not my favorite place, and I will do my work and get through it. And I will learn something whatever I do...even if it's just learning for the next 2 months when I come back.

 

[megacolon]

Hopefully as a fellow you will treat all your residents the same and not hold a grudge against the med/peds folks that come through.

 

[oldbearprofessor]

3. The discussions I have had with many graduates of med/peds over the last month that work at my institution have told me that there isn't really anything they use that they learned in their NICU rotation.

When I am on service, among the things we ALWAYS talk about are managment of jaundice, normal nutrition of newborns including vitamins, human milk benefits and issues (e.g. medications compatible with BF), resuscitation in the delivery room and transition and management of the near-term infant (34-36 weeks). Often we talk about post-discharge management of preterm infants and the long-term outcome of such patients. If none of the graduates in your institution are being taught those things, especially when rounding on non-ventilated patients, then perhaps in your evaluation of the month you should suggest that the rotation in the NICU there be certain topics that are covered. I am certain that my fellow faculty members cover these areas, especially in the level 2 nursery. If they are being taught and not used ever by your med/peds graduates, then they are not doing much if any hospital-based pediatrics and have an atypical mix of patients for a pediatrician. It's true that some pedis, especially in big cities no longer do any nursery, but I think most still do.

Regards

OBP

 

[megacolon]

We have discussed some of those issues, like the management of jaundice, neonatal seizures, apnea, etc. We haven't really gone into an in-depth discussion of nutrition...other than I know how to calculate the nutrition a baby is receiving and when to advance and such and calculate TPN (without which I would die on the weekend when I'm covering other patients for my fellow residents)

I think a lot of the topics you mention will be discussed when I am spending my month in the newborn nursery vs. the NICU, which I feel is what my attending would say if I mentioned I felt certain topics should have been covered.

 

[RuralMedicine]

The discussions I have had with many graduates of med/peds over the last month that work at my institution have told me that there isn't really anything they use that they learned in their NICU rotation.

I'm a Med-Peds attending, although I doubt you're training at my former institution--and I realize that there is a lot of variability between residency experiences. I offer things I think I took away from NICU/nursery only because you still have two more NICU months to go 😉 🙄 🙂 and I think you can get something from the experience. Or I did (😉 albeit our mileage always varies)
-Delivery experience is key! Get comfortable with neonatal resuscitation/intubations/emergent code UVs this is where as a general pediatrician you can make a real difference some rocky delivery room experiences yield healthy happy kids that you can follow for years in your practice. [Think even more years if you're Med-Peds]
-You don't have to love HFOV and ecmo (understand it enough to get through the night with fellow assistance as an upper level when you need to) or other NICU technology but the reality is that we're seeing some extrapolations into adult critical care (ok so adult oscillators are a little different but concepts similar). Also I think it's helpful to have familiarity with the technology to be a resource to families later on in practice. If you have an established relationship with a family who is unfortunate to have a NICU baby they may call you with the questions they were afraid to ask the neonatologist.
-Don't laugh but there are similarities between neonatal and extreme geriatric airways. (Very floppy and anterior cords--reach for Miller blades again just not those 00 ones you get handed in the NICU).
-Most neonatology attendings can also teach you a lot about systems based care and addressing end of life issues with compassion. (Yes we had a few where I trained who well ummm I guess had their own issues--of course we all do, but they were the exceptions).
-In general in my experience if you're frustrated that you aren't getting enough autonomy on the Pediatrics side I found that if I approached things proactively with a plan I could have a lot more autonomy. Obviously if my plan wasn't the best option that was pointed out. I got frustrated as an intern at times too but when I took a deep breath and used that approach things got better.

Enjoy the rest of your internship (it will have it's moments I promise)

 

[kickazzz2000]

Hopefully as a fellow you will treat all your residents the same and not hold a grudge against the med/peds folks that come through.

no grudge anticipated, in fact, most of my best friends here are med/peds

 

[megacolon]

Enjoy the rest of your internship (it will have it's moments I promise)[/QUOTE]

I won't quote your whole post, but thanks. I think it would be better if we did go to deliveries on our NICU month, but we don't do any delivery coverage, that's for the nursery intern/resident on call. I do think that stuff will be very important to learn and know.

 

[KidDr]

I think it would be better if we did go to deliveries on our NICU month, but we don't do any delivery coverage, that's for the nursery intern/resident on call. I do think that stuff will be very important to learn and know.

Oh, that sucks. IMO, doing a NICU rotation w/o going to deliveries (so therefore always being stuck in the NICU) is kinda brutal (at least for those of us not going into NICU). I learned a ton of practical stuff going to deliveries, stuff that will definitely help me out when I'm done with residency. I think going to deliveries and taking care of the 30+ weekers, and especially taking care of the full-term kids with various issues (r/o sepsis, mec aspiration, congenital stuff, etc) are the most important aspects of a NICU rotation for those of us peds and med/peds residents who aren't NICU fellowship-bound. As an aside, in my experience, it DOES get better as a senior resident (whether you're taking care of micropreemies or FT babies admitted for r/o sepsis), because people know you (nurses, RTs, attendings), and you know more as well. Every rotation is hardest as an intern.