How to survive the NICU?

[crinkle]

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Hello everyone,

I know that this board is frequented by residents, NICU fellows, and NICU attendings, so I wanted to ask you wise ones how you manage to survive in the NICU. I am a first year pedi resident whose first rotation is in the NICU and it is harder than anything I have done before (never did NICU as a med student). I find it much harder to be efficient in the NICU than on the wards, perhaps because sometimes I'm pulled amongst covering the NICU, deliveries, and newborn nursery. Do you have any tips for being efficient? Do you have any pearls of wisdom on how to learn to remember what's going on with a bunch of really sick patients? What, after having had years of experience, do you find has helped you the most throughout your training?

I realize that this is a pretty broad set of questions, but I thought I'd at least put the question out there, because I have to find a way to get through this rotation! I really, really appreciate your hard-won insight!

Thanks a bunch!

 

[oldbearprofessor]

Hello everyone,

I know that this board is frequented by residents, NICU fellows, and NICU attendings, so I wanted to ask you wise ones how you manage to survive in the NICU. I am a first year pedi resident whose first rotation is in the NICU and it is harder than anything I have done before (never did NICU as a med student). I find it much harder to be efficient in the NICU than on the wards, perhaps because sometimes I'm pulled amongst covering the NICU, deliveries, and newborn nursery. Do you have any tips for being efficient? Do you have any pearls of wisdom on how to learn to remember what's going on with a bunch of really sick patients? What, after having had years of experience, do you find has helped you the most throughout your training?

I realize that this is a pretty broad set of questions, but I thought I'd at least put the question out there, because I have to find a way to get through this rotation! I really, really appreciate your hard-won insight!

Thanks a bunch!

Greetings "Crinkle"

Sorry, but I've been way out of town for a while and haven't been able to keep up with the neonatology action on this board...

Remember that this is your first rotation anywhere as an intern so it may seem a bit tough anywhere you start. Some hospitals tend to "protect" the interns in neonatology, but there are others where you can definitely be thrown into the fire pretty quickly.

The most important piece of advice I can give you in neonatology is to make friends fast with some of the nurses. NICU nurses can make or break a resident's month there. If they think you are arrogant or even if they think you are overly pestering their babies, they will make it tough on you. On the other hand, they can also help you find the information you need quickly for rounds, alert you to any problems with the baby, and often tell you what you need to do today to make you sound good on rounds ("I think we should advance oral feeds today since s/he did so well last night....").

If your hospital uses nurse practioners, they also can be a huge source of help. Many of them have easy to use guides for common IV solutions, infusions and the like.

Also, the respiratory therapists can be very helpful in telling you what is going on. They will even, when asked nicely, tell you what you are hearing in the chest on chronic babies and what changes have occurred recently. They usually have good input into blood gasses and the like as well.

Finally, and I realize this is hard and comes from someone who has lived NICU's for more than 20 years, try to not be too worried about what you may miss. Get the facts, write them down, tell your senior residents and attendings, and then focus on LEARNING. No intern really can understand the NICU well, so take the chance to learn physiology and patient care basics on rounds during the day and focus on what the others can teach you.

Hopefully, next time your in the NICU it'll seem easier.

Also, take a second to enjoy the healthy babies in the DR. It'll help remind you of why you are doing pedi.

Regards

"oldbear professor"

 

[docmartin]

Hi Crinkle,

I am a 4th year student, who is currently doing NICU, and I understand your frustration. It is a whole new language at times. Luckily, my team is not too busy, so I have time to ask questions. But one of the best guides is Neonatology by Gamelia...it has a lot of good information. As far as meds are concerned, like old bear said, nurses are SO helpful, as are RT's, we also use the Neofax (drug book for neonates). The nurses and RT's have been doing this so long...but you have to be very nice and respectful to them, and they will be to you. NICU fellows have been pretty helpful, but sometimes I can tell they get overwhelmed with the preemies. So hang in there...!

🙂

 

[Mr_Money]

Hello everyone,

What, after having had years of experience, do you find has helped you the most throughout your training?

Alcohol........lots of alcohol! 😉