Let's find it

A Personal Guide for Parents Like many other pregnancy journeys of lucky parents, ours seemed pretty typical. The ultrasounds were routine, the checkups didn’t raise any red flags, and there weren’t any signs that anything was out of the ordinary. We were excited and hopeful while preparing for the arrival of baby Sloane. So when her diagnosis of congenital hypothyroidism came, we were absolutely shocked. I’ll be honest: It was overwhelming at first (even as a nurse). How could something so serious not have shown up during the pregnancy? Jacob and I wrestled with fear, uncertainty, and a thousand questions. But we quickly learned that early diagnosis is EVERYTHING. Thanks to newborn screening and early treatment with thyroid hormone replacement, babies like Sloane who are diagnosed with congenital hypothyroidism can go on to lead fantastic lives. Sloane’s diagnosis was identified 4 days after she was born, through standard newborn screening a routine blood test completed for every newborn. As a NICU nurse, I had completed hundreds, if not thousands, of newborn screening labs at the bedside. I never realized just how much the routine testing would affect my little family.    Even with all of my clinical experience, the emotional shock of going from a “normal” pregnancy to a serious diagnosis is something I’ll never forget. It taught me and Jacob that even when things seem perfectly fine, hidden conditions can still exist, and that early testing truly saves lives. Below, I’m going to answer a few frequently asked questions about congenital hypothyroidism to help new parents who may be struggling. I’m also going to share a few tips that I’ve learned during our journey with the condition to help your first few weeks and months go a bit more smoothly. Congenital Hypothyroidism: An FAQ for New Parents What Is Congenital Hypothyroidism (CH)? Congenital hypothyroidism  is a condition where a baby is born with an underactive or missing thyroid gland. The thyroid is a small, butterfly-shaped gland  in the neck that makes hormones important for: Growth and overall physical development Brain and nervous system development  (especially critical in the first 3 years of life) Metabolism and energy use Body temperature regulation Heart rate and cardiovascular function Muscle strength and tone Digestion and gut motility Bone growth and maturation Hormone balance and endocrine system signaling (so ya, a lot of things!) Early signs and symptoms of congenital hypothyroidism can include sleepiness/low energy, poor feeding, jaundice (yellowing of the skin and eyes), constipation, a hoarse cry, cold hands and feet, a puffy face, and an umbilical hernia ( weak abdominal wall and poor muscle tone, hypotonia) . In our situation, Sloane was a bit cooler to the touch and had a hard time regulating her temperature, she also had a low resting heart rate (on ultrasound during pregnancy, 90-110), which is below the typical range (130-160bpm), and I believe her diagnosis was caught early enough that she did not develop more severe signs or symptoms. If CH is not caught early, thyroid hormone deficiencies can lead to developmental delays, stunted growth, and potentially worse (we won't go there) . Early detection through newborn screening is crucial. And if patenting isn't humbling enough, Sloane’s journey has taught us so much in the process! What Is a Newborn Screening Test, & Why Didn’t These Conditions Show Up During Pregnancy? I was asking myself the same question! And I am assuming you ar e too. After all, pregnancy involves many ultrasounds, lab tests, and checkups designed to monitor your baby’s health. So how could something important not show up? The truth is that many conditions can’t be detected during pregnancy  because they affect how a baby’s body functions after birth rather than how the baby physically develops in the womb. Ultrasounds are excellent at identifying structural differences, but they often cannot detect certain hormonal, metabolic, or genetic conditions that only become apparent once a baby is born and their body begins functioning independently. *In some cases, more advanced testing during pregnancy, such as amniocentesis , can detect certain conditions earlier. For example, congenital hypothyroidism may sometimes be identified by measuring elevated thyroid-stimulating hormone (TSH) levels in the amniotic fluid around the 22nd week of pregnancy. However, procedures like amniocentesis are invasive and carry risks , so they are typically reserved for pregnancies considered higher risk and are not part of routine prenatal testing for most families. Because of this, many babies who are later diagnosed with conditions like congenital hypothyroidism appear completely healthy throughout pregnancy and at birth . That’s exactly why newborn screening exists, to identify certain rare but serious conditions early, often before symptoms appear, so treatment can begin right away. What Exactly Is a Newborn Screening Test? A newborn screening test is a simple medical metabolic screening test done (18 - 48 hours) after a baby is born to test for these hormonal, metabolic, or genetic conditions . Each state in the US has different conditions that they test for. You can find out more about your state’s unique newborn screening test here .  The test usually involves: A small blood sample  taken from the baby’s heel (called a heel prick) Sometimes a hearing test A heart screening  for certain conditions If CH shows up on a newborn screening, the goal is to find and treat any issues as early as possible to help the baby grow and meet all developmental milestones. Usually, treatment starts immediately after confirming the findings with thyroid-stimulating hormone  (TSH/T4) lab testing.  What Happens After Congenital Hypothyroidism Is Diagnosed? Once we received confirmation from Sloane’s lab results (yes, she did in fact have congenital hypothyroidism, and her TSH and T4 levels were completely off the charts ), treatment started right away. Sloane was prescribed Levothyroxine , which is the standard and most effective medication used to treat congenital hypothyroidism in infants. Levothyroxine is a synthetic thyroid hormone that replaces the hormone the body isn’t producing enough of. Most babies start on a standard starting dose , which is exactly what our pediatrician did for Sloane. Early treatment is extremely important because thyroid hormone plays a major role in brain development, growth, and metabolism , especially during the first few months of life. During the first month, we stayed on that starting dose and closely monitored how she was doing. After that, we began monthly lab draws  to track her thyroid levels and make sure her medication dose was appropriate as she grew. The Reality of Giving Medication to a Newborn Now I’m going to be honest with you, getting Sloane to take her medication wasn’t exactly a walk in the park. At first, we were prescribed the tablet form of levothyroxine , which meant we had to crush the pill and give it to her ourselves . And honestly? It was a challenge (even for me as a NICU / Peds nurse). We tried everything: Mixing it with a tiny amount of milk Adding it to her bottle Even trying to give it through a nipple I didn't have my typical IV or OG tube to put it down The problem was that during her first week of life , Sloane was only taking about 10 mL of milk at a time , which is basically the size of a walnut. Because she could only tolerate such small feeds, it made giving the medication really difficult. Sometimes it took 20–30 minutes  just to get her to take the full dose, and even then, she wouldn’t always finish it. Between the taste of the medication and the tiny volume she could handle, there were definitely moments where it felt like a real struggle. What Made Things Easier: Switching to Liquid Medication After a week, we were able to switch Sloane’s medication to a liquid formulation made by a local family owned, trusted compounding pharmacy , and it made a HUGE difference. Giving her medication became: Faster Easier Much less stressful for everyone If your baby is diagnosed with congenital hypothyroidism, it may be worth asking your pediatrician or endocrinologist if a compounded liquid version of levothyroxine  is an option. One thing we learned along the way is that not all compounding pharmacies prepare medications the same way , so it’s really helpful to find one your doctor trusts. We were fortunate to work with a pharmacy recommended by our pediatrician, and having the liquid version made our routine so much smoother. (This is the "do your research PSA part of the blog") How Often Are Doctors' Appointments and Lab Draws? The frist year, Sloane saw her Pediatric endocrinologist once a month, and her pediatrician once a month. (Yes it can be a lot of appointments, especially if you add lactation specialists or any other things that pop up). Each time we visited, they assessed her weight, head circumference, height, feeding intake or new food introductions, energy levels (based on our knowledge), and labwork (which we had drawn the week prior). TIP: always have the lab draw first! That way, you can have results with the Endocrinologist or Pediatrician. (The labs can take a few days to process. They like to track these values closely.  For lab testing, she had labs drawn once a month for the first year. Babies grow a lot that first year so close attention to their levels is important. Currently, we draw her labs every 2-3months (as she is 1+ years and we have her levels pretty dialed in. Tips and Tricks for New Parents 1.Take Notes After Sloane’s diagnosis, I started taking notes at every doctor’s appointment and lab draw. I keep a detailed record  of our endocrinologist’s words of wisdom and advice, along with the projected plan for the foreseeable future. I keep a copy of all important phone numbers and Sloane’s insurance card with these notes as well, so that I have all of her important medical information in one place. Trust me, it’s a lot to take in, especially in the first few weeks and months. Coupled with all of the other challenges of new motherhood (breastfeeding, postpartum changes, etc.) I wanted to make sure I remembered everything correctly.  2.Find Lab Draw Tricks That Work For Your Baby Lab draw appointments can be stressful for parents and babies. Having a few tricks up your sleeve makes the whole experience less traumatic for everyone. Here are a few things that REALLY work for us:   3.Pre-lab draw feeding:   Milk just before a feed made Sloane a little drowsier and happier than she would be otherwise. Plus, it helps hydrate her and plump up her veins so that the blood draw is more successful! (As she got older, we made sure to do lab draws in the morning. Get them done earlier in the day, have her drink her sippy cup of water on the way, and get it done before nap or cranky end of day shennnigans. On occasion, we have her BMP (basic metabolic panel) drawn as well, and that is preferred fasted. So we make an early appointment and do it first thing. 4.Med ication same time each day! On an empty stomach. (Easier said than done). The beginning was difficult to time between feeds, but as she grew, it became easier. We aim to give her medication around 8-9 am each morning, one hour before breakfast. The liquid form is sweet and she has learned that it is part of the routine. I have her participate now, and help me draw it up or become part of the process to give her some ownership. 5.Find a lab or doctor's office that draws Infants well! I’m not going to lie, finding a good lab for baby’s blood draws took a little bit of trial and error. Not all labs are great with little ones, and we had to be extra picky about where we went. We found one we loved, but we were even looking into concierge lab draws in case we didn’t find a good fit. 6. Warm the injection site:   While holding Sloane in the waiting room, we tried to apply a warm pack to the injection site. You can use a Warmie or a heated stuffed animal to help increase a baby's circulation. Use cautiously, don't overdue it, but a little warmth can go a long way. (Many labs use cold packs for older kids and adults. For babies (especially with CH), warmer is better (take it from your NICU nurse). 7. Numb the site: If your baby needs frequent blood draws (like many babies with congenital hypothyroidism do), anything that can make the experience more comfortable is worth considering. One option is EMLA cream , a topical numbing cream that many hospitals use for pediatric patients before procedures like blood draws or IV placements. It requires a prescription, so you would need to ask your pediatrician if it’s appropriate for your child. However, during our journey, we also discovered a company called Thimble , founded by Dr. Manju Dawkins (physician and mom) . Her mission is to help make medical procedures less painful and less scary for patients, something I can absolutely get behind as both a nurse and a mom. We’ve personally used The Prepare Patch , which is designed to help reduce discomfort from procedures like: Blood draws Injections IV placements The patch contains 4% lidocaine , which helps numb the skin and make procedures more comfortable. It’s easy to apply, comfortable to wear, and doesn’t leave the mess that sometimes comes with creams. For families navigating frequent labs or medical procedures, tools like this can make a really meaningful difference in helping reduce both pain and anxiety . Do whatever seems to work best for your baby. This is definitely a trial-and-error experience! 8. Buzzy Bee trick 🐝:  If you don’t already know about the Buzzy Bee , let me just say, this is also a game-changer for lab draws. I would help hold Sloane, and Jacob applied the Buzzy on top of the injection site, it combines a little vibration and cold, which distracts from the pain and makes the whole process way easier for her. 9.For Babies With CH, Comfort Is Key Babies with congenital hypothyroidism are sensitive to temperature fluctuations, so you’ll want to make sure you can keep them cozy and comfortable. Sloane loves: Warmer temperatures Soft layers:  I’m talking cozy onesies , swaddle blankets , etc.  Heated surfaces: Sloane’s mini heated pad was a Godsend. We would wrap her up in it after bath time, bring it with us on overnight trips to make sure she’s comfortable or just let her fall asleep on it. (Caution, not medical advice. This was done with supervision and not for long periods of time. We would use this as a little extra warmth during fall/winter months). Massages and skin care:  CH can cause dry skin in babies, so we’re really mindful about the detergents and skin care products we use with her. Our favorites right now are LINKS Endless cuddles:  Babies with hypothyroidism often have a quiet temperament and love cuddles all day, every day! For m e , a comfortable baby carrier  has b een a GODSEND for the days when Sloane simply won’t let me put her down!  I’ve Heard of Radio-Nucleotide Uptake Scans Being Used for CH. What Are These?   A radio-nucleotide uptake scan , sometimes called a thyroid uptake scan or thyroid scintigraphy, is a diagnostic test that uses a small amount of radioactive material (usually radioactive iodine (I-123 or I-131) or technetium-99m )   to evaluate how well the thyroid gland is functioning. After injecting the radioactive material, a gamma camera captures images of the thyroid gland to assess its location, size, shape, and function.   For us, Sloane hasn’t had her radio-nucleotide uptake scan yet. Her Pediatric Endocrinologist likes to do them around 2 years of age (unless absolutely clinically needed). A Final Word to Parents Walking this Journey If you’ve made it this far in the blog, chances are you’re either navigating a congenital hypothyroidism diagnosis yourself or trying to learn everything you can to support your baby. I want you to know something important: you’re not alone in this. When Jacob and I first heard Sloane’s diagnosis, we felt overwhelmed, scared, and honestly a little confused. How could something like this happen when everything during pregnancy looked completely normal? But what we quickly learned is that early diagnosis truly changes everything . Thanks to newborn screening and early treatment, babies with congenital hypothyroidism can grow, develop, and thrive just like any other child. The beginning may feel like a lot, lab draws, medication routines, and appointments, but over time, it becomes part of your rhythm. Today, Sloane is happy, growing, and doing beautifully. Watching her thrive has been the greatest reminder that this diagnosis does not define her future . As both a NICU nurse and a mom, I’ve learned that sometimes the scariest moments in parenthood are also the ones where we discover just how resilient our babies and we as parents can be. So if you're in the early days of this diagnosis, take a deep breath. Ask questions. Lean on your pediatrician and endocrinologist. And give yourself grace as you learn this new routine. You’ve got this. And your baby does too. With love, Tori Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

It’s an exciting time to   become a NICU nurse: hospital admissions are at an all-time high, and persistent nursing shortages mean there are tons of bedside jobs available. Whether you’re a new graduate , are a practicing nurse in a different specialty, or are in nursing school exploring employment options, it’s always a good time to make sure you know what’s down the pipeline in terms of career moves. Quick intro, for those who don't know me! My name is Tori Meskin, better known as @nurse.tori_ on insta. As a NICU nurse, blogger, and podcaster this is one of the most common questions I receive! Here, we answer a few frequently asked questions about starting out as a NICU RN, and provide tips for nurses looking to begin their career on a positive note :)  Frequently Asked Questions for Starting as a NICU RN Are there any special education requirements for working in the NICU? The short answer is “no”. You’ll need the same schooling to work in the NICU as you would any other nursing jo b — either an Associate’s Degree in Nursing (ADN) or a Bachelor’s of Science in Nursing (BSN). Most hospitals give priority to RN’s with a BSN or may require that you go back to get your BSN within a certain number of years of being hired.  I, as of 2024, completed my MSN Leadership through Capella University and highly recommend their specialized, flexible undergrad programs as well if you are looking to advance your degree in Leadership & Administration, Education, Informatics, or Care Coordination. What NICU Nurse Certifications Are There? Are these Required? Certifications are not required, but may help you gain a competitive edge against other job applicants. Being certified shows that you’ve worked as a NICU nurse for a number of years and have the knowledge and clinical experience necessary to provide safe patient care.  There are two main certification pathways you can take: the RNC-NIC  route, or the CCRN   route. Types of NICU Nurse Certifications: RNC-NIC C-ELBW C-NNIC CCRN-Neonatal  If you’re interested in learning more abou t NICU nurse certification, be sure to check out our blog on how to earn a nursing certification! HOT TIP!!! To stay organized I suggest that you create a photo album or NOTES iphone page named “Nursing Compliance” or “Certifications / CEUs” in your phone with screenshots of each certification you have completed in order to best keep track of them! Do NICU Nurses Only Work in Hospital Settings? Most neonatal intensive care units are located in pediatric or women’s health hospitals, so NICU nursing occurs mostly in these acute care settings. However, NICU nurses can  work in a variety of settings, including: Community health organizations Emergency medical evacuation and transport services  Birthing centers What Types of Things Would I Be Seeing and Doing at Work? There are four NICU acuity levels: Level I to Level IV. The most basi c Level I NICUs provide basic resuscitation on premature but otherwise healthy infants, whereas the most acute Level IV NICUs provide complex treatments for critically ill newborns.  The skills you’ll be expected to have will be different depending on the type of facility you work in. Here are some of the tasks  that you could be asked to perform: Starting IV lines Collecting vitals Documenting assessment findings Feeding infants  Completing diaper changes and documenting output volume Administering medications Collecting lab specimen  Performing genetic screening tests Managing airways and ventilators Assisting during emergencies Attending high-risk births Educating family members Providing lactation assistance to new mothers When I arrive at my level IV NICU I am met with my assignment, gather my report sheets and learn from the shift nurse before me which meds to give, labs to gather and tasks to perform. I do my safety checks, introduce myself to parents when applicable and then start hands-on care. During an average 12 hour shift you will focus on 1 to 4 patients (this largely depends on your STATE and hospital ratios) depending on staffing and their acuity. Your role varies from day to day but overall as the NICU nurse, you perform assessments, monitor / record vital signs, draw labs, administer medications, admit & discharge, pre-op and post op surgical care, assist with procedures, assist with diagnostic imaging, monitor your patient for any sudden changes, prepare feedings, change out IV fluids, perform blood draws, educate family members, and ultimately be your tiny patient’s advocate! Not to mention charting, uhhhhh (my least favorite part, but one of the most important). What Types of Clinicians Provide Care in the NICU? Like in any unit or facility, nurses in the NICU don’t work independently. You’ll work with a strong multidisciplinary team of: Doctors (called neonatologists) Nurse practitioners (called NNPs) Respiratory therapists Dieticians Physical and occupational therapists Social workers Secretaries Music therapists Translators TIP:  Make friends with other clinicians in your unit — not JUST the nurses. Your shifts will go so much smoother if you are working with clinicians you know and trust. Mistakes happen when groups work in “silos” and don’t openly plan or communicate, so be sure to put yourself out there when you’re new to a unit! What Will My Orientation Look Like? If you’re a new graduate nurse, you’ll probably be looking to join a NICU nurse residency program. These programs often involve lengthy orientations in classroom and clinical settings, and can be a great way to ease your way into your first nursing job .  If you are an experienced NICU nurse switching hospitals, your orientation may be a bit quicker, as you’ll be expected to know the basics already and will be focusing more on getting familiar with facility-specific rules and procedures.  Most orientations will include any or all of the following elements: NICU RN Orientation Checklist: Human resources paperwork (dress code policy, email log-in details, ID badge photos, payment details, etc.) Unit orientation (safety equipment, medication room, patient care area, nursing station, etc.) Explain documentation standards  Review shift workflow (RN to RN report, safety checks, physical assessments, medication administration, bathtimes, visiting hours, etc.) Precepted orientation (can be anywhere between 4 weeks and 6 months long, depending on the acuity of the unit and the nurse’s clinical experience) NICU RN ORIENTATION GOALS Here are a few things you can think about during your orientation periods! Identify 3 goals you would like to accomplish on your shift. Identify 3 ways you took responsibility today. Identify if your goals were met and how you accomplished them! What types of patients were you assigned? What skills/competencies did you learn? What are your goals on your next shift? Feedback from your preceptor. What did you do right? Where can you improve? Do You Recommend Any Resources to Help Me Prepare? NCUity Academy's NICU Nurse Masterclass So much of what you need to know about working in the NICU will be learned on the unit! If you really want to prepare, I recommend the following review courses and books! Review Courses Books NICU Essentials Masterclass Merenstein and Gardner’s Handbook of Neonatal Intensive Care NICU New Grad Miniclass Neonatal Certification Review for the CCRN and RNC High-Risk Examinations New to the NICU: Experienced Nurse Essentials NICUity’s Respiratory Therapy E-Book ♡EXTRA TIPS♡ MEDICATION ADMINISTRATION EXPECTATIONS This one of the most important parts of our job as nurses. Medication administration and something we should not take lightly. (Especially in our NICU patient population where every decimal / ml counts. First things first, don't freak out. This will become second nature to you the more you are in NICU practice. It is nerving at first, but the weight-based medication administration gets easier with time. HINT: ALWAYS KNOW THE WEIGHT OF YOUR BABY! You will get to a point where you can literally eyeball an order and think to yourself, "Yep, that's on point, OR NOPE!! Wayyy too much (Resident who is writing orders for the first time!)." You are the last line of defense, so when in doubt, CLARIFY or ASK THE QUESTION. Refer to your Safe Medication Administration Policies, but here are some general ideas. NICU MEDICATION TIPS TO CONSIDER 1. Look up every medication! 2. You should know the following before administering safe dose ranges why are you giving the medication? how fast to run the medication (IV route) 3. Take Medication bedside. With EMR and manual conduct review Medication Rights right patient - check ID band right medication right time right route right reason right dose right documentation 3. Barcode scan (and or second nurse verification) administer safely once all checks have been thoroughly completed 4. Ensure proper documentation GET TO KNOW YOUR TEAM! This is KEY! And something we don't talk about nearly enough. NICU care takes a village and the faster you get to know your team, the easier it will be for you to provide tip top care to your patients! 1. Neonatologists 2. Fellow NICU Nurses 3. NP / PA Advance Practice Providers 4. RTs!!!! THESE ARE YOUR BEST FRIENDS; GET TO KNOW THEM WELL! 5. Nutritionists / Registered Dietitians 6. Developmental Specialists (OT/PT, SLP) 7. Social Workers 8. Secretaries 9. Lactation Specialists 10. Translation Services The list goes on...but you get the idea! Get to know your resources and team members. As with anything, gaining confidence and skill in practice takes time. Don't be too hard on yourself. It took me several years to feel comfortable working as a NICU nurse, and even after 10+ years, these babies can throw me for a loop! I hope this blog was helpful for you! Every unit and hospital offers different orientations and cultures in terms of NICU nurse care. Be fearless and humble. Take the good with the bad. If you make a mistake, own it and learn from it! We are human, and we have all been there! Love you guys! Let me know what you thought about this blog below! I love your feedback and always try to give you nurse life on the pulse. If you are looking for a great listen, here is "Life of a NICU Nurse," where I break down my experiences as a NICU nurse over the past 8 years. It's a fun one full of the real real on being a NICU nurse! Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

The neonatal intensive care unit, often abbreviated “NICU”, is an acute care hospital unit that provides comprehensive care  to newborns. A multidisciplinary team of doctors, nurse practitioners, nurses, and respiratory therapists work together to ensure positive outcomes for the infants in their care.  If you’re a nursing student or are a current RN looking to switch jobs , you may be wondering — What does a NICU nurse do, and what steps do I need to take to become a NICU RN? In this post, we provide an overview of the role, list key job duties of NICU nurses, and review the requirements necessary to get a job in the NICU.  What Is A NICU Nurse? Newborns are vulnerable and sensitive to their new environment outside of the womb, no matter how healthy they are. These infants may require attention from specialized nurses who have the training, skills & expertise to improve their outcomes and help them live safely at home. Typically, this infant care is provided in a hospital by labor & delivery nurses (nurses who help during birth) and postpartum nurses (nurses who care for the baby and mother after birth). However, some babies end up requiring additional care. Whether they’re born prematurely, experience birth trauma, are born with genetic diseases or become sick during the first few days of life, up to 10% of all hospital-born babies  end up requiring care in a neonatal intensive care unit (NICU). This is where NICU nurses come in!  A NICU nurse is a provider who specializes in the care of neonates  — the hospital term used to describe newborn babies. They provide comprehensive, 24/7 care and help the babies get to a place where their caregivers can take them home safely. Some NICU units provide newborn surgical care, while others may administer multiple IV medications and nutrition sources to help the infant grow and develop.  What Do the Different NICU Acuity Levels Mean? Not all NICU units provide the same degree of care. In the US, hospitals use a 4 level system  (with level I being the least acute, and level IV being the most advanced) to describe the complexity of their treatments and interventions. We outline these levels below: LEVEL I  - Also known as well-newborn nurseries, these units provide a basic level of newborn care to infants at low risk. They have the capabilities to perform neonatal resuscitation at every delivery and to evaluate and provide routine postnatal care of healthy newborn infants. In addition, they stabilize and care for near-term infants (35–37 weeks' gestation) who are stable and can stabilize newborn infants who are less than 35 weeks gestation until they can be transferred to a facility that’s able to provide specialized care. LEVEL II - These special care nurseries treat infants who are moderately ill with conditions that are expected to resolve in days to weeks. These patients are at moderate risk of serious complications related to immaturity, illness, and/or their management. In general, care in this setting should be limited to newborn infants who are more than 32 weeks gestational age and weigh more than 1500 g at birth or who are recovering from serious illness that has already been treated in a level III (subspecialty) NICU. Level II units are differentiated into 2 categories, IIA and IIB, on the basis of their ability to provide assisted ventilation. LEVEL IIA -  These units do NOT have the capabilities to provide assisted ventilation except on an interim basis until the infant can be transferred to a higher-level facility.  LEVEL IIB -  These units CAN provide mechanical ventilation for brief durations (less than 24 hours) or can provide continuous positive airway pressure (CPAP). They must have the equipment (eg, portable chest radiograph, blood gas laboratory) and personnel (physicians, specialized nurses, respiratory therapists, radiology technicians, and laboratory technicians) available 24/7 to provide ongoing care and to address emergencies. LEVEL III - These NICU units are defined by having continuously available personnel and equipment to provide life support for as long as needed. Level III NICUs are differentiated by their ability to provide care to newborn infants with differing degrees of complexity and risk. Newborn infants with birth weight of more than 1000 g and gestational age of more than 28 weeks can be cared for in level III NICUs. These facilities have the capability to provide conventional mechanical ventilation for as long as needed but do not use more advanced respiratory support such as high-frequency ventilation. Other capabilities that may be available are minor surgical procedures such as central venous catheter placement or inguinal hernia repair. LEVEL IV REGIONAL NICU - These are the most advanced NICUs, most of which are located in children’s hospitals or academic medical centers. These units perform complex procedures like ECMO catheterization and surgical repair of serious congenital cardiac malformations. These units staff a full range of health care providers, including pediatric subspecialists and specialized nurses. They also employ state-of-the-art equipment to care for their babies.  Concentrating the care of infants with conditions that occur infrequently and require the highest level of intensive care allows these centers to develop the expertise needed to achieve optimal outcomes and avoids costly duplication of services in multiple institutions within close proximity. What are the Most Common NICU Nurse Job Duties? Each NICU will provide different treatments and interventions according to their acuity level. Despite the uniqueness of every unit, this list compiles some of the most frequently performed NICU RN job duties: NICU Nurse Job Duties: ♡ Perform thorough physical assessments ♡ Collect and document infant vital signs ♡ Assist with diagnostic imaging (CXR, ECHO, MRI, etc.) ♡Initiate IVs ♡ Complete lab draws  ♡ Assist during bedside procedures (intubations, extubations, bronchoscopies, central line placements, etc.) ♡ Manage central line care (sterile line changes, tube & cap changes, dressing changes, etc) ♡ Place feeding tubes (nasogastric and orogastric)  ♡ Prepare infants for surgery ♡ Provide post-op care after surgery ♡ Tend to surgical sites (tracheostomy, ostomy, chest tube, incisions, etc) ♡ Administer medications (IV, IM, oral, rectal, buccal, etc) ♡ Collaborate with the multidisciplinary team to establish a plan of care ♡ Communicate changes in baby’s status in a timely and efficient manner ♡ Feed babies ♡ Bath babies ♡ Recommend support services (PT, OT, lactation consultant, etc.) when necessary ♡ Provide mothers with breastfeeding and pumping support ♡ Encourage patient and family centered care ♡ Educate and train parents on infant safety and newborn care guidelines ♡ Connect & provide resources for families looking for additional support ♡ Participate in NICU nursing research, evidence-based practice initiatives & quality improvement projects ♡ Precept new nurses ♡ Participate in hospital-wide collaborative teams and leadership groups Each NICU department is different, providing its own level of care to the patients needing treatment. This makes pursuing a career in the specialty fresh, fun, and exciting. The NICU nurse job market can be competitive, but there are a few things you can do to make yourself a competitive candidate . Let’s start by answering a few frequently asked questions.  What Degree Do You Need To Become a NICU Nurse? The minimum degree you’ll need to practice nursing in the United States is an associates degree in nursing (ADN). However, many facilities — including academic medical centers and large community hospitals — prefer or require a bachelors of science in nursing (BSN). If you’re looking to earn a spot in a competitive new graduate program , pursuing the BSN route will be your best option.  How Do You Get a Nursing License? To get an RN license in the United States, you’ll need to graduate from an accredited nursing program, pass the NCLEX examination, and apply for a nursing license in the state you’re looking to work in. Bear in mind that some states have unique requirements for state licensure, like specific academic coursework or safety training.  Are there Any Certifications Required to Become a NICU Nurse? The short answer is – no. Like most other nursing specialties, you’re qualified to work in the NICU as soon as you graduate nursing school and pass the NCLEX. Some facilities hire new graduates  without previous experience! However, once you have experience working at the bedside, earning a certification will certainly make you a more competitive and hireable candidate. Some hospitals will even pay you a shift differential or monthly bonus for holding a specialty certification. The two most common NICU nursing certifications are the RNC-NIC  and the CCRN (neonatal) . You’ll be qualified to sit for each of these certification exams after getting a few years of experience in the field.  Take the First Step In Pursuing the Career of Your Dreams If you’re a nursing student or recent graduate looking to start in the NICU, you have an exciting journey ahead! At NICUity, we’ve got you covered with a full array of NICU nurse educational materials  to prepare you for the role and nursing merchandise   to help you look the part! Visit us at www.nicuity.com   to see all we have to offer — we can’t wait for you to begin! Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

Access to Exclusive Nurse content, blogs, websites, resources, etc. All educational material to help you in your nurse journey! Welcome to MY PREMIUM NURSE CONTENT This is my EXCLUSIVE blog content curated to help you in your Nurse journey! From NICU Nurse career resources, to Nurse Interview Tricks, Portfolio curation, New Grad Nurse Tips, & everything in between, I have compiled all of my BEST content here for you to help land that dream job! ♡ ♡ ♡ ♡ ♡ ♡ ♡ ♡ ♡ ♡ ♡ I truly hope these provide invaluable insight, education, and resources to help you in your Nurse Journey! premium NICU Nurse Content Below Hot Tips for Nurses Starting in the NICU! Whether you have landed your job in the NICU, are a new grad or an experienced nurse, thinking about applying to nursing school, in the EXCLUSIVE NURSE CONTENT 55 Tips for New Grad Nurses So, you are a new NICU Nurse! Congrats & welcome the “The Real” Nursing NICU World. Bedside Nursing can be different! Here are a few tips! EXCLUSIVE NURSE CONTENT How to Land Your Dream Job as a NICU Nurse: 14 Hot Tips Want to become a NICU nurse but having a tough time navigating the job market? These 14 tips can help you kickstart a successful career. EXCLUSIVE NURSE CONTENT NICU Resources and CEUs Every Nurse Needs to Know About Finding trustworthy educational materials can be tough for NICU professionals. Here, we’ve compiled a list of the top resources and courses. EXCLUSIVE NURSE CONTENT 12 NURSE INTERVIEW TIPS & TRICKS! After spending much time applying for jobs I have certainly had my fill of Nurse Interviews. Here are some Interview Tips and Tricks! EXCLUSIVE NURSE CONTENT NICU Nurse 101: What Do NICU Nurse Shifts Look Like? Curious what a normal NICU shift looks like? We’ll review the typical workflow and show examples of the kinds of patients you’ll care for. EXCLUSIVE NURSE CONTENT Nurse Portfolio 101 The job application process can be daunting. Trying to find the job, apply to the job, create that portfolio, interview, and try to land the EXCLUSIVE NURSE CONTENT Tori Meskin has been a dedicated clinician since 2012, working in acute care and inpatient NICU settings in Southern California. She holds a National NICU Nurse Certification (RNC-NIC) and has extensive experience as a travel NICU nurse. Tori is a sponsored MSN student at Capella University and a Brave Beginnings Ambassador. She recently launched NICUity, a company dedicated to empowering NICU professionals with education, bedside tools, and resources. Follow her journey as she navigates the NICU world, married life, and new motherhood, all while juggling work, school, and content creation. Discover her top-notch tips and tricks at www.tipsfromtori.com or contact her at tipsfromtorimanagement@gmail.com . GET THE TIPS INFO@TIPSFROMTORI.COM I 4733 Torrance Blvd #868 Torrance CA 90503 SIGN ME UP ♡ THANK YOU FOR SUBSCRIBING ♡

Nurse Tori I NICU Nurse I Tips from Tori Nurse Blog My Professional Life as A Nurse ♡♡♡♡♡♡♡♡♡♡ Welcome to the most special corner of my website. For over 10+ years now I have been working bedside in the secret gem of a unit called the "Neonatal Intensive Care Unit." (NICU). After 4 years of collecting memories, experiences, & developing my career, I finally mustered up the courage to start this blog. scroll so you want to become a nicu nurse Becoming a nurse can be stressful — you’ll get different suggestions and opinions from professors, mentors, friends, and family members. All who believe that their way is the only way to success. The truth is that there isn’t one “best” way to get into NICU nursing. We all take different paths that best suit our personal needs, but like other parts of life, there are so many ways to get to a position where we feel fulfilled and successful. Here, I answer an array of the most frequently asked questions about becoming a NICU nurse and outline a few of the most common journeys coworkers and friends have taken to get to where they are in their career today. I outline some of the challenges you may face and provide tips I’ve learned along the way to help you become the strongest and happiest nurse you can be. scroll How do I Become A NICU Nurse? This is by far my most asked question. And a very loaded question at that! There are so many ways to become a NICU nurse and I have so many TIPS to offer you. Topics including: How to become a NICU Nurse Interview & Portfolio Tips & Tricks Resources/Websites for hopeful & current NICU Nurses What is it REALLY like to be a NICU nurse? I have created YOU Exclusive NICU Nurse Content & Resources. All of my best modern-day nurse insight & experiences, a collection of Level IV NICU education, curated blogs, with100+ hours of diligent research, podcast interviews, and more. scroll Nurse BloG Your Exclusive Nurse Tori Content I am stoked to bring you this content! These are my PREMIUM posts curated to help you in your Nurse journey! I have compiled all of my BEST content here for you!! TAKE ME THERE ! Widget Didn’t Load Check your internet and refresh this page. If that doesn’t work, contact us. Mommy Labor Nurse EP132: NICU Tips from NICU Nurse Tori Click here to tune in! Listen Here Happy Birthway Podcast Peak into the NICU Click here to tune in! Listen Here CLOCKED OUT PODCAST Failing foward with Nurse Tori Click here to tune in! Listen Here The Birth Trauma Mama Ep. 182. Trauma-Informed Care in the NICU Click here to tune in! Listen Here the angels you did not ask for (a poem by Nurse Tori) 12 Example Nurse Interview Questions Common NICU Terms A-Z 5 Reasons to Become a Nurse In Tucson What Does a Neonatal Nurse Practitioner (NNP) Do? All You Need to Know All You Need to Know About NICU Nurse Certification What Does a NICU Nurse Do? A Career Guide Hot Tips for Nurses Starting in the NICU! 55 Tips for New Grad Nurses How to Land Your Dream Job as a NICU Nurse: 14 Hot Tips NICU Resources and CEUs Every Nurse Needs to Know About 12 NURSE INTERVIEW TIPS & TRICKS! NICU Nurse 101: What Do NICU Nurse Shifts Look Like? NICU Nurse Continuing Education Baby Basics Blog NICU Research Ideas & Topics to Consider Best NICU Nurse Apps!! NICU HOLY GRAIL OF PODCAST EPISODES 1 2

Nurse blog. NICU nurse. Nurse podcast. Best new podcast! Real nurse story. TOP 30 in Medical Podcasts. Tips from Tori & The Cellfie Show Podcast. From her nursing journey, nurse grad school journey, travel nursing, NICU nurse 101, beauty, health & fitness & living a spicy lifestyle. Hey There! I'm Tori Meskin MSN RNC-NIC Nurse. Blogger. Content Creator. Welcome To Tips From Tori. My zesty blog With an informative & trendy side of the medical field. Welcome Hey friend 👋🏼 I started this blog to share the real side of nurse life, both the wins and the wild moments. Over time, it’s grown into something so much more. From bedside shifts to brand collabs with major names in healthcare, this space is all about keeping it real, helpful, and a little bit fun. Read More Glad you're here My mission? Still simple: to help nurses (new and seasoned) feel confident, empowered, and supported. You’ll find top-tier NICU content, nurse life tips, career resources, beauty + lifestyle inspo, and plenty of behind-the-scenes realness. Welcome to Tips From Tori—we’re so glad you’re here 💉💅🏼 1 2 3 4 5 PREMIUM NURSE CONTENT EXCLUSIVE ACCESS to CAREER TOOLS & RESOURCES. THE COMPLETE NURSE INTERVIEW GUIDE. NICU NURSE INSIGHTS & MORE. complete with all of my HOT tips & tricks to land your dream job. TAKE ME THERE