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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 BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com  or info@tipsfromtori.com

If you’re a NICU nurse, you’ve probably heard your coworkers discussing the benefits of certification. Although certification can be great for nurses and facilities, it can be challenging to find accurate and reliable information on how to begin the certification journey.  Here, we provide an in-depth overview of NICU nurse certification, list the ways that becoming certified can boost your professional portfolio  (and your paycheck!), and provide next steps for RNs looking to become certified and take the next step in their nursing career.  What Is a Certified Nurse? A certified nurse is an RN who has gone on to earn an additional specialty certificate in their area of practice. This certification is achieved after completing nursing school, becoming licensed, and working as a nurse for a few years in your specialty.  Being certified means you've taken extra "training" and have studied and passed a specialty exam. This looks good to employers because neither nursing schools or the NCLEX go into detail on these specialty nurse duties and roles. What Is the Difference Between a Certified Nurse and Registered Nurse? Being a registered nurse means that an individual is a licensed nurse who has completed nursing school and has passed the NCLEX. A certified nurse, like stated above, has earned a specialty certification above and beyond  the normal nursing license criteria. Being certified in an area or specialty isn’t usually mandatory to qualify for a nursing job, but it can help you stand out among applicants  and can even help you earn a bit more money when negotiating your salary! What Kinds of NICU Nurse Certifications are There? In the NICU world, there are two main certification pathways you can take — the RNC-NIC and CCRN-Neonatal certifications. After becoming an RNC-NIC, you can further your certification journey by pursuing a sub-specialty certification: Care of the Extremely Low Birthweight Neonate (C-ELBW) and Neonatal Neuro-Intensive Care (C-NNIC) Types of NICU Nurse Certifications: ♡RNC-NIC ♡C-ELBW ♡C-NNIC ♡CCRN-Neonatal You may be wondering — which NICU certification should I pursue? Both NICU RN certification routes are good options. Some hospitals provide extra pay for one or the other, so be sure to check this out before choosing which route to take.  Becoming a Certified Nurse: 3 Key Steps to Get Started Now that you’re familiar with the NICU RN certification types, you’re probably curious about the certification processes and timelines. Below, we outline three tips to help you get started.   1. Make sure you meet clinical practice requirements We’ve listed current requirements for each certification below, but be sure to check each organization’s website prior to beginning your certification journey to ensure no recent changes have been made.  RNC a. Current licensure as an RN in the U.S. or Canada. b. 24 months of specialty experience as a U.S. or Canadian RN comprised of a minimum of 2000 hours (this must have occurred sometime in your career). This specialty experience can be comprised of direct patient care, education, administration or research. Both practice time and hours must be met. This is not an either/or criterion. c. Employment in the specialty sometime in the last 24 months. Certified-Care of the Extremely Low Birth Weight Neonate (C-ELBW) Current licensure in the U.S. or Canada as a physician, registered nurse, advanced practice registered nurse (NNP, CNS), neonatal therapist (PT, OT, SLP), neonatal dietitian, pharm-D, respiratory therapist or paramedic.  No practice experience is required (minimum of one year of experience recommended)  Once you pass the Care of the Extremely Low Birth Weight Neonatal certification examination, you’ll be able to use the credential C-ELBW. Certified-Neonatal Neuro-Intensive Care (C-NNIC) Current licensure in the U.S. or Canada as a physician, registered nurse, advanced practice registered nurse, or respiratory therapist.The license number, licensing state or province and expiration date will need to be recorded. You will need to upload verification of current licensure.  No practice experience is required (minimum of one year of experience recommended)  Once you pass the Neonatal Neuro-Intensive Care certification examination, you’ll be able to use the credential C-NNIC CCRN-Neonatal a. A current, unencumbered U.S. RN or APRN license is required. b. There are two options for clinical experience and practice hours: Two-Year Option: Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill neonatal patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application 5-Year Option:  Practice as an RN or APRN during the previous five years with a minimum of 2,000 hours in direct care of acutely/critically ill neonatal patients, with 144 of those hours accrued in the most recent year preceding application. 2. Sign Up for a Certification Review Course There are tons of NICU nurse certification review classes out there. Some are hosted in-person, while others are conducted online. While these courses aren’t necessary to pass the exam, they definitely help you get familiar with all of the tested concepts. I think this RNC-NIC Review Course  & Amanda's RNC-NIC Success are two of the best out there! Make sure to use code: NICUITY for 15% off Amanda's course. 3. Register For Your Exam and Begin Studying Independently Once you’ve met all of the clinical requirements, finished your review course, and feel prepared to sit for the test, it’s time to register for your certification examination. You can take this exam at a variety of testing centers, which are located all over the country in convenient areas.  Looking for additional ways to prepare for your nursing certification exam? It’s important to continue studying up until the day of your exam! If you’re looking for additional nursing certification study resources, check out our NICUity Academy courses  and resource materials ! These can help you prepare for certification and can also be an excellent reference material for practicing at the bedside. Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com  or info@tipsfromtori.com

In the post-covid era, becoming a NICU nurse can be challenging. If you’re just starting out on your nursing journey, it can be daunting to know exactly where to begin. NICU nursing is an incredibly unique specialty, and many career guidance sites just don’t have the insight or understanding to help those just starting out. Here, I’ve collaborated with top NICU nurses in the industry to develop 14 clear and effective tips to help you get started on the right foot. Whether you’re a nursing student looking for your first RN job or are experienced in the field, these tips can help you get an interview  for your dream job. Let’s dive right in! Hi! My name is Tori Meskin BSN RNC-NIC. I have been a bedside NICU nurse for 9 years. Prior to writing this blog, I did A LOT of research. I have worked in Level III-IV NICUs in Children's hospitals, University hospitals, community settings etc. I have also been a staff, and travel nurse; working days & nights, full-time & per diem positions within the NICU. And I love being a NICU nurse. How to Become a NICU Nurse: 14 Tips Every NICU manager has their own unique preferences for the nurses that they’re looking to hire. Trying to cater your portfolio to meet the expectations of each job can be stressful and time consuming, and if it’s not done efficiently, it can be disappointing and disheartening if you don’t end up getting the job. To avoid any unnecessary stress, we’ve compiled a list of strategies that can help you land any NICU nursing job, whether it’s a new graduate position  or experienced hire role. These tips should empower you with the knowledge and skills to land that interview you’ve been hoping for! 14 NICU NURSE JOB HOT Tips! 1. Spend Time in the NICU Before Applying as an RN Getting familiar with the NICU environment should be the first priority of anyone looking to get a NICU nurse job. This can be done a few different ways: As A Volunteer:  Many NICU units advertise volunteer opportunities, like “baby cuddler” or “family greeter”. Whether you’re an experienced RN or are new to the field, becoming a volunteer in a unit you’d like to work in can show a manager that you’re passionate about the NICU population and are willing to take the time and effort it requires to get comfortable on the unit.  This is also a great way for you to get a feel for the staff, and for them to grow to love you! When a job opportunity comes up and your application is the first one in, you’ll be fresh in their minds and an obvious first choice.  As An Unlicensed Assistant:  If you’re still in nursing school but know starting out in the NICU is what you’d like to do, getting a job as a patient care tech, secretary, or unlicensed aide would show employers that you’re driven and motivated. It would also put you in the hospital’s employment record earlier, which could elevate your pay and streamline the process of transitioning into an RN position. As A Shadowing RN:  Some hospitals offer shadow opportunities for nurses interested in working in a specific unit. Sometimes these are offered to students, and other times they may be limited to nurses already working in another unit of the hospital. It never hurts to send the hiring manager an email, expressing your interest in seeing the unit! The worst that can happen is that they say “no” — even then, your name is still on their radar, and they know you’re really interested in a job! 2. Find a NICU Nurse Mentor : Mentorship is one of the most underrated career building tools out there! If you’re looking to work in the NICU, finding a mentor that you can trust and ask questions to can be especially helpful when navigating the NICU world. Look for someone who serves as a role model for learning, critical thinking, and evidence-based practice, and helps you ask questions and reflect. If you’re a nursing student, your university may have a mentorship program already in place that you could ask to join. If not, don’t hesitate to ask a clinical instructor or preceptor if they would be willing to mentor you — chances are, they’d be ecstatic and honored to guide you through the journey! Just be sure to repay the favor to a younger nursing student once you’re an experienced and confident NICU nurse yourself :) 3. Enroll in NICU Continuing Education Courses : A surefire way to impress a hiring manager is to mention any NICU-specific CE courses you’ve taken to prepare you for the role. It not only proves your serious interest in the field, but also helps  prepare you for clinical challenges ahead. If you’re still in nursing school, consider taking electives that could help boost your portfolio, like a genetics course or child development class. 4. Join Professional Nursing Organizations : Becoming a member of a professional NICU nurse organization like AWHONN  or NANN  is not only a great way to get involved with other members of the NICU community, but it’s also a great resume booster. As a member of these organizations, you can stay up-to-date on the latest NICU nursing research, get involved with community activism, and meet other NICU nursing professionals who want to make a difference. 5. Spruce Up Your LinkedIn : Healthcare isn’t necessarily one of those industries where keeping a thorough and active LinkedIn profile is required  to land a job. However, it could increase your chances of becoming a top contender if your profile showcases some of your marketable strengths  and lists commendations received from professors, managers, and coworkers.  It’s becoming more common for healthcare recruiters to browse LinkedIn when searching for job candidates — you never know, you might stand out to a NICU manager in your area. Again, it doesn’t hurt to put in a little extra effort here! 6. Get Certified : The most common NICU certifications are the RNC-NIC  and the CCRN (neonatal) . These certifications require a certain amount of clinical experience and time on the job — meaning that those that have earned the certification are confident, competent, and motivated to learn.  Managers LOVE hiring certified nurses, and some facilities may even give you additional income if you come in as a certified NICU nurse. Earning a NICU nurse certification is only possible for experienced nurses who have spent time working as an RN. However, if you’re a new nurse or are a student who’s interested in becoming certified, you should definitely mention in your interview that you’re looking to pursue this route. It shows that you’ve prepared, know the steps ahead, and are motivated to become a nursing leader on your unit! 7. Take On Leadership Roles Showing that you’re a team player and leader will put you miles ahead of other candidates. If you’re already working as an RN, consider taking on a unit-based charge nurse, team leader, or EBP coordinator position. If you’re still a student, consider joining your nursing student association or spearheading your class’s social council. No leadership role is too small or insignificant — don’t be afraid to talk yourself up! Hiring managers love go-getters. 8. Stay Current On NICU World Happenings : This may seem unnecessary, but familiarizing yourself with NICU-related news, legal changes, and care guideline updates can help you stand out. Whether it’s during a shadow day or during an interview, you never know what may come up in conversation — being prepared and in-the-know can show that you’re on your A-Game! Our nursing newsletter  is chock full of resources  that can keep you in the loop. 9. Keep an Organized List of Job Application Information : For new graduates and experienced nurses alike, navigating the job market can be difficult if you don’t stay organized. When you’ve got multiple jobs you’re looking to apply for, I always find keeping a detailed spreadsheet of application deadlines, manager contacts, and interview dates to be helpful. That way, you’ll be able to prioritize applications that are due earlier and can easily find information you may need for each unit or facility. 10. Build Your NICU Network : The more involved you get with the NICU community , the better chance you have of getting that job! Attending nursing conferences and community health events can help you enmesh yourself in a network of NICU professionals. You never know who you’ll meet out and about — it’s always the casual conversations that turn into something more exciting :) 11. Optimize Your Resume Content and Layout: Here, we’re taking the job hunt back to basics. As you prepare for the application process, it’s the perfect time to ensure your resume is updated and accurate. Be sure to keep the document to one page, with a font that’s at least size 11 and easy to read. List any credentials or certifications you may have, the degree you’ve earned, relevant career experience, and any professional organization involvement you may take part in. If you have room, listing relevant volunteer experience can also help your portfolio stand out . If you need a bit more help, we’ve got some incredible resume templates and guidance for you — check them out here !   Resume Cover Letter References NICU Nurse Masterclass Certifications (printed) Registered Nurse License Volunteer Experiences Target your entire application to what they want! HOT TIP – The job posting will usually tell you what they require/recommend . Their website will provide other keywords and phrases you can use that resonate  with you. WRITE OR EMAIL A THANK YOU TO THE INTERVIEWER AND MANAGER! 12. Craft a Well-Written Cover Letter “Template” : A well-crafted cover letter has always been my secret to landing a job. This letter should be tailored to each job you’re applying for — however, this doesn’t mean you have to reinvent the wheel every time!  I’ve created a cover letter “template” that I use for every job application. I use that template and plug in facility specific details like: The manager’s name, address, and contact information The role title  The ways I embody the facility’s unique mission, vision, and values Any connection I have to that particular position (mentor on the unit, student at their affiliated university, previous shadow experience, etc.) Be sure to highlight the ways you behold important NICU nurse traits like compassion, critical thinking, effective communication, and attention to detail.  13. Prepare For Interviews Ahead of Time : While it might seem like you’re counting your eggs before they hatch, it can be smart to get ready for the interview stage  as soon as you start applying for jobs. It’s surely going to be a busy time for you, and you don’t want to be scrambling at the last minute to get things in order. You can prepare by: Acquiring a fun and professional “interview outfit” . First impressions are everything. I am a firm believer in looking sharp and showing that you’re ready to take on anything. Power suits are my jam! I invested in a tailored navy blue suit, which has been my go-to for all of my interviews since. If you’re expected to wear scrubs or other clinical attire, here are some professional options  that may work well for you.  Drafting answers to commonly asked interview questions.  While each interviewer is unique, there are some interview questions you’ll surely be asked. Knowing how to professionally respond to questions like “Tell me a bit about yourself?” and “Why are you interested in the NICU?” can help take some of the fear and anxiety out of the whole process.  Doing a bit of research on the unit.  What acuity level is the NICU you’re looking to work in, and what patient population do they serve? What are the mission, vision, and values of the facility? Has the unit been awarded any certifications or accolades? These are the things you can research (and mention in an interview) to show that you’ve done your homework and are prepared for the role. 14. Don’t Be Afraid to Pivot: Despite putting your best foot forward, some hiring managers aren’t able to consider candidates that don’t have a minimum of 2+ years of experience. While I believe that there’s a place in the NICU for everyone regardless of experience, you may find it easier to get a job in a pediatric unit to build your skill set and transfer to a NICU role once you’ve gotten a few years of experience under your belt.  Taking a pediatric float pool job is another great way to introduce yourself to the NICU world — it may even allow you to take shifts in the NICU while you develop your clinical skills.  Don’t see this move as a failure, or a permanent derailment from what you REALLY want to do. I promise — it’s a step in the right direction, and will be a step in your career you definitely won’t regret down the line. Find More Resources to Boost Your Career Getting a job in the NICU can seem challenging, but with the right resources and guidance, you can make the process a lot less stressful. We’ve got you covered, with tons of job prep materials, educational classes, and bedside tools to help you succeed. Find more at https://www.nicuity.com/ . If you are seeking a more " in-depth conversation" head over to check out my podcast! Episodes #1 #2 and #10 are all great resources for you to hear more details about being a NICU Nurse, NNP, and the working dynamics of a level IV NICU! THE CELLFIE SHOW. CLICK HERE. Another great resource for you BELOW. I was featured on The Morning Rounds and talked all things NICU Nursing. Dynamics, my personal journey, NICU Nurse Tips & Tricks! NICU Nurse Essential Resources American Academy of Pediatrics Academy of Neonatal Nursing Childhood & Adult Immunization CDC Guidelines March of Dimes! Resources for parents & providers Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories National Association of Neonatal Nurses National Certification Corporation - NICU National certifications for experienced nurses NICU University & Peds University Vermont Oxford Network - 1,300 hospitals collaborating around the world! Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

All of the best NICU nurse resources. These are the best tips, tricks, websites, CEUs, certifications, organizations, etc. to help you transition and add to your NICU nurse career. After almost a decade of NICU nursing, I have a lot of resources up my sleeve...and I want to bring them here to you! Let's dive in... LET'S START AT THE BEGINNING If you’re a neonatal nurse, you know that staying up-to-date on the latest evidence and research is not only necessary to renew your license, but is also essential to practicing safely and effectively. Those that have been in the NICU field for a while know that finding reliable educational materials and CEU courses can sometimes be as stressful as providing infant care.  Embarking on my social media journey , I realized that the new generation of NICU nurses is still struggling to find the resources I needed when I was just starting out over 10 years ago. Don’t worry — we’ve done the research and have found the high-quality learning materials we know you need.   NICU Nurse Resources By Category ♡♡♡♡♡♡♡♡♡♡♡♡♡ Here, we review top NICU nurse resources, including continuing education courses, conferences, books, podcasts, websites, and professional nursing organizations. This list is comprehensive and offers hundreds of opportunities to find the accurate and trustworthy information you need! Let’s dive in.  CONTINUING EDUCATION COURSES: ♡ NICUity Academy Courses : Whether you enroll in our New Grad Miniclass, NICU Essentials Masterclass, or Experienced Nurse Crash Course, you’ll be learning from the best in the field while earning valuable CEUs. You can enroll in our comprehensive courses or if you prefer to read on your own time, you can stick to studying our electronic or hard copy materials. Either way, once you’re done, you’ll feel confident and prepared to face any work challenge! ♡ University MedEd : On this site, you’ll find short-form comprehensive medical education. As part of NICU University , Med On The Go is the new mobile-friendly platform delivering comprehensive pediatric nursing education in short videos. ♡ NCC Continuing Education : Here, you can find tons of CE courses in a number of NICU-related fields, including neonatology, women’s health, and obstetrics. You can also receive free CEUs in any core area for helping the NCC pretest questions for their certification exams! This is a super fun way to get involved with the NCC and make a difference in the lives of the next generation NICU nurses! ♡ Nurse.com Neonatal Continuing Education :  This site offers a variety of NICU CEUs and advertises courses like “Neonatal Life Support”, “Newborn Screening”, and “ELNEC Pediatric Curriculum”. For those who may be interested in other specialties as well, Nurse.com offers hundreds of contact hours for RNs, LPNs, and nurse practitioners in a variety of clinical settings.  ♡ NetCE Nationally Accredited Evidence-based CME :  NetCE offers nationally-accredited evidence-based CME/CEU/CE for a variety of healthcare professionals. For NICU specific education, we recommend their “Breastfeeding”, “Newborn Assessment”, and “Care of Families With Sick Newborns” courses.  ♡ Pediatrix Continuing Education : Here, you can find a variety of engaging courses and webinars, most of which are completely free! They also host live “Grand Rounds” webinars on the first Wednesday of every month from 1600-1700 ET! This is a great opportunity to network and learn with NICU providers from around the world.   ♡ Abbott Nutrition Health Institute : The mission of ANHI is to connect and empower individuals with science-based nutrition information to help improve health. They offer a variety of NICU-specific courses, reading materials, and training programs to help you better familiarize yourself with the most updated NICU nutrition research out there. NICU BOOKS : This list of hardcopy and e-book references is great for both new and experienced NICU nurses. Whether you like having the book with you at the bedside or prefer referencing information on your phone, there are plenty of books for you. You can find a more expansive list of my favorite clinical and career guidance books at my Amazon store .  ♡ The NICU Essentials Masterclass eBook : Our comprehensive 130 page e-book will provide you with all the necessary NICU knowledge from nursing school and resumes, to diagnosis and prematurity, to bedside skills, to cardiac defects, night shift tips, and much more! This e-book contains a mix of informational and interactive pages to guide you through your entire NICU journey. ♡ Merenstein & Gardner’s Handbook of Neonatal Intensive Care : This is a thorough clinical review tool that can help you understand the more complex clinical concepts surrounding NICU nursing.  ♡ Peds Congenital Heart Education : This organization’s Illustrated Field Guide to Congenital Heart Disease and Repair is one of my favorite NICU resources on the market. It contains great pictures and explanations for some of the most common congenital heart diseases seen in the NICU- I highly recommend! ♡ Fast Facts for the Neonatal Nurse: A Nursing Orientation and Care Guide in a Nutshell : This is a great bedside reference tool for new NICU nurses and NICU nurse preceptors. The book provides an overview of care guidelines for a variety of NICU patient populations. In addition to skills checkoff lists, it also contains a quick-guide to lab values and commonly used medications. CHECK OUT OUR COMPLETE NICU E-BOOK COLLECTION ♡♡♡♡♡♡♡♡♡♡♡♡♡ NICU CONFERENCES Looking to learn while growing your NICU network and community? Attending conferences is the perfect way to expand your knowledge, meet other NICU professionals, and travel to new parts of the world! Here are a few great conferences coming up: ♡ National Association of Neonatal Nurses : NAAN is hosting their 40th annual conference this year in Orlando, Florida! From September 18-20th 2024, you can attend workshops, seminars, and educational sessions, all of which are aimed to teach and inspire us NICU nurses!  ♡ American Academy of Pediatrics National Conference and Exhibition : From September 27-October 1st 2024, you can be one of over 10,000 pediatric health professionals to learn and grow at this conference held in Orlando, Florida. Listen to keynote speakers, network with other NICU nurses, and earn CEUs! ♡ National Neonatal Nurses Conference : Held September 4-7 in New Orleans, this conference is sure to be the perfect mix of learning and fun. Perinatal, NICU, and NICU NP professionals are all invited to attend.  NICU NURSE PODCASTS & BLOGS Academic materials are great, but sometimes you just want the cold, hard truth about NICU nursing and what it entails. Here, I’ve listed a few blogs and podcast episodes  for those that are looking to cut straight to the chase:  ♡ NICU Nurse 101 Blog: "What is NICU Nursing really like?" : This article should answer questions like “ What are the most common NICU diagnoses ?”, “What is a NICU nurse’s workflow?” and “What are the most important factors involved with infant assessment?”. If you’re looking to see whether NICU nursing is for you, I highly recommend checking this blog out.  ♡ Cellfie Podcast: Answering Your NICU Questions Roundtable with @thatnursetia : In this podcast episode, TikTok NICU RN Tia, a close friend of mine, gives her input on her favorite parts of NICU nursing, common NICU myths, and the biggest hurdles she’s faced on the job.  ♡ NICU Heroes Podcast by Hand To Hold : This podcast provides great bedside tips for NICU nurses, including how to best communicate with grieving parents, avoiding burnout, and guidance for supporting NICU dads. An extra perk is that listening to these episodes earn you CE hours! This is a great option for earning education hours on vacation or during your commute! NICU EDUCATIONAL WEBSITES Here, I’ve compiled a list of the top couple informational NICU websites that you can peruse or provide to families who are looking to learn more about NICU research , charity outreach, or community events: ♡ March of Dimes : The March of Dimes strives to close the health equity gap for all mothers and infants, through research, legislative action, and community education.  ♡ Nationwide Children’s NICU Resources : Nationwide houses an incredible reference section for NICU professionals and families. They provide an in-depth review of developmentally appropriate care, feeding guidelines, discharge planning resources, and more. PROFESSIONAL NICU NURSING ORGANIZATIONS Joining professional nursing organizations not only boosts your career portfolio, but can also help you network and learn more about cutting-edge devices, therapies, and treatments! By becoming a member of these groups and organizations, you’ll gain access to all the info you’ll need. Here are few of my favorites: ♡ National Association of Neonatal Nurses (NAAN) : NAAN is a professional nursing organization aimed at training and empowering NICU nurses across the United States. They provide 20 free online CEUs to members and allow access to their monthly newsletter and journal to read up on all the latest NICU news. You’ll also receive discounted rates on conferences and seminars — it’s a membership that’ll pay for itself and look good on your resume! ♡ Academy of Neonatal Nursing : Becoming a member of the ANN is a great way to network, learn, and grow as a NICU leader. Your membership fee provides discounts on conference attendance, certification review courses, and CEUs. ANN members looking to go back to school can even apply for one of their great scholarships! You should definitely check this one out.  ♡ The Association of Women’s Health, Obstetrics, and Neonatal Nursing (AWHONN) : AWHONN prioritizes advocacy, education, research, and professional development. Their website is chock full of webinars, journals, and online courses to help you practice at your best.  Looking to Stay Current On the Latest NICU Happenings? At NICUity, we’ve got you covered with the nursing resources, educational materials, and work essentials to help you perform your best. By subscribing to our free email newsletter , you’d be the first to hear about any hot NICU news or new merchandise drops! For more info on all we have to offer, feel free to check out our site ! ♡♡♡♡♡♡♡♡♡♡♡♡♡ If you are seeking a more "In Depth Conversation" head over to the Podcast! "The Cellfie Show." EPISODE #2 & EPISODE #9 REVEALS all things NICU Nurse 101! ♡♡♡♡♡♡♡♡♡♡♡♡♡ Another great resource for you BELOW. I was featured on The Morning Rounds and talked all things NICU Nursing. Dynamics, my personal journey, NICU Nurse Tips & Tricks! NICU Nurse Essential Resources NICU Essentials Masterclass NICU Badge Reference Cards NICU E-Books - Instant Download American Academy of Pediatrics Academy of Neonatal Nursing Childhood & Adult Immunization CDC Guidelines March of Dimes! Resources for parents & providers Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories National Association of Neonatal Nurses National Certification Corporation - NICU National certifications for experienced nurses NICU University & Peds University Vermont Oxford Network - 1,300 hospitals collaborating around the world! 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 . Instagram @nurse.tori_

So, you are a New Nurse! Congratulations & welcome to“The Real” Nursing World. Nursing school was a great foundation to teach you the importance of SAFETY, medical lingo, & help you pass NCLEX of course. But, there is a lot more to nursing than textbooks & lectures. Here are the best new grad nurse tips I practice & have compiled from my colleages! Bedside nursing can be different from your Nursing School experiences. Here is a list of TIPS I have compiled to help you transition into your nursing role. 1. Never be afraid to ask questions. Asking questions as a New Grad nurse can be intimidating. For the safety of your patients, ALWAYS ASK. You might be surprised if you ask the question and your seasoned Nurse learns something too! 2. Learn to admit your mistakes. We all make them. Don’t make a habit of covering up a mistake or trying to argue out of it. You colleagues will understand if you admit your mistake, and they will help you solve it. 3. Always clarify if you have doubts. Never hesitate to clarify a detail regarding your patient’s care if you are unsure about it. 4. Always safety check your bedside after report . (IV assessment, suction, oxygen, code sheet, ambu bag (or neo puff), IV fluid check etc.) 5. Know the SIZES of all Tubes & lines in your patient . The NICU is a small & delicate population of patients. Attention to detail is vital. Examples of things to know: Nasogastric Tubes, IV gauge, ETT Tube, UVC/UAC, Foley Catheter, etc) 6. Keep up with your charting. If you save it for later, there might not be enough time to complete it. (Staying over to chart is not fun). Remember that you cannot fully anticipate when you will be really busy. 7. Don’t be too hard on yourself. If you need to pee, don’t hold it as it will just take few minutes of your time. If you need to hydrate yourself, drink before continuing with your tasks. Most nurses delay the little things they need because they focus on finishing a task but in reality, if you are too hard on yourself the work you do can be affected. 8. Before calling a doctor, always think about & make a list of the things you need to mention. You can’t fully trust your memory when talking through a phone call especially when the doctor is always in a hurry. 9. Invest in your footwear. You will walk a lot in your entire nursing career so wear appropriate nursing shoes that are made for ultimate comfort and durability. Check out my favorite! Sanita Clogs ( Nurse Tori for 20% off your order. ) 10. Learn to be assertive. Learning your confidence takes time. Watch and learn from seasoned nurses on how they give report, ask questions, take phone calls etc. 11. Avoid being involved in workplace gossips. It will do nothing good to your career as a nurse. 12. Always look up your Medications. You are administering new medications you don’t know. Take the time to understand dosage, compatibility, reasons for treatment, side affects etc. 13. Read the Doctors Notes . Often times nurses forget to pass things along in report. Make a habit of reading through the Doctors notes and plan of care. You may find extra information you didn’t know. 14. Make your statement short and precise when calling a doctor in the middle of the night. These doctors are usually sleepy and you will need to relay your concern straight to the point so they can quickly understand you. 15. Extend a helping hand to your colleagues when they need it. You will soon realize how helpful it is to have caring co-workers. 16. When in DOUBT, take it OUT ! NICU IV’s only usually last 24-96 hours depending on the baby’s vasculature. If it looks puffy, red, a little swollen, difficult to flush, or blanches, take it out. 17. Don’t fully trust an IV pump or Equipment. Manually check the rate and volume (and concentrations) of the IV fluid during your rounds. 18. When drawing up new medications or narcotics, always ask an experienced RN to watch you. This will give you confidence and security that you have prepared the right medication. Also ask how they reconstitute and administer the medication. You can learn a thing or two! 19. Be careful with your charting. Remember that if it is not charted, it was NEVER done. Your charting will be very significant in case a lawsuit is brought against you or the hospital. 20. Whenever you are about to do a procedure like dressing change or Foley catheter insertion, make a list of things so you don’t forget anything. This will save you time and energy if something unexpected happens while doing the procedure. 21. Always get the right size of gloves for your hands. Gloves work better when they fit your hands perfectly. 22. Be a nursing ambassador. Just remember that wherever you go, you are representing the nursing profession. Your actions, hygiene and attitude should reflect the nursing profession you have worked hard for. 23. Always appear calm and try relaxed even though you are freaking out inside. You will need this to calm down your patient’s relatives in times of critical conditions. 24. Treat yourself at the end of a tiring shift. #TREATyoSELF This will give you the energy and motivation to continue the next day. 25. Wear compression stockings. Nursing involves a lot of footwork and prolonged standing. Take care of your legs early so you can avoid developing varicose veins . 26. Be open to suggestions. If your senior nurse suggests an easier way to do a task, try it. Experience is the best teacher and your senior nurses know it very well. 27. When you are working under a preceptor, ask all the questions you have in your mind. This is the time to ask ANYTHING. You are new and they know that. 28. Time Management . Organize your shift and the things you need to do. Writing them down in a piece of paper will help you remember them. Prioritize which needs to be done first. You can also use it as a guide in doing your shift report and charting. 29. Get to know everyone in your unit. You don’t need to make friends with them even outside work but getting to know them will help you adjust to your assigned unit and feel more comfortable asking for help. 30. Your first year as a nurse is the toughest. All nurses who are new in the profession undergo the same period of adjustment, so be patient. 31. Avoid complaining. Complaining at work affects the mood of your co-workers. So, try to stay positive and minimize negativity. 32. Delegate tasks. You can’t do all the work alone. Delegate simple tasks to others in a respectful manner and ask their opinions as well about patient care. 33. Develop your own support system. It’s helpful to talk about your problems at work with someone who understands it well. 34. Set goals. Where would you want to be in 5 years? Setting your career goals will help you maximize your profession as a nurse. You should make room for growth. 35. Find something you enjoy doing which has nothing to do with nursing. A hobby will help you direct your attention away from nursing while at home. 36. While you are still under the orientation program, watch every procedure you will encounter in the unit. The more seasoned nurses have their own tricks in doing certain procedures like Foley catheter insertion, dressing changes and Sterile line changes, Admissions, etc. 37. Be flexible. If you are asked to float in another unit for extra help, accept it. You will learn a lot from floating to other units. 38. When you have experienced all the hardships of being a nurse, you will have nothing to fear for. If you run three codes in a single shift, the next time you have a code you will know what to do very well. The same thing applies when inserting IV lines; when you have done IV insertion hundreds of times, you will feel that it is now easy to do venipunctures. 39. When talking with a doctor over the phone, read the order back & clarify. There’s an old saying that we forget 80% of what we hear, so take down notes. 40. If you make mistakes, don’t dwell on them. What’s important is you learn from your mistakes and move on. 41. Don’t apologize for doing your job. If you need to call the attending physician at the middle of the night, do it. 42. No matter how tired or stressed out you are, always approach your patients with positivity and a gentle touch. They are at the hospital because they have illnesses and they will thank you for being the bright part of their day. 43. Get to know your secretaries, respiratory therapists, UAPs, techs and housekeepers. They make your tasks easier and can even teach you a couple of survival tricks to boot. 44. When you’re faced with a crisis and you don’t know what to do, always start with the basics. Get the patient’s vital signs, perform head to toe assessment, visualize your lines, tubes. Etc.. The other important assessments will stem out from here. 45. . Listen to your “gut feeling”. Trust your instinct. As you develop skills and an understanding of your patients, you will develop instincts that may help you along the way. 46. Leave your work at the hospital. Go home with peace in your mind. It is unfair to think about what you might have forgotten to do at work when you are already at home with your family. 47. When the more seasoned nurses grill you at your report, don’t take it personally. Remember that they know more than you so take this opportunity to learn from them. 48. When giving medications, double check everything. Remember the 6 rights – right medication, right patient, right time, right dose, right route right documentation. - NICU Common Meds & Code Meds at Your Fingertips - 49. If you are not really sure about something, ask and if you still aren’t sure continue to follow the chain of command. For example, if you are not sure that the ordered dose is correct, ask the opinions of your senior nurses, then charge nurse, pharmacist, or even doctor. 50. Do physical assessment properly as it will serve as the foundation of your care. Practice it over & over with a systematic approach. Soon it will become second nature with a speedy, detailed, accurate approach. 51. Use proper body mechanics all the time. When pushing equipment, lifting objects, moving isolettes, and even charting, protect your body. 52. Always disinfect your bedside & stethoscope at the beginning of your shift. Remember that the NICU population are very vulnerable and they already have weak immune systems, so don’t pass the infection to them. 53. Never forget the reason why you became a nurse. Think about it whenever you are feeling tired, down or burnt-out from work. It will help you go through the rough times of being a nurse. (Burn out is a real thing) 54. Nurse with Compassion & Family Centered Care. Remember you are caring for someone’s most precious gift. You care caring for a neonate/preemie or infant at their most vulnerable time in life. Provide a caring touch, families will never forget it. 55. Start your retirement! More than likely your organization provides a retirement plan! Whether you are able to contribute 5% or 15%, start your retirement NOW! This always seems to be put on the back burner, however it should be one of the top things you prioritize for your future! ​ 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 . ​

In my NICU Nurse journey, I found it difficult to find credible information about the NICU, and what nurses do in this setting. So, in order to help others, I have compiled all of the BEST information on the NICU Nurse basics & what we do on a daily basis! So, here we go... So, What do NICU Nurses Do?? We take care of the tiniest, and often, sickest humans in the hospital. It is important to understand that premature infant are not only small, their entire body is premature and underdeveloped (including their brain, heart, lungs, GI system, skin etc). We are in the business of “Growing & Healing Humans.” NICU LEVELS OF CARE The first thing to understand is there are several different levels of NICUs, ranging from Level I (which is a well-baby nursery) to Level IV (which are the most advanced, usually part of a large children’s hospital or academic medical center). Basic NICU Level Breakdown Level I (nursery level, community-based hospitals, birthing centers) Level II Level III Level IV (most acute, Children's Hospitals, University Hospitals, Destination centers) I have worked in Level III & Level IV NICU’s where & life-saving procedures happen daily. I have also worked in Level II NICUs where babies need a little support before going home. Every day in a NICU looks different from the last. Every shift in the NICU looks different from the one before it. And every NICU looks different from another. Remember that everything in NICU is smaller. NICU BABY BASICS MEASUREMENTS : Our patients are measured in grams & centimeters. GESTATION AND CARE : Baby age (in gestation) drives the care plan. How old they determine their day-to-day. (Ex: feeding plan, respiratory status, medications, "touch times" etc). MEDICATIONS : Our medications are often measured in tenths of MLS. OXYGEN : 2L of oxygen is considered “high flow," but don’t panic if you see a patient with oxygen saturations in the high 70s, that might be acceptable for that patient (Cardiac, Premature, different Diagnosis) DIET: We measure our feedings in MLS as well, sometimes only giving drops. SIZING : We use the smallest blood pressure cuffs you have ever seen and sometimes those are too big! NICU nursing is delicate work. NICU DIAGNOSIS 101: ♡ NICU patient population admissions range from birth - 1 year. ♡ Most babies are admitted from L&D, or Mother/Baby, or transferred from other facilities (to a higher Level NICU). ♡ Listed below are just a few of the reasons a baby would be admitted to a NICU. ♡ (Keep in mind some of the Diagnoses would refer a baby to a Level IV NICU setting). Respiratory Distress Sepsis Rule Out (Maternal Fever, Pre-Ruptured Membranes for several days/weeks Multiples (Twins, Triples, etc). High-Risk Deliveries (drug-related, STD exposure, unknown pregnancy) Medical Conditions (Cardiac issues, GI/GU,) are usually pre-diagnosed Traumatic Delivery (Body Cooling) Premature Birth (22-37 wks) “Preemies” Congenital Defects (Chromosomal, Genetic) Intrauterine Growth Restriction (IUGR) Jaundice Necrotizing Enterocolitis (NEC) Feeding Issues NICU NURSE WORKFLOW: 0700 or 1900 Before our unit meets for huddle we "SCRUB in." Huddle consists of the Nursing team, Respiratory therapists & Charge Nurse who all meet together to give a "brief" on the patient's and plan of care or updates for the day. It is a both a safety precaution & time to bond with your team of the day or night. Leave your jewelry and watches at home, your arms will be bare from the elbows down as you scrub with soap and water (or the scrub your NICU requires: a no-rinse surgical sanitizer for example), clean under your fingernails. NICU is "bare arms." NICU NURSE HAND OFF REPORT: After huddle, begins report. A NICU report looks much different than an adult world one. HISTORY OF PREGNANCY & DELIVERY Age (Birth Gestation & Current Gestation) Weight (Gain or Loss, Daily) Head circumference Length of the patient. VITAL SIGNS Temperatures (36.5-37.5 C) Heart rate (100-200) Respiratory (10-100) Blood pressures (MAP 20-70) Apnea/Bradycardias/Desaturations DIET NPO or PO eating Breast milk or formula OG or NG tubes (and their APPROPRIATE SIZES! 5-6 Fr) PO feeding status How well the infant takes oral feedings (nipple preference, slow-flow or regular) GI/GU Urine output (all diapers are weighed until discharge) Last stool Ostomy (bag change & skin care plan) Foley (french size, reason for placement, date of placement, placement cm, & output) GI Surgical Tubes (size & type: Salem Sump or Repogle) IV OR CENTAL LINE ACCESS Umbilical lines PICC line Peripheral IV IV fluids Broviac (sometimes) TPN and lipids Or D10W Any replacement fluids, like sodium acetate? It is practice in our unit to “walk the line” together with the off going RN. No matter what type of line the patient has, a feeding tube, IV access, ET tube, we confirm proper placement and proper infusions/settings and connections at the start/end of our shift RESPIRATORY SUPPORT ETT size Placement of ETT Ventilator Settings (HFOV, SIMV, BCPAP, NIMV, etc) Suctioning needs Nasal Canula FiO2 Requirements How to respond to baby “spells” CARDIAC Review hemodynamic stability Last Blood transfusion Pulses (Goal +2) (Brachial & Femoral, Distal Color (Pink/Pale/Appropriate for Ethnicity) Review Cardiac Medications (Dopamine, Epi, Atropine etc). NEURO Review Neonatal Neuro baseline Sutures, Fontanells overview Reflexes (Sucking, moro reflex, ability to console, Review head ultrasounds as available. Review MRIs as available PAIN Pain is assessed with NPASS “Neonatal Pain, Agitation, & Sedation Scale" SKIN Last bath Products to use (Mepitel, Mepilex, Gauze, Sterile Water etc.) Skin tears, bruises, wounds LABS: Review Lab trends NICU tends to focus on Bili Levels, H/H, Chem panels, CRP, INR etc. DIAGNOSTICS: Chest x-rays, Head ultrasounds, Echocardiograms, We review those as well as any that might be scheduled for that day. ORDERS: Finally, we review the most recent lab results and go over all of the orders together. Here are 2 scenarios, one featuring a nurse 1:1 with a critically ill or premature infant, and another with a nurse caring for 3 feeder-grower infants. 1 to 1 NICU PATIENT CARE Caring for the 1-on-1 patient Examples: Pre-op Cardiac Surgery, Body Cooling, Micro Preemies (22-26wks), Pre & Post-Op Surgical patients, Complex Chronic Patients, etc. Example: Let’s say this nurse is caring for a baby that was born at 23 weeks gestation. The bed area is going to have the following (most likely): a High-Frequency Oscillating Ventilator (these things are BEASTS but are SO gentle on little lungs), multiple IV pumps and syringe pumps with a variety of medications running, a cardiopulmonary monitor displaying heart rate, oxygen saturation, and respiratory rate, and possibly a Bili-light used to assist the body in breaking down bilirubin (increased levels cause jaundice). Report finishes around 7:30 (AM or PM), and shortly after that, you would begin your first round of cares on this infant. After assessing the safety of the bedside, checking orders, assessing lines, etc. you would Sanitize the bedside. (Isolette or Warmer, Buttons, IV pumps, Work areas, Charting areas, etc. After touching base with the RT (Respiratory Therapist) we would combine assessments & care. Example: while listening and counting the heart rate and respiratory rate, I am working on my head to toe assessment as well. Diaper changes, temperature taking, feeling pules, assessing baby vigor, all at the same time & providing containment. We also group or “cluster care”. So, if I knew I have a scheduled chest x-ray & labs to draw, we time them together. I could help my RT draw my labs (from a UVC, or heel stick), (do a blood glucose along with the blood draw!) perform the chest x-ray bedside, AND make sure the Doctor knows we are doing “touch time” so they can assess the baby during this time. A NICU Head-to-Toe Assessment Example (0800-0900) What does the baby’s head feel like? Are the sutures separated or overlapping? Do I hear a murmur? (Actually, while the piston is running on a HFOV, you cannot hear heart sounds!) What do the lungs sound like? Crackles? Wheezing? Clear and equal? What do bowel sound & appear visually? Is the abdomen soft Distended Bowel loops visible (they look like sausages under the skin) How is the patient’s muscle tone? Does the Infant have full range of motion with their limbs Does one stay still? Is the patient vigorous and “fighting” me Or are they flaccid? After obtaining blood pressure measurements (with the tiniest blood pressure cuff you have ever seen!) and an axillary temperature, I work on several other checks from head to toe. I perform oral care with any colostrum that we may have available, check the OG tube to remove any air from the stomach, suction out the ETT tube and make mental note of the secretions, and finally change the infant’s diaper. We weigh diapers from admission to discharge. By now you should have your ABG results back along with the x-ray image, which may result in some HFOV setting changes. As the bedside nurse, you are actively managing the patient’s oxygen concentration to keep their saturations between the ordered parameters. Too much oxygen for too long can be detrimental to the infant’s developing retinas, and too low is starving the body of needed oxygen. Oxygen keeps us busy to say the least! Then Bedside rounds (0800-1200) During bedside rounds, all in medical roles discuss the plan of care and changes to the daily neonates needs. Then our Neonatologist explains it to the parents if they are at the bedside for rounds. During rounds the people present at the bedside include: the Neonatologist, NNP, the bedside RN, Respiratory therapy, PT, OT, SLP, Social Work, the unit Charge Nurse, and the parents. The plan of care for the day is discussed but you won’t change anything until your orders are written. CHARTING & ASSESSMENT GOALS Around 1000, monitor vitals are recorded and charting begins! It is practiced in my unit to obtain hourly vitals, including heart rate, respirations, blood oxygen levels (other NICUs maybe Q2 for babies on respiratory support). Vital signs & assessments vary based on the patient’s gestational age & stability. For example: This 23-week neonate would have “Touch Times” at 08/20 & 14/02 (Head to toe assessment, temperature, diaper, blood pressure etc). Other Post-Op Surgical patients every 4 hours, at 8/20, 12/00, and 16/4, the RN performs hands on cares: a full head to toe, diaper change, oral care. On the off hours only monitor vitals are obtained to allow the patient a chance of having a period of undisturbed sleep. Of course, all of this is dependent on the acuity of the patient, vitals may be needed more frequently, or the RN may be disturbing the infant more frequently to keep the patient safe and alive. As the bedside RN for a critically ill or premature infant, you really are not ever leaving that bedside. You will be continually watching the patient’s vital signs, reporting changes in status to the Neonatologist and or NP/NICU Fellow, explaining changes to the parents, and charting EVERYTHING. In addition, product transfusions (Blood, FFP, Cryo, Platelets), administering medications, starting new IVs (24 gauge catheter!), or request assistance in repositioning your patient may occur. It is on days like this, when your brain is going a million miles an hour, that all of your critical thinking skills are used. It is such a rush. Lastly, most procedures are done at the bedside in the NICU as well: PICC lines, lumbar punctures, chest x-rays, and head ultrasounds to name a few. 3 to 1 patient care Caring for the 3-to-1 babies On the complete other end of the spectrum from caring for one critically ill baby, is managing the care of three NICU babies! Report would look similar to that of the critical baby, but more information focusing on discharge planning would also be shared. Infants that are close to going home are cared for and fed on a 3-hour schedule: 8, 11, 1400, & 1700 / 2000, 2300, 0200 & 0500 9, 12, 1300 & 1800 / 2100, 0000, 0300, & 0600 Or a baby may be “Ad Lib,” and eat whenever they want! Which could throw your whole shift in a tizzy. Managing 3 babies might involve coordinating care times with speech or occupational therapy, assisting parents with feeding skills, having parents complete parts of discharge education, (car seat education, baths, diaper changes, feedings, follow-up appointments, well-baby care, etc.) hearing screens, or simply just care for the three patients and getting some snuggles in (especially on night shift J ) While caring for three infants may not seem as stressful as caring for 1 critically ill baby, the days where you have 3+ patients are stressful. Some days feel as if you are just moving from baby to baby; feeding one patient, vital signs, diaper changes, linen changes, then to the next, and the next, and finally charting it ALL. Then, repeating all day long. NICU LIFE Life can change in the blink of an eye in the NICU. One minute the unit is calm, the next, a crash c-section is performed and a 24-week gestation baby is being admitted and your team comes together to make it as smooth as possible. Quite often, NICU is feast or famine! We slow down a lot discharge babies home and then L&D is popping with high-risk NICU admissions. NICU is no stranger to that phenomenon. When I tell people that I am a NICU nurse, they often respond by saying: “How sad, seeing all those sick babies!” or “How do you do that?” Quite simply, this unit is addicting! You get to help families through quite possibly the hardest time in their lives & see the fruits of your labor grow into “line-backer” toddlers! If you are looking for a high-risk, high-reward nursing specialty, the NICU might be the place for you! HEAD OVER TO THE PODCAST! EPISODE #1 & #2 ANSWER MANY NICU 101 QUESTIONS! Another great resource for you BELOW. I was featured on The Morning Rounds and talked all things NICU Nursing. Dynamics, my personal journey, NICU Nurse Tips & Tricks! NICU Nurse Essential Resources American Academy of Pediatrics Academy of Neonatal Nursing Childhood & Adult Immunization CDC Guidelines March of Dimes! Resources for parents & providers Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories National Association of Neonatal Nurses National Certification Corporation - NICU National certifications for experienced nurses NICU University & Peds University Vermont Oxford Network - 1,300 hospitals collaborating around the world! Tori's Tips on NICU NURSE 101: Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com ​

After spending 9 years in the nursing field and much time applying for jobs (New Grad positions, Travel Nurse positions, Per Diem & Staff Nurse) I have certainly had my fill of the Nurse interview process. Filling out the online applications can be overwhelming, but landing that interview is so exhilarating! Here are some Nurse Interview Tips and Tricks I have learned along the way. 12 NURSE INTERVIEW TIPS & TRICKS! Interviews. They are nerve-racking NO MATTER WHO YOU ARE! Someone is dangling a carrot in your face and has the potential keys to your future. BUT I believe Interviewing well is a true skill. It takes time to master. Here are a few insights for you I have learned along the way. INTERVIEW BASICS 1. DRESS THE PART! Yes, management does judge the book by the cover. Professional & well groomed. I personally love a sharp power suit! Women A skirt or pantsuit with jacket and button down collared shirt or blouse Skirts or dresses should be knee-length Avoid flashy colors or patterns Heels should be low or wear flats, no open toes Pantyhose for skirts or dresses No cleavage exposure Natural hair color Earrings should be studs or no bigger than dime sized Necklace should be simple Handbag should be neutral No perfume or mild use of perfume Fingernails should be short and without chips in polish Men A suit is preferred with jacket and button down collared shirt Pants and jacket should match, if they are not a suit Tie is optional but when in doubt, wear it Avoid bright colors or patterns, keep it simple Black or brown socks, avoid wearing white socks with dark dress shoes Black or brown dress shoes Avoid exposing tattoos or piercings Natural hair color and neat haircut Avoid wearing earrings Mild cologne or none at all Neat and natural fingernails 2. PORTFOLIO Prepare a portfolio and practice with it using stories & examples of your experiences. 3. DO YOUR RESEARCH Know the company & position you are interviewing for! Nothing worse than a candidate who doesn't know anything about the organization they are applying for. 4. ONE-MINUTE PITCH Practice the question “Tell me about yourself,” planning out your focus & emphasizing relevant skills for the interview. (See details below!) 5. OVER PREPARE Portfolio and resume!! Assume your interviewers forgot everything. Bring extra (fully updated) copies of resumes and references. Bring notebook & pen (just Incase) 6. BE EARLY Allow time for parking, traffic, & map out where to go! You never know what could happen leading up to your interview. Planning ahead is key. 7. SMILE & MAINTAIN GOOD EYE CONTACT Something I think we forget to talk about. This is so important. I know you are going to feel so nervous but really try to show your passion to be there and part of that is smiling. Be confident in yourself and hold good eye contact as well. 8. ASK QUESTIONS Prepare a few insightful questions for the interviewer. (I have some good details below.) 9. PRACTICE PRACTICE PRACTICE! I can't stress this one enough. Practice interview questions until you are blue in the face! I personally like practicing in the car, shower, envision the pressure of sitting in that room. Talk out loud, practice your stories until you CAN NOT forget them. 10. SHOW YOUR PASSION Employers want to know you WANT to be there! Show them. Let them hear it. 11. PHONE OFF Turn down your phone OFF. Nothing worse than an unexpected call from mom or text from your friend asking "How it went," when you are right in the middle of the interview! Don't make that rookie mistake. 12. RELAX They want to get to know you. Take a few deep breaths & remember the AWESOME reasons they should hire YOU! Remember how hard you worked to get there! You deserve it. Envision the practice you want to hold as a nurse. And let that vision come to life in your interview. You are going to kill it! While there are many questions a facility may ask a new graduate here are some potential questions and approaches to answering them. Review and think about how to answer these questions prior to the interview. Come up with a handful of situations that could be useful to answer variations of these questions honestly. These are just examples of types of questions. 12 NURSE INTERVIEW EXAMPLE QUESTIONS I get a lot of questions via instagram: "How do I prepare for a NICU interview?" Well, frankly, most people who have never worked in a NICU prior don't know much about it. Managers know that. Rather they want to know WHY you want to be there and how you have prepared to work there. Most interviews are general and will include something like this! Tailor your interview to the unit. (Regardless of it is NICU or not). They ask situational questions. How you handled something, patient or co-worker related. How you respond to stress. They are looking for someone who is a good fit & addition to the team. (Being an expert IV start isn't the only thing that makes a good nurse. It is the nurse who will: jump to and help their neighbor, be open to learning & growing (easy to teach) can stay calm in high-pressure situations & have the confidence to speak up for their patient in rounds. Also, a nurse who has a list of a million things to do but understands how to delegate & comfort a family or child. Is a leader and wants to take on leadership roles. (Doesn't mean management, it can be precepting or joining a committee.) We can't teach these powerful skills in school or on the job. But you CAN teach and review skills (hands-on) once that new team member is hired. To nursing students who have decreased clinical hours : Write down situations during your clinical or current job that show these skills. Exemplify your leadership during COVID. What have you learned? How can you contribute to the unit and most importantly your patients? LIST OF INTERVIEW QUESTIONS 1️. TELL ME ABOUT YOURSELF. (This is your time to shine, 2-minute PITCH!) Prove that you have the traits of a good employee. (Personality, professional experiences, education,, and career goals.) 2️. WHY THIS UNIT? (NICU, ICU, OR, L&D, TRANSPORT, MED-SURG, CLINIC) Lead with an educated understanding of the patient population & your passion to joining their team! 3️. TELL ME WHAT YOU KNOW ABOUT OUR INSTITUTION. Research about the institution. You can visit their website, check out patient feedback & reviews, and even ask friends. 4️. TELL ME ABOUT A TIME WHEN YOU FAILED OR MADE A MISTAKE, EXPLAIN THE SITUATION & HOW YOU HANDLED IT. (HINT: WEAKNESS QUESTION) Be realistic and honest with your answer. Interviewers can smell a fraud answer. What did you learn from your mistake? 5️. TELL ME ABOUT A TIME YOU EXCELLED (HINT: STRENGTH QUESTION) Bedside experience, school project, other work experience, etc. 6️. A PATIENT IS DECLINING, HOW WOULD YOU HANDLE THE SITUATION? (HINT: PRIORITIZATION QUESTION) Assess, monitor, notify, and escalate care. 7️. WHERE DO YOU SEE YOURSELF IN 5 YEARS? (HINT: they want to hear some loyalty here) Married, kids, home, OH and working HERE!!!!!! 8️. NAME A TIME YOU HAD A CONFLICT WITH A MANAGER/CHARGE NURSE/ ETC HOW DID YOU HANDLE IT? (HINT: what did you learn from the situation?) 9. TELL ME ABOUT A TIME YOU WENT ABOVE & BEYOND FOR A FAMILY. Give good examples of how you have affected someone (preceptorship or personal to go above & beyond the expected job or experience). A situation or scenario & practice practice practice so you will NOT forget. 10. TELL ME ABOUT A TIME YOU HAD A DISAGREEMENT WITH A CO-WORKER OR DIFFICULT FAMILY. This is often something we face in our everyday life as a Nurse. How did you handle it? What did you learn, how can you improve in the future. 11. WHAT DO YOU DO TO DE-STRESS FROM A DIFFICULT DAY? (HINT: How do you handle difficult situations?) Can you compartmentalize and manage stress effectively? 12. A CO-WORKER IS SLACKING ON THEIR DUTIES, HOW WOULD YOU HANDLE THIS? (HINT: how do you interact with co-workers?) Are you tactful and encouraging, can you lead by example? 13. WHY SHOULD WE HIRE YOU? (HINT: Be humble yet VERY confident you are meant for them! Explain your specific characteristics will be valuable to them.) 14. DO YOU HAVE ANY QUESTIONS FOR US? HINT: YES! YOU ALWAYS HAVE A QUESTION FOR THEM. Ask about the details of the position. You can ask about the usual nurse-patient ratios in the facility, length of orientation phase, and educational opportunities for employees.) DO YOU HAVE ANY QUESTIONS FOR US? LIST OF QUESTIONS TO CONSIDER: 1. What is the size of the unit, organizational structure of the unit, volume? 2. Can you explain your overall organizational structure? 3. Can you discuss your take on the hospital's culture? and philosophy? 4. What does the transition period look like? Expectations of days / nights? 5. What does the orientation look like? Preceptorship? 6. What are some recommendations of getting involved and growing within the unit? 7. What will be the greatest challenge in the job? 8. What are the greatest strengths of this department? 9. Can you describe a typical day for someone in this position? 10. What are the traits and skills of people most successful within this unit? 11. What do you like about working here? 15. FEEDBACK. If you don't land the job, ask for feedback. Where can you improve? Also, don't get discouraged. If you want it (that bad) keep going and make your journey. My journey WAS NOT EASY. I spill the #REALTEA on the first episode of my podcast!! Lots of juicy deets, tips & tricks for you there. (Episode #1 The Cellfie Show) BONUS: Pediatric RN Interview: Highly advise getting experience with the Pediatric population. When to start thinking about applying to jobs for nursing school? 1 semester before you graduate is a good time. Don't put it off until graduation because you lose direct networking while in clinical . CHECK OUT OUR E-BOOK COMPLETE WITH INTERVIEW TIPS & TRICKS. BONUS QUESTIONS, PORTFOLIO BREAKDOWN, RESUME AND COVER LETTER RESOURCES, SOCIAL MEDIA CONSIDERATIONS AND MORE! Things you can do early: ♡ Spruce up your Resume (typing it out will help you fill in the blanks & be ready to start applying) ♡ Make a list of possible references of people who would write a letter of recommendation for you (get their emails) usually need 2-3 references ♡ Participate in leadership activities at school to stand out in applications ♡ Start an excel spreadsheet of hospitals/units you would consider applying to. Find out when their new grad program applications are due. Interviewing can be very nerve-racking ! With a confident yet humble approach, you can shine in your interview! I hope these tips and additional resources are helpful in your Nurse Career Journey. ​ 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 .

Do you have any TIPS for starting in the NICU? The short answer is, yes. I have a bunch for you! This is such an exciting time! Starting in a new setting, getting to know a unique tiny but mighty patient population! Not to mention that NICU nurses have been in high demand, with most hospitals seeing an above-average flood of NICU admissions. 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 thick of school, or are a new grad considering where to apply - here are some hot tips for you if you’re considering starting out your career in the NICU! 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! Let's dig into some of the basics when starting in the NICU! What are the special educational requirements to start working a NICU nurse? To become a neonatal intensive care nurse, you will first need to be a registered nurse (RN) with either an Associate’s Degree in Nursing or a Bachelor’s of Science in Nursing (BSN). While some hospitals will hire those with an ADN background, many hospitals are giving priority to RN’s with a BSN (versus an ADN) so I highly recommend pursuing a BSN if you know you want to work in the NICU. I am currently working on 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. Which certifications do I need to start working in the NICU? Typically, these are the standard certifications required to start in a NICU. (Side note: Many organizations will have you take them during your orientation or preceptorship periods and others will require them upon hire.) BLS, NRP, STABLE, and or PALS. Hospitals most commonly require NRP, although Children’s Hospitals typically require PALS as well, in case you are required to float to other Pediatric units. Working in an intensive care setting has its challenges, but it also can feel extremely rewarding when you are able to impact life positively at its most critical point . NRP = Neonatal Resuscitation Program. This certifies that you can safely give a baby life support whether it was just born and needs resuscitating at delivery or there is a code at the bedside. NRP MUST be renewed every two years to stay in compliance. (RQI with the American Heart Association are updating these requirements, you will stay up to date with your hospital organization). PALS = Pediatric Advanced Life Support . It is an in-depth guide to providing life support to pediatric patients 30 days to 18 years old. PALS must also be renewed every two years.  (RQI with the American Heart Association is updating these requirements; you will stay up to date with your hospital organization. ) STABLE = S.T.A.B.L.E. stands for the program's six assessment and care modules : S ugar, T emperature, A irway, B lood pressure, L ab work, and E motional support. A seventh module, Quality Improvement stresses the professional responsibility of improving and evaluating care provided to sick infants. If you accidentally let your certification expire without renewing it on time, you will not be permitted to work until you’re certified again. 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! Where can I work as a NICU nurse? • Hospitals (Both Private and Public) • Neonatal Intensive Care Units (Levels 1-4) • Community Health Organizations (Consult or Board Member) • Emergency Medical Evacuation & Transport Services • Home Health Services (Less common) What are the types of things I would be doing and seeing as a NICU nurse? Average day in the life? The answer to this question really depends on what level NICU you are working! Here is a quick breakdown of the NICU levels. Level I NICUs (Basic Newborn Care): In these facilities, RNs help maintain the physiological stability of newborn infants at 35 to 37 weeks gestation. They also help stabilize infants born at less than 35 weeks gestation and/or sick until they can be transferred to a healthcare facility that can provide an acceptable level of neonatal care. Level II NICUs (Advanced Neonatal Care): RNs working at this level care for less critically ill newborns who may require breathing, feeding support, or special medication. Level II NICU units are found in smaller healthcare facilities called special care nurseries. (Respiratory support, IV antibiotics, feeding issues, jaundice, etc). Level III NICUs (Sub-specialty Newborn Care) : RNs working at these NICUs care for infants that have been born at less than 32 weeks' gestation and newborns suffering from severe afflictions at any gestational age. (Respiratory support, central line management, UAC / UVC / PICC lines, complex medical care, intubation, minor surgical repair, body cooling, prematurity, multiples, etc). Level IV NICUs (Regional NICU- Highest Level of Neonatal Care): These facilities (Children's Hospitals, University Hospitals, Consult Centers) provide care for infants who are born as young as 22 to 24 weeks of gestational age. Level IV NICUs provide mechanical ventilation, high-frequency ventilation, SIMV, NIMV, CPAP, and a wide range of advanced surgeries, including "open-heart" surgeries needed to correct congenital heart defects. (Life support, complex surgical repair, pre / post op care, iNO, ECMO, consult specialties, congenital anomalies, etc.) 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 CAN I EXPECT WHEN I START MY NICU JOB? Every NICU orientation is different. You may be reading this as a new grad NICU nurse or an experienced nurse transitioning into the NICU setting. Here are some general things you may experience in your transition and orientation period! 1. Review New Hire Expectations 2. LOTS of paperwork!! 3. Introduction to NICU Standards of Care 4. Scheduling expectations (online or paper. Holidays/Weekends/Requirements etc) 5. Mandatory Class Sign-Ups 6. Pyxis and Medication Access information 7. Seek and Find on the Unit (Get to know the ins and outs of unit supplies, safety etc). 8. Orientation Pathway Competencies 9. Preceptor Education & Evaluations 10. Review Professional Expectations (Dress code, Fingernails, Attendance & Punctuality) 11. Meet your Management & Educators (Director, Mangers, CNS, Charge Nurses) 12. Skills Validations SKILL VALIDATIONS MAY INCLUDE: 1. Blood Administration 2. Chest Tube Management 3. Medication Administration 4. Narcotic Continuous Infusion 5. NICU Central Vascular Access Devices (CVAD) Management 6. NICU Central Vascular Access Devices (CVAD) Blood Culture Draws 7. NICU Central Vascular Access Devices (CVAD) Blood Draw 8. NICU Line Change Procedures 9. Universal Protocol 10. Zoll Defibrillator 11. NICU Lactation ROUTINE NICU TESTING TO CONSIDER IN YOUR ORIENTATION PERIOD 1. Eye Exams 2. Head Ultrasounds 3. Car Seat Challenge (some NICUs require, others do not per hospital policy) 4. Congenital Heart Screening 5. Bili Light Measurements 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. NICU RN ORIENTATION PATHWAY 1. Tour the Unit/Orient to patient rooms 2. Review the dress code policy 3. Seek and Find crash carts intubation carts admission carts glucometers and strips medication rooms various departments (OR/Radiology/Lab/Blood bank/ED/Morgue) 4. Safety Checks (Oxygen, Suction, Code Sheets, Vital Sign parameters) 5. Code Sheets (critical care tables, how to print them, update them, DCW) 6. How to associate patients to the monitor 7. Give and receive report from ongoing / off going nurses 8. Physical assessment, head to toe 9. Care times (consider when you need to adjust them) 10. Documentation and time management 11. Blood draws (venipuncture and heel sticks etc) 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? NICU AMAZON BOOKS LIST Here is a compiled list of NICU books and resources for you. These are books you might often find in your NICU. If you are looking to read up a little these are great to look into. Keep in mind...you will learn so much on the job. So don't go crazy here! But, they are all great resources for you, credible books we actually use, and can help you deep-dive into the neonatal population. 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 8 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 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 .

There are many ways to bond with your baby – even during his or her NICU stay. Bonding is important for baby development. It helps babies feel loved, safe and secure. But bonding can take time and baby in the neonatal intensive care unit is a family crisis. Parents are rarely prepared for the challenges of the NICU environment, such as the fragile condition of the infant, the high level of technology, and frequent crises. No matter your vision, the reality of admission to the NICU with a medically fragile infant causes feelings of reactions as fear, anger, confusion, and loss. You may first feel as if you have no idea how to handle the situation, but with time, new preemie parents grow confident in their understanding of what is happening and what to expect . So even if you're feeling lost now, give these 12 suggestions below a try. They'll get you off to a good start. Suggestions for Bonding with Your Newborn in the NICU 1. Do Your Research, But Don't Overwhelm Yourself When you’re about to go online to look up preemie-related questions, take a moment to ask yourself: "Do I really need this information right now?" Stumbling across preemie stories with negative outcomes may make you anxious. If you’re going to stress and fret all night long after reading about worst-case scenarios, it's just not worth it. Instead, talk to your baby's doctors and nurses and consult with other NICU parents you meet. If you must go online to do research because you feel you’re just not getting the answers you need, remember that the scary stuff and the negativity is not your baby and it’s not guaranteed for every baby. Stay focused on the positives. 2. TALK TO BABY A quiet soft voice will offer a sense of comfort. Babies are familiar with your voice from inside the womb so hearing it now might be able to help stabilize him or her . Bonding will look different for each individual family due to each baby’s unique circumstances. Certain factors – such as the mom’s health, the baby’s medical issues, diagnoses, and gestation at birth – will affect the ways in which families can bond. For example, a baby born at 25 weeks cannot be held right away due to his/her medical instability, (IVH and infection precautions). However, a baby born at 34 weeks may be held, depending on his or her medical condition. Some NICU babies are able to tolerate touch very well, while others require minimal stimulation due to respiratory support, pre/post op care, hemodynamic instability, etc. If you were unable to hold your baby within the first 24 hours or the first several weeks of life, please know that your opportunity to bond with your baby was not completely lost. In fact, it is imperative! Initial bonding might be a bit different than you anticipated but your presence and calm energy are a big piece of baby's healing and growth. 3. VISIT WHEN YOU CAN Your presence alone can have a long-term positive impact on your baby’s development and give you confidence as a parent too. Spending time with your baby in the NICU is such an important part of bonding. Parents or parent figures are constant. Although your situation seems so foreign, getting involved and getting into the routine provides structured normalcy. Ask questions, review the plan of care, and empower yourself with an understanding of the NICU day-to-day routine. The more we see you and get to know you the better. It is helpful when you know as much about your baby as we do! NICU Parent Perspectives. Innovators. Entrepreneurs. 4 . ASK FOR NURSES YOU LIKE Probably the most unpopular opinion. Some personalities jive better than others. If you have a nurse or two you really bond with, ask if they are able to primary your baby. Some hospitals do this, while others do not due to staffing needs. But it never hurts to ask! This is your time too. Parents can start to change the baby's diaper, help in taking temperature, and participate in feeding (if appropriate) the baby. Whether it be a bottle or breastfeeding understanding the process can truly empower you to feel a part of the process. Parents are the baby’s best health advocates! Get to know the nurses. Get to know the MDs, RTs, OTs, and medical team members. Together we can help lead you throughout the NICU Journey. 5. FINGER-GRASP For our especially tiny micro preemie or medically fragile newborns offering your baby, a finger with a gentle grasp can be a beautiful and precious way to bond with baby. You can also offer a "hand hug" and provide a positive soft touch while talking to baby. 6. SKIN TO SKIN: KANGAROO CARE After baby is stable and the medical team has confidence in baby's health status parents can start the skin-to-skin process. The sound of mom's heartbeat is a familiar sound to them & it has been medically proven that skin-to-skin helps a baby thrive in the NICU. Also, a great aid for mothers' breastmilk production & daddy’s bonding. Daddy this is your time too! Babies know your heartbeat, scent, voices, tones etc. Skin to skin is the best way to bond with your new little one. 7 . PERSONALIZE YOUR SPACE You can also decorate the baby’s area. Decorating your baby’s Isolette with a milestone, holiday, or special moment is another great way to create that special bond. Bring "home" to the Hospital. Bring pieces of your family’s life to place in your infant’s isolette or crib in the form of family photos, a special blanket, artwork from siblings, and more. (Some NICUs are more strict on policies so just ask what they allow). Etsy has some fun "Milestone Cards," and NICU decor to offer. Many families find that making a sign with your baby’s name, decorating with family pictures, or adding other personal touches can feel like you are giving your baby a piece of home while you are away. 8. LETTERS TO BABY Write it out. Writing can be therapeutic and tangible. Noting big milestones, tracking the journey, and processing your NICU stay can really empower you during the process. This is something you & your baby can look back on & can also give you an outlet to express how you’re feeling at that moment. Some families find that documenting their baby’s experience in the NICU by journaling or scrapbooking (either digitally or in physical form) can be helpful. Taking photos and journaling experiences may feel very tender and sometimes painful. I encourage you to document what you can and when you feel able. In moments when you’re not feeling up to it, ask someone else to help you do this by taking pictures or writing memories. 9. FACE-TIME Thank goodness for technology! Some NICUs have a “NIC-VIEW” camera (a little camera that can be placed above your baby’s bed) that parents can view live online. This is a great opportunity for parents that can’t always be at their baby's bedside. (Not all NICUs have this technology but it doesn't hurt to ask. Each NICU holds a different platform and policy for viewing. 10. INFANT MASSAGE Take a class through a certified infant massage instructor and utilize techniques with your MEDICALLY STABLE baby. Benefits include reduced levels of cortisol (stress hormone), increased muscle tone, and supported parent-infant interactions, among others. Speak with your baby’s doctor and bedside nurse before using this technique with your medically fragile infant. MASTERING PREEMIE / MEDICALLY FRAGILE MASSAGE 11. LEAVE YOUR SCENT Check with NICU staff to learn what cloth items are appropriate to place in the baby’s space. Sleep with that item or wear it all day tucked under your clothing, then place in your baby’s space. Swapping scents back and forth from mother and father to baby are well documented evidence-based practiced outcomes! Not only will this help your baby, but it is also a source of comfort for you! You can find "Lovies" on Amazon or Etsy if your NICU does not offer them. 12. LEAN ON LOVED ONES AROUND YOU This can feel like the most overwhelming time in your life. You may experience a variety of emotions. Overwhelmed, frustrated, and even loneliness. This is a great time to use people around you who want to help. Whether it is a family member or distant friend, lean into their help. From delivered dinners, help with laundry, childcare, transportation, amazon gift cards, etc. Let these people in your life help you. This can truly help you, which will ultimately help you and your beautiful baby. 13. TAKE CARE OF YOU & YOUR RELATIONSHIPS This time can be one of the most overwhelming times of your life. If you feel overwhelmed and insecure, you’re not alone or failing at this. If you’re feeling sad or confused, that’s okay. These are all such normal responses. It's ok to take some time away and revive yourself. Take a shower, go on a date night, sleep, take a walk, girl or boy night, and refocus your mindset. One of the most important components of this time frame is parental involvement, both in gains for the baby and in fostering an appropriate parent/baby relationship that will allow for an easy transition to home. All care should be family-centered, and every effort should be made to involve parents in all aspects of caring for the baby. It is during this stage that we prepare both baby and parents for discharge from the small baby unit. Our ultimate goal is to empower the family to become the best caregivers for their infant, thereby improving the outcomes of the baby and the satisfaction of the family. You got this! Listen to this holy-grail list of episodes from all aspects of the NICU! These Cellfie Show episodes will give you insight into your most pressing NICU-related questions as well as a fresh perspective from the point of view of NICU providers, entrepreneurs, and parents. No matter your experience with the NICU so far, I hope you take away something new in these episodes that you can apply to your unique journey! *If you have any questions about what is most appropriate for your baby, consult with your baby’s medical team. NICU Essential Resources American Academy of Pediatrics Childhood & Adult Immunization CDC Guidelines March of Dimes! Resources for parents & providers Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

The job application process can be daunting to say the least. From trying to find the job, applying to a job, creating a high-quality niche portfolio, mastering an interview, and hoping to land that dream job….whew! So, I thought I would give you the “real tea,” on all things New Grad Nurse Job application. Let's get into how to land your dream nursing job! Should I know anything specific about the organization I applied to for the interview? This is an often overlooked step, and the answer is yes. You need to spend time researching the organization you have applied to. (I get it, sometimes it is tough to find information, but do your best). It is always better to be overly prepared. Is the organization a magnet hospital? What are the core values of the organization? You can also impress your interviewer by asking them a question in your interview about the culture of the organization! Should I Obtain Certifications / PALS / BLS / ACLS / NRP? Always assume someone went the EXTRA MILE to land the job you want! Think of it this way, just as athletes put in extra hours & practice when no one is watching, nurses should operate with a similar mindset. If you made it through nursing school, you have GRIT, use it and go that extra mile. Find extra opportunities if possible in the specialty you seek, as anything you can do to land the job you want will be important when your resume is compared to others'. Certifications are a great way to boost the resume and prove to your future employers that you have what it takes! While it is possible that your employer may have you re-do the certification once you're hired…who cares! Repetition will only benefit you by building confidence and reinforcing the skill. It is absolutely worth it to have a certification(s) and hold an edge over your competition! CHECK OUT OUR E-BOOK COMPLETE WITH INTERVIEW TIPS & TRICKS. BONUS QUESTIONS, RESUME AND COVER LETTER RESOURCES, SOCIAL MEDIA CONSIDERATIONS AND MORE! Should I make a LinkedIn profile? No matter what career you want to be in, a LinkedIn profile is a must in 2021. Your LinkedIn profile will help a manager, HR rep, etc. put a face to a name and will make you more memorable. While it is true that not every employer will use this as a resource, you may want to utilize it for building a network of like-minded, professional connections and for possible job searches down the road in your career. Your profile should include a professional picture, along with your educational achievements (school, honors, projects, volunteer), certifications, etc. Social Media…does this really matter when I am applying to jobs? Yes. Clean it up! It doesn't matter if your profile is private either. Keep it classy and refrain from posting anything that could be perceived at all negatively. Possible employers will not waste their time on potential candidates that they believe have poor character and will not fit the organization's core values and professional culture. When you are applying to jobs, keep it all professional and think before you hit post! Should my Resume be 1 or 2 pages? The rule of thumb is to keep your resume at one page, as managers care less about the second page. All of the important information needs to be on the front page. In all honesty, my resume ended up being two pages when I applied to my new grad nurse position. If you have the extracurriculars, pertinent certificates and volunteer experience by all means include it on the second page if needed rather than leaving it out. If you go to two pages, make the highlight reel on the first page. You will want to make sure that your resume is also visually appealing and in an easy to read font and format. From a glance, the manager who is reviewing your resume should be able to determine your most important attributes front and center. How do I find the “actual” job listing? It is hard to know when to apply and the official name of the job. 1. Call HR! They are the gate keepers. Inquire when the New Grad Residency (Versant program, Clinical Nurse I) positions will open up and mark your calendar. 2. Ask HR what the official name of the job position will be. 3. Sign up for the job notifications so you don't miss your window. 4. Sign up & create a profile on the organization job application website. Should I call HR or manager to inquire about my job application status? Both management & HR are VERY busy. In due time, I promise they will get to you. I would suggest sending the manager a thank you note & or emailing him/her a thank you so that you are fresh in their mind. If you send a thank you, keep it brief and to the point and mention that you are looking forward to hearing back soon and are grateful for the opportunity. Sending a thank you a day or two after your interview is a nice idea to let them know how thankful you are for the opportunity & your desire to join their unit. (HINT: make sure to get the manager’s card or contact information at the end of the interview, or look through the emails they sent you to obtain the manager’s mailing address or email). You will not want to seem demanding or overbearing, so make sure to let them contact you after sending the initial thank you. Do you have tips on interviewing? (NICU, PICU, CVICU, ICU, Med Surge, Oncology, Clinic, etc.) Let’s talk about the entire reason for an interview. The bottom line is that they want to know if you will be a good fit for the unit/setting. Do they like you? How qualified are you (with your limited time as a nurse) to start on their unit? So, that being said, focus on why you want to be there in the first place! Communicate why you believe they should they hire you (over the person interviewing next) by sharing your key competencies. Also, Practice. Practice. Practice! Practice interviewing until you are blue in the face. Practice in the shower, on your drive, in front of your mom. Practice until your stories come so naturally that you can’t possibly forget them. You've got this! See full Blog post on Interviewing 101! Is it beneficial to communicate with someone I know on the unit prior? Ask them to vouch for me? (Family friend, Preceptor, Cousin, etc.) If you know someone on the unit, yes it can be beneficial to touch base, inquire about application dates, and ask about any highlights you should know about the unit. As far as “vouching for you,” to the management team, tread lightly, as that should only be suggested by the person you know. In addition, keep in mind, some people have a GREAT relationship with their management team and others do NOT. Therefore, the person you are in touch with may not be the best to “vouch.” It pays to be self-aware on this one. What do I include in a Portfolio? Let’s talk the purpose of a portfolio. A portfolio is the extended highlight reel and extension of your resume. A properly prepared portfolio will give you the “edge” over your competition. Honestly, I have only used my portfolio 3 times out of 8 different job interviews. For your first job, a portfolio is a MUST. Why? This is a supplemental tool for you to use in order to speak to and solidify your job application. Below is a bulleted list / outline of what to include in your portfolio. You create it. You practice with it. You speak to it. A portfolio is a TOOL to use in order to help you pull together stories and experiences, as well as ultimately ease the nerves for your interview. I suggest practicing your interviews with the portfolio. Due to current circumstances with virtual interviewing, you may not be able to share the portfolio with the management team as easily, however, use it as a tool to help you interview! What should I include in my Portfolio? Let me give you the deets! Professional Role Resume (Shop Resume Rx Templates code CELLFIE 20% OFF) Cover Letter (Shop Template) Professional Certifications National Certifications Education University (Copy of your Degree) Professional Activities Projects Volunteerism Professional References (Shop Template) Professional Recommendations I hope these tips help you as you work to land your dream job as a new grad nurse! I believe in you!!! Xo Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com ​ Instagram @nurse.tori_

Nursing is truly a calling & one with rewards far beyond money and three day work weeks. ♡♡♡♡♡♡♡♡♡♡♡♡♡ Let's face it, if we learned nothing else from 2020, it was that Healthcare providers are truly essential. Well that is certainly the case with the onset of the Sars-Cov-2 (COVID 19) virus. And without a doubt, we will never be out of a job. The need for providers continues to surge and there is never a shortage of people (& infants / children) who require care. Yet, there are not enough Nurses. While the demands for healthcare providers continue to rise the shortage of nurses continues as well. Why is this?! Money. It takes a lot of time and resources to train a brand new nurse (It took me 6 months before I came off orientation & became an asset to the hospital. $30,000 cost to the hospital) With this being said, it is important to make yourself as marketable as possible as a potential candidate, which we will get into later. Before we dive into my Tips, let me tell you a little bit about my path to becoming a nurse. I moved out of state to Arizona (from California) where I attended The University of Arizona, Tucson AZ. I started at UofA #beardown as a Pre-Nursing Major, where I completed my 2 years of undergrad and applied to nursing school. But it wasn't all roses! Well, this is how that went…… Applied once, REJECTED . Applied a second time, got an interview, REJECTED . Applied third time, got an interview, REJECTED . Then got a call, I had made the (second) cut of students (someone had dropped out prior to starting school). WAITLISTED My admission to Nursing school was anti-climatic to say the least. ♡♡♡♡♡♡♡♡♡♡♡♡♡ Yes, it took me 3.5 times to get into Nursing school! Therefore, I feel you! I have been in the hot seat and I know what it is like to climb your way into Nursing with every ounce of hope and hustle you have. So how did I finally get into nursing school?! I DIDN’T GIVE UP! I PERSEVERED. I HAD SUCH DETERMINATION & FOCUS THAT NOTHING COULD STOP ME. I KNEW I WAS GOING TO BE A NURSE. Here are some personal tips & advice for your first hurdle, getting into Nursing School! ♡♡♡♡♡♡♡♡♡♡♡♡♡ TORI'S PRE-NURSING TIPS 1. RE-TAKE THE CLASS If you have to, just do it! If I got the “B” in Microbiology, I went back that summer for the “A." Was it fun? No! Was it time consuming? Yes! But it was worth it! Boosting those grades was key for my application to Nursing school. 2. PRACTICE YOUR INTERVIEW Many nursing schools require an entry interview. If this is the case for you (and it will be for your first job as well) I suggest start preparing now! Practice practice practice. I was horrible at interviews! Nerves, overthinking, rambling on, overwhelming feelings of what to say. But I practiced! If I stumbled over words in an interview, I re-practiced questions all the time! In the shower, in front of friends and family, my car, until my brain hurt. 3. BOOST THAT RESUME From activities to boosting grades I found every way to boost that resume! I added activities (to my already overly busy schedule) to help boost me over the next candidate. 4. VOLUNTEER Find something you are passionate about! Red cross, student leadership, homeless shelters, Hospital help, Veterans causes, etc! There are so many organizations that could use your help. In addition, these are great experiences and resume boosters for your nursing application. I volunteered at “Ride On” Therapy (Equine therapy for Children & Adults with physical & cognitive disabilities), the Workforce Diversity Program at University of Arizona (to help low socio-economic middle schoolers learn about the opportunities in Nursing), and a Veterans cause! 5. WORK IN THE FIELD! CNA, SCRIBE, VOLUNTEER, SECRETARY, HEARING SCREENER, ETC . Working directly in a hospital can give you great "in field" experience, offer opportunities to learn about units first hand, and most of all NETWORK! You will have opportunities to meet nurses, staff, managers, etc. A face to a name! Not only will you be able to add this to your resume, but you will become a familiar face to the nursing staff! 6. BACK UP PLANS ! Make several plans. Personally, I had plan A, B, & C. If University of Arizona hadn’t worked out, I had back up schools & programs planned out (with classes that transferred to the schools). There are so many options out there! Plan ahead and if something isn't working, make plans for your next move. 7. GO THE EXTRA MILE Many schools require different curriculum. One school may require one class or lab, but another may require another class. I opted to take that extra Lab (that wasn’t required for UofA) just incase I needed it for another school. Through this, I actually learned more! Two classes I decided to take actually helped my overall nursing thought process and taught me MORE than I had anticipated! Planning ahead and going the extra mile can make a big difference. 8. SHOOT FOR A "BSN" DEGREE IF POSSIBLE Although this is not a "hard and fast" rule, most most New Grad Programs in teaching hospitals (Level I trauma Hospitals, Children’s Hospitals, Level IV-III NICUs etc) require a BSN “Bachelor’s of Science in Nursing.” In addition, most hospitals are moving towards becoming "Magnet" certified. Magnet is a nation wide program focused on improving patient outcomes with improved nursing engagement. Part of this includes hiring and having Bachelors prepared nursing staff. Healthcare is focusing on having more educated staff members. Therefore, many are requiring staff to obtain Bachelors Degrees. In addition, opportunities for advancement (Management, Education, etc) require higher degrees. My advice, try to land that BSN degree. 9. NEVER GIVE UP I knew Nursing was my calling. Therefore, I never gave up! My advice to you, is NEVER give up. Find a way to make it work! You may have to go far above the call of duty. Work another job, volunteer more often, take a class over to get the better grade, look into other cities (or states), sacrifice social life, some family time, etc. I did all of the above and it was well worth it! LIST OF NURSING SCHOOLS WITH BSN PROGRAMS (CA & AZ) University of Arizona Nursing School Azusa Pacific Nursing ASU Nursing Concordia University Irvine Grand Canyon University UCLA Nursing UCI Nursing UC Merced Nursing UC Davis Nursing UC San Francisco Biola University Cal State University Chico Cal State Chanel Islands Nursing Cal State University Bakersfield Cal State University Northridge, Nursing Cal State University, Long Beach Nursing Cal State University, Fullerton Nursing Cal State Fresno Nursing Cal State University Stanislaus Cal State University Northridge Cal State University Los Angeles National University Nursing West Coast University Nursing Mount Saint Mary’s University Los Angeles Nursing Point Loma Nazarene University San Diego State University Nursing San Francisco State University Sonoma State University West Coast University Western Governors University Tori's NICU NURSE BLOG: See Blog Post Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms AmbassadoR & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

As a New NICU nurse I was so overwhelmed by the amount of medical "jargon" I needed to learn. (In addition to learning the best way to change a babies diaper...yes there is "the best way!") Here is a list of terms we use daily in the NICU setting & small (hopefully) helpful description of each. While you are in the Neonatal Intensive Care Unit as a new nurse or parent you will hear the doctors & nurses speaking in what seems to be a foreign language. Understanding these words and adapting to this NICU culture can be quite a challenge. I have compiled a list of common terms here to help you in this process! NICU Terms A's & B's an abbreviation referring to episodes of apnea and bradycardia; see APNEA and BRADYCARDIA. ANEMIA less than the normal number of red blood cells in the blood. APNEA The cessation of breathing <20 seconds ASPHYXIA A condition where there has been a lack of sufficient oxygen to the tissues of the body. The brain and the kidneys are the most sensitive organs to a lack of oxygen. ASPIRATION Breathing a foreign material (such as formula, stomach fluids, meconium, etc.) into the lungs. ATTENDING PHYSICIAN a doctor who has the primary responsibility for coordinating the medical care for a patient. In the NICU this will generally be the neonatologist. “BAGGING”  A slang term often used in the NICU meaning, to pump air into the baby’s lungs using oxygen and a rubber bag. This method is used temporarily to help a baby who needs help breathing. "BLOW BY” A slang term often used in the NICU meaning, to give a baby a small amount of oxygen through a tube pointed towards the nose. BILIRUBIN A yellow-pigmented waste product that forms when the body naturally eliminates old red blood cells. It may make the skin and eyes look yellow. In premature infants, they are often put under fluorescent light or on a bili blanket to help the levels come down. BLOOD GAS A blood test used to evaluate an infant’s level of oxygen, carbon dioxide, and acid. This helps to evaluate an infant’s respiratory status. BRADYCARDIA (Brady) A slowing of the baby’s heart rate. BILILIGHTS (Phototherapy) special lights used in the treatment of jaundice; see JAUNDICE. BILIRUBIN A breakdown product of red blood cells. See JAUNDICE. BLOOD GASES The amounts of oxygen, carbon dioxide and degree of acidity in the blood. A small amount of blood is taken from the heel (by heel stick), umbilical catheter or from the artery near the wrist where your pulse is felt to test for these levels. BLOOD PRESSURE (BP) The pressure of the blood in the arteries with each pulsation of the heart. BRADYCARDIA An abnormally slow heart rate. CARDIOLOGIST A medical doctor who specializes in the heart and circulation. CASE MANAGER A staff member who interfaces with insurance agencies regarding medical necessity and length of stay, as required, helps with discharge planning, arranging for medical equipment and visiting nurses when necessary, and makes referrals to CCS for medically eligible infants. Many insurance companies also have CASE MANAGERS who are assigned to customize and individualize benefits for those with extensive or complex health care needs. CBC (Complete Blood Count) A count of the various types of cells present in the blood, chiefly: red cells (for carrying oxygen), white cells (for fighting infection), and platelets (for prevention of bleeding). CCS (California Children's Services) a state agency, operating by county, which assists with medical benefits and ongoing therapies for infants and children who meet certain diagnostic criteria. CENTRAL CATHETER or CENTRAL LINE a thin, flexible tube (catheter) placed in a larger vein or artery to deliver medications or necessary fluids and nutrients to the body. Broviac catheters are usually placed in the upper chest and tunnel under the skin to enter the vena cava, the large blood vessel in the center of the body carrying blood to the heart. PICC lines (percutaneously inserted central catheters) are usually threaded through a vein in the arm to the vena cava. Central catheters also include umbilical venous and umbilical artery catheters which may be inserted into the vein or artery of the umbilical stump (belly button) shortly after birth. CHEMSTRIP a test in which a drop of the baby's blood is placed on a strip of special paper to determine the amount of sugar in the blood. CHEST TUBE A small plastic tube placed through the chest wall into the space between the lung and chest wall to remove air or fluid from this space. See PNEUMOTHORAX. CIRCUMCISION A surgical procedure done to remove the foreskin of the penis. Usually done just before the baby goes home and only on request. CONGENITAL Existing at the time of birth.: CHRONOLOGICAL AGE A baby’s age based on their actual birthday. CORRECTED AGE A baby’s age based on their gestation. CPAP Continuous Positive Airway Pressure - a form of ventilator assistance which helps to keep the baby's lungs properly expanded. CPAP does not breathe for the baby, but allows the baby to breathe into a "wind." CT SCAN (of the head) Computerized x-rays which show the size and position of many parts of the brain. A CT scan also can be done on other parts of the body. The baby must go to another area of the hospital to have a CT scan. CULTURE A laboratory test of blood, spinal fluid, urine, or other specimens which shows if germs are present and which ones they are. CYANOSIS Blue color of the skin occurring when there is not enough oxygen in the blood. DIFFERENTIAL A test which divides the white blood cell count (from the CBC) into several categories, chiefly: "polys" (short for polymorphonuclear leukocytes), "bands" (immature "polys"), "lymphs" (lymphocytes), "monos" (monocytes), "cos" (eosinophils), "basos" (basophils). The percentages of each cell type may vary in different kinds of infections; for example, polys and bands usually will predominate in bacterial infections, while the number of lymphs usually will increase in viral infections. ECHOCARDIOGRAM A test done to look at the heart using soundwaves through the chest wall. This is much like an ultrasound done during pregnancy and is neither harmful nor painful. EDEMA "Puffy" skin from a build-up of fluid in body tissues. ENDOTRACHEAL TUBE (ET Tube) A plastic tube which goes from the baby's nose or mouth past the vocal cords and into the upper trachea (windpipe). EXCHANGE TRANSFUSION A treatment which removes the baby's blood in small quantities and replaces it with donor blood. This procedure is used most frequently to lower the level of bilirubin in the baby's blood. (See also Jaundice.) It also may be used to raise or lower the number of red blood cells, and improve the ability of the blood to clot. EXTUBATION removal of a tube which has been placed through the nose or mouth into the trachea; see ENDOTRACHEAL TUBE. FELLOW (in Neonatology) A trained pediatrician who is receiving additional specialized training in the care of sick newborns. GAVAGE FEEDINGS (Tube Feedings or NG- Nasal Gastric Tube):   Providing nutrition through a plastic tube passed through the baby’s mouth or nose and into the stomach; when the baby is too weak or too premature to suck and swallow. GENETICS the branch of medicine that deals with heredity, the variation of individuals, prognosis for development and function, and risks of recurrence of genetic conditions. HEART MURMUR A rushing sound made by the blood within the heart, usually heard with a stethoscope. This may or may not be a sign of a problem for a baby. HEELSTICK A quick prick of the heel with a sterile instrument (much like a finger prick) to obtain small blood samples for tests. HEMATOCRIT (crit) A test done to determine if the amount of red blood cells in the blood is adequate. HUMOR, SENSE OF Something you used to have before your baby was in the NICU. Don't lose your sense of humor, it helps parents get through these difficult times. HYDROCEPHALUS an abnormal accumulation of cerebrospinal fluid (the normal fluid which bathes the brain and spinal cord) in the ventricles of the brain. HEAD ULTRASOUND (HUS): A painless test that uses sound waves to look at a baby’s brain. This test can be done at the bedside in the NICU.  "HEEL STICK”:  A slang term often used in the NICU meaning, to obtain a blood sample by pricking the baby’s heel. HIGH-FREQUENCY OSCILLATORY VENTILATOR A special ventilator capable of breathing for a baby at rates exceeding those of a normal ventilator. HYPOTENSION Low blood pressure. HYPOGLYCEMIA A low amount of sugar (glucose) in the blood. I:E RATIO The ratio of the length of the forced breath provided by a ventilator to the length of the time between two breaths. INFILTRATE (IV Inflitrate) the slipping of an IV needle out of a vein, allowing IV fluid to accumulate in the surrounding tissues. INTRAVENOUS (IV) THERAPY A small plastic tube or hollow metal needle placed into one of the baby's veins, through which fluids, sugar, and minerals can be given when the baby cannot take all of his nourishment by feedings. INSPIRATORY TIME (IT) The length of a forced breath provided to the baby by a ventilator. INTRAVENTRICULAR HEMORRHAGE (IVH) A collection of blood in and around the ventricles (hollow portions) of the brain. INTUBATION   Inserting a tube into the trachea (windpipe) through the nose or mouth to allow air to reach the lungs. See Endotracheal Tube. "I's and O's” A slang abbreviation often used in the NICU meaning, the amount of fluid, (IV and feeds) baby takes in compared to how much the baby pees and poops out. ISOLETTE OR INCUBATOR: A type of enclosed bed for an infant who is not mature or well enough to maintain her body temperature in an open crib. JAUNDICE A yellow coloration of the skin and eyes caused by increased amounts of bilirubin in the blood. Bilirubin is a break-down product of red blood cells; it is processed and excreted by the liver. Treatments for jaundice include phototherapy ("bili-lights") and (rarely) exchange transfusion. LUMBAR PUNCTURE ("Spinal Tap") A procedure in which a small needle is placed in the small of the back, between the vertebrae (back bones), to obtain spinal fluid for bacterial cultures and other tests. KANGAROO CARE Skin-to-skin care where the baby is placed on the bare chest of the mother or father. MECONIUM The first bowel movements that a baby has which are thick, sticky, and dark green to black in color. MECONIUM ASPIRATION MAS (Meconium Aspiration Syndrome) The inhalation of meconium into the lungs. If a baby passes meconium before delivery, the meconium may be inhaled into the lungs, causing problems with breathing after the baby is born. This condition is called meconium aspiration syndrome (MAS). MENINGITIS Infection of the fluid that cushions and surrounds the brain and spinal cord. MRI (Magnetic Resonance Imaging) A computerized method of viewing any portion of the body. It uses magnetism rather than x-rays. All metal must be removed from around the baby. The baby must go to another area of the hospital to have an MRI. Monitor :  A machine that displays the heart rate, respiratory rate, blood pressure and blood oxygen saturation of the baby. NASAL CANNULA A clear plastic tube which passes under the nose to provide supplemental oxygen. NECROTIZING ENTEROCOLITIS (NEC) An infection of the wall of the intestines, which may spread to the blood. Premature babies are particularly vulnerable to this disease. Surgery is sometimes necessary to remove damaged intestine, and the baby may need prolonged feeding by vein until he recovers. See also PARENTERAL NUTRITION, SEPSIS. NEONATOLOGY The medical specialty concerned with diseases of newborn infants (neonates). Neonatologists are pediatricians who have received several years of additional training. NEPHROLOGY A medical doctor who specializes in disorders of the kidneys. NEUROLOGIST A medical doctor who specializes in the brain and nervous system. NPO Latin abbreviation for “nothing by mouth.” If the baby is kept NPO, all nutrition will be given intravenously. OPHTHALMOLOGIST A medical doctor who specializes in disorders of the eye. OTOLARYNGOLOGIST A medical doctor who specializes in the ear, nose, and throat. PNEUMOTHORAX A collapsed lung- the collection of air in the space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath. PHOTOTHERAPY Light therapy to treat jaundice. Bright blue fluorescent lights, called bililights, are placed over the baby’s incubator or the baby may be placed on a blanket that also shines the light up to the baby. PARENTERAL NUTRITION (also called Total Parenteral Nutrition, or TPN) Protein and sometimes fats (lipids) given along with sugars and salts by vein when the baby cannot tolerate complete feedings by nipple or gavage. PATENT DUCTUS ARTERIOSUS (PDA) A small vessel which allows blood to bypass the lungs. This vessel is open while the baby is in the womb, but normally closes shortly after delivery. If the vessel fails to close on its own, special medication or surgery may be needed. PEAK INSPIRATORY PRESSURE (PIP) The highest pressure that is delivered to the baby by the ventilator during a forced breath. PEDIATRICIAN A medical doctor who specializes in infants and children. PEEP See POSITIVE END-EXPIRATORY PRESSURE. PHOTOTHERAPY A treatment in which the baby is placed under bright lights (frequently blue in color) or on a special light blanket which helps bilirubin to be excreted into the intestine. See also BILIRUBIN, JAUNDICE. PERIPHERALLY INSERTED CENTRAL CATHETER (PICC Line) A PICC is a line inserted through a vein and then advanced through increasingly larger veins, toward the heart. Used when IV therapy, antibiotics, or nutrition (TPN/lipids) are administered for a long period of time.A thin, flexible tube (catheter) placed in a larger vein or artery to deliver medications or necessary fluids and nutrients to the body. Broviac catheters are usually placed in the upper chest and tunnel under the skin to enter the vena cava, the large blood vessel in the center of the body carrying blood to the heart. PICC lines (percutaneously inserted central catheters) are usually threaded through a vein in the arm to the vena cava. Central catheters also include umbilical venous and umbilical artery catheters which may be inserted into the vein or artery of the umbilical stump (belly button) shortly after birth. PIP see PEAK INSPIRATORY PRESSURE. PKU A rare disorder in which one of the amino acids (a building block of protein) cannot be handled normally by the baby, leading to elevated levels in the blood. Babies with PKU require a special diet. All babies are routinely tested for PKU, as well as several other disorders, before going home from the nursery. This test is required by law. PNEUMOMEDIASTINUM Leakage of air from the normal passageways of the lung into the space surrounding the heart inside the chest. A pneumomediastinum is usually harmless in itself, but is often associated with a pneumothorax (which can be life-threatening if large). See PNEUMOTHORAX. PNEUMOTHORAX Leakage of air from the normal passageways of the lung into the space surrounding the lung inside the chest wall, causing a partial or complete collapse of the lung. POSITIVE END-EXPIRATORY PRESSURE (PEEP) The lowest pressure that is delivered by the ventilator to the baby between forced breaths. See also PEAK INSPIRATORY PRESSURE (PIP). PROGNOSIS What is expected in the future. RED BLOOD CELLS The cells in the blood which carry oxygen. REFLUX A return or backward flow; gastroesophageal (GE) reflux occurs when portions of feedings or other stomach contents flow back up into the esophagus. REGIONAL CENTER One of a network of state-funded agencies which helps to coordinate community services and resources to infants at risk of having a developmental delay; also provides services and coordination of resources to children and adults with specific developmental disabilities. RESIDENT (Pediatric) A medical doctor who is training to become a Pediatrician. A residency program is usually three years long. First year residents are sometimes referred to as interns. Third year residents are sometimes called senior residents. RESPIRATORY DISTRESS SYNDROME (RDS) A common breathing problem of premature infants caused by insufficient surfactant in the baby's lung. This results in an excessive stiffness of the baby's lungs. See also SURFACTANT SEIZURE A "short circuiting" of the electrical activity in the brain, sometimes causing involuntary muscle activity or stiffening. There are many causes of seizures. If your child has a seizure, speak with your baby's doctor about this condition and its implications. SEPSIS A potentially fatal and dangerous condition in which the body is fighting a severe infection that has spread via the bloodstream. Infection of the blood. See also MENINGITIS, NECROTIZING ENTEROCOLITIS. SEPTIC WORKUP An assortment of tests is performed on an infant who is suspected of having an infection. This may include a chest x-ray and/or abdominal x-ray, as well as blood, urine, and spinal fluid cultures. Because infections in babies can progress very rapidly, the baby is frequently started on antibiotics until the results of the cultures are known. SPINAL TAP/LUMBAR PUNCTURE (LP) A procedure in which a needle is inserted into the lower spine to obtain spinal fluid. SUCTIONING the process of removing secretions from the baby’s nose, mouth or lungs by using either a bulb syringe or suction catheter. SURFACTANT A material secreted by special cells within the alveoli (air sacs) of the lung, which makes the lung flexible and helps to keep the lung from collapsing. Deficiency of surfactant is the main problem in Respiratory Distress Syndrome (RDS). Commercial products are available which can be put into the lungs through the tube in the windpipe. These products frequently are very helpful to the premature baby with RDS. TACHYCARDIA:  A fast heart rate. TACHYPNEA:  A fast breathing rate. TRACHEOSTOMY A surgical opening in the trachea, below the larynx (voice box) to allow air to enter the lungs; usually done to by-pass a narrowing in the area immediately below the larynx. TRANSFUSION Giving donated blood to the baby by vein or artery. ULTRASOUND OF THE HEAD A test done using soundwaves which shows an image of the brain. The test is not harmful or painful to the baby and may be done at the bedside. UMBILICAL CATHETER A small plastic tube in one of the umbilical (belly button) blood vessels (either an artery or a vein). WEAN   To take away gradually. In the NICU, it is often used to describe the process of removing an infant from a ventilator or incubator. Learning your A, B, D’s (apnea, bradycardia, desats) will help you better understand your baby's journey through the NICU. You will soon, not only be accustomed to the lingo, but you too will be speaking this newfound language with ease. HEAD OVER TO THE PODCAST! EPISODE 1 & 2 ANSWER MANY NICU 101 QUESTIONS! Another great resource for you BELOW. I was featured on The Morning Rounds and talked all things NICU Nursing. Dynamics, my personal journey, NICU Nurse Tips & Tricks! NICU Nurse Essential Resources American Academy of Pediatrics Academy of Neonatal Nursing Childhood & Adult Immunization CDC Guidelines March of Dimes! Resources for parents & providers Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories National Association of Neonatal Nurses National Certification Corporation - NICU National certifications for experienced nurses NICU University & Peds University Vermont Oxford Network - 1,300 hospitals collaborating around the world! Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

The NICU is a complex unit full of tiny brand new fighters. One diagnosis is certainly our most common admission. Typically babies require about 270 days to fully develop in the womb, after which they are usually ready to make the transition to life on the outside. When babies are born too early, many of their body's organs and systems are immature and unable to function properly on their own. Fortunately, medical science has the ability to help those babies stay alive until they can sustain themselves. A premature baby is one who is born too early, before 37 weeks. Premature babies may have more health issues and may require hospitalization longer than babies born term or closer to term.  Even the most stable of former extremely preterm infants will be challenged by various degrees of lung disease, extra‐uterine growth challenges, difficulty learning oral skills, and even late-onset sepsis during this time period. One of the most common ..... Respiratory Distress! Breathing difficulties are one of the most common issues for premature babies! SO, WHAT CAUSES BREATHING DIFFICULTIES IN PREMATURE INFANTS? Respiratory The primary function of the lung is to transport oxygen from the inspired air into the blood and to clear accumulated carbon dioxide from the blood. The site of this gas exchange is the alveolus Breathing difficulties develop in premature babies for many reasons. One of the main being their lungs don't have the full chance to reach full maturity in the womb. Breathing complications in premature babies are caused by an immature respiratory system. Immature lungs in premature babies often lack surfactant. This substance is a liquid that coats the inside of the lungs and helps keep them open. Without surfactant, a premature baby’s lungs can’t expand and contract normally. This increases their risk for respiratory distress syndrome . Some premature babies also develop apnea and experience pauses in their breathing lasting for at least 20 seconds. Some premature babies who lack surfactant may need to be put on a ventilator (breathing machine). Babies who are on a ventilator for a long time are at risk of developing a chronic lung condition called bronchopulmonary dysplasia . This condition causes fluid to build up in the lungs and increases the likelihood of lung damage. Treatment: While being on a ventilator for an extended period of time may injure a baby’s lungs, it still may be necessary for the baby to receive continued oxygen therapy and ventilator support. Doctors may also use diuretic and inhaled medications. MOST COMMON RESPIRATORY CONDITIONS: 1. Respiratory distress syndrome (RDS) Symptoms include rapid, shallow breathing and a sharp pulling in of the chest below and between the ribs with each breath. 2. Bronchopulmonary dysplasia , a chronic lung disease, is commonly seen in preemies who weigh less than 1,000gm or <28 weeks Gestational Birth. It can be caused by the long-term use of oxygen and mechanical respiration. 3. Apnea  is a condition characterized by prolonged pauses in breathing. Apnea is usually caused by immaturity in the part of the brain that controls involuntary respiration. Let’s talk NICU patients & of different modes of Respiratory Support for our NICU Patients. AIRWAY IS EVERYTHING... The primary function of the lung is to transport oxygen from the inspired air into the blood and to clear accumulated carbon dioxide from the blood. The site of this gas exchange is the alveolus 4. Alveolarization is a process where existing airspaces are subdivided by the formation of new walls, called septa. Therefore, in the NICU we rely on our Respiratory therapists (ALL THE TIME!). Many NICU units have primary care NICU RT’s that specialize in Preemie care. You might call Nurses & RTs “Besties!” TYPES OF VENTILATORS & NICU SUPPORT: 1️. HFOV (High-Frequency Oscillator Ventilator) Gas is pushed into the lung during inspiration and actively pulled out during expiration (Push/Pull Action). Uses small tidal volumes and active exhalation. HFOV provides smaller, faster, but shorter bursts of breaths which may be less damaging to the premature lungs. 2. SIMV “Conventional” Synchronized Intermittent Mandatory Ventilation : (Breaths delivered at a set pressure) Initiation of each breath is a ventilator breath in synchrony with the patient’s breath.  PIP, PEEP, and Inspiratory time are set 3️. CPAP (Continuous Positive Airway Pressure) Continuous positive airway pressure (CPAP) is a mode of ventilatory assistance in which positive pressure is delivered to the airway throughout the respiratory cycle. CPAP is delivered through a set of nasal prongs or through a small mask that fits snugly over a baby's nose. CPAP is used to deliver constant air pressure into a baby's nose, which helps the air sacs in the lungs stay open and helps prevent alveolar collapse. 4️. NIPPV (Nasal Intermittent Positive Pressure Ventilation) Provides a set number of breaths per minute (Delivered at a set pressure) In NIPPV, CPAP provides a constant distending pressure & added ventilator support (add back up rate & pressures) (ventilator with no ETT). It is also referred to as continuous distending pressure (CDP) or positive end expiratory pressure (PEEP) when applied through a ventilator along with intermittent mandatory ventilation (IMV). 5️. HFNC (High Flow Nasal Cannula) This is a small plastic tube that goes into the babies nose; Humidified with increased oxygen/air potential. The air-oxygen flow (via blender) of 1-6 L/min. 6️. NC- Nasal Cannula Small plastic tubes that go into your baby’s nose. Air and oxygen go through the tubes into your baby’s lungs. 7️. iNO (Inhaled Nitrous Oxide) T his is a gas we deliver with our intubated babies to help improve gas exchange. iNO is a vasodilator which can help improve respiratory failure through enhanced ventilation–perfusion matching and/or a reversal of extrapulmonary shunting. (Used in very sick babies) I will do another Medical Monday explaining more! 8. Oxygen blenders allow O2 concentration to be adjusted between 21% and 100%. Quick Terminology: pH : amount of acid in blood  Acidic: lower pH, associated with pulmonary edema, renal failure, and lactic acidosis  Alkalotic: higher pH, associated with hyperventilation, anxiety, pain, hypokalemia, and gastric suctioning CO2 : acid from the lung; reflects respiratory status of acid‐base balance PO2 : partial pressure of oxygen dissolved in blood; and how well oxygen moves from lungs ‐> blood decreased levels = anemia and hypoventilation HCO3 : a base excreted or removed by kidneys; reflects the metabolic acid‐base balance Base excess (BE) : amount of acid required to restore a liter of blood to a normal pH, possible marker of metabolic acidosis or alkalosis Blood gas skeleton example: pH / PCO2 / PO2 / HCO3 / SaO2 / BE The use and the details of management with these techniques should be discussed with the Neonatology Fellow or the Attending Physician for each individual patient. In the era of gentle ventilation and open lung strategy noninvasive ventilatory support in neonates has gained momentum and its use in nurseries around the world is also increased. Another great resource for you BELOW. I was featured on The Morning Rounds and talked all things NICU Nursing. Dynamics, my personal journey, NICU Nurse Tips & Tricks! Tori's Tips on NICU NURSE 101: See Blog Post Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms AmbassadoR & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

What is the “Golden Hour”?! What do NICU Nurses do in the Golden Hour? THE GOLDEN HOUR "Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The “Golden hour” concept includes practicing all the evidence-based interventions for the term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcomes. Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants. The first 60 minutes of a premature infant’s life is considered the “Golden Hour”. Care and treatment provided during the first hour of life can mean the difference between life and death or long-term health problems. In recognition that some of its processes were not meeting best practices (e.g. administering antibiotics within one hour), hospitals around the country use lean methodologies and process improvement techniques to standardize practice for all premature infants admitted to the Neonatal Program. Although the current evidence supports the concept of the golden hour in preterm and still there is no evidence seeking the benefit of the golden hour approaches in term neonates, neonatologists around the globe feel the importance of the golden hour concept equally in both preterm and term neonates. The initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborns to the neonatal intensive care unit, respiratory and cardiovascular support, and an initial course in the nursery. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In this review article, we will discuss various components of neonatal care that are included in the “Golden hour” of preterm and term neonatal care. Conditions We Treat in the NICU Apnea Brain Bleeds Bronchopulmonary Dysplasia (BPD) Cerebral Palsy (CP) Complex Birth Defects Congenital Diaphragmatic Hernia Down Syndrome Extreme Prematurity Feeding Disorders Gastroesophageal Reflux Gastroschisis Hyaline Membrane Disease Jaundice (Hyperbilirubinemia) Meconium Aspiration Meningitis Metabolic Diseases Necrotizing Enterocolitis (NEC) Neonatal Abstinence Syndrome Patent Ductus Arteriosus (PDA) Perinatal AsphyxiaPrematurity Pulmonary Hypertension Respiratory Distress Syndrome: Newborn Retinopathy of Prematurity Seizures and Epilepsy in Children Sepsis Spina Bifida Myelomeningocele Transient Tachypnea Twin to Twin Transfusion BASELINE PATIENT ASSESSMENT What makes the NICU so unique is our patients are brand new. And often unpredictable. In addition, we must learn about this brand new baby quickly! FORTUNATELY for these babies, special newborn care is available, THE NICU. NICU “GOLDEN HOUR” BEDSIDE NURSE TASKS 1. Prepare the bed (isolette or warmer) 2. Turn on warmer 3. Attach temperature probe 4. Place electrodes & pulse ox probes 5. Take temperature 6. Measurements (Head circumference, length, weight) 7. Suction available (oral & nasal) 8. Oxygen as needed (neopuff or mask) 9. Intubation (breathing tube) if necessary 10. Blood pressures 11. Vital Signs (Heart Rate, Respiratory, Temperature) 12. Head to Toe Assessment 13. Skin assessment 14. Sacral Dimple Check 15. Nare /Throat Patency nose 16. Collect Labs (CBC, Type & Cross, MRSA, Blood Cultures) 17. IV access (UVC/UAC or peripheral IV) 18. MD or NP / RN assess Ballard Neonatal Reflexes 19. Start antibiotics if needed 20. Blood Glucose 21. Review Newborn Delivery Room History 22. Review Maternal Mother History 23. Orient Mother & Father to Unit as available 24. Eyes & Thighs! (Erythromycin and Vitamin K) 25. Obtain Orders 26. CHART!! The Golden Hour Protocol reviews a baby’s health status at one hour after admission in five critical areas: respiration, cardiovascular function, neurological response, fluid and glucose levels, and body temperature. The results from each of these five areas determine the infant’s health status: red (acute) zone requiring immediate interventions, yellow zone requiring close monitoring, or green zone where the infant is responding well to stabilization. Small Baby Recommendations ~ Post Admission 1st 72 hrs of life: Keep head midline Head of bed elevated 30 degrees * Two person cares (one person provides containment throughout) Do not raise legs with diaper changes No weights or abdominal girths Minimize handling, suctioning & movement in space With UAC lab draws, 40 second pull/40 second push per 1ml (set timer) ** No peripheral BP’s if UAC line present No prone positioning or skin-to-skin holding (encourage “hand hugs”) Do not forget Colostrum swabbing Administer a loading dose of caffeine in 1st 24 hours, maintenance dosing beginning the following day (if applicable to gestation) Complex decisions are based on Diagnoses, Age, & Weight! NICU Nurse Essential Resources American Academy of Pediatrics Academy of Neonatal Nursing Childhood & Adult Immunization CDC Guidelines March of Dimes! Resources for parents & providers Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories National Association of Neonatal Nurses National Certification Corporation - NICU National certifications for experienced nurses NICU University & Peds University Vermont Oxford Network - 1,300 hospitals collaborating around the world! Tori's Tips on NICU NURSE BLOG: See Blog Post s ​ Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

NICU practice and Evidence-Based Research is constantly changing. Many of the practices I have seen over the past 9+ years have changed with updates, new technology, procedures, and treatments, with a movement to push our patient population forward with improved outcomes! Here are a few topics to consider when searching for a research project, paper, or developing an abstract for your project! Many of these are controversial with a lot of different research supporting various outcomes. NICU Research Project Ideas DOUBLE JEOPARDY. WHAT DO WE KNOW AND WHAT CAN WE DO? Common comorbidities of prematurity. Intraventricular hemorrhage Bronchopulmonary Dysplasia Necrotizing Enertocolities Retinopathy of Prematurity Sepsis Congenital heart Disease (CHD) NEC! WHAT FACTORS INCREASE THE RISK OF NEC? Standardization of assessments and treatments, Pneumoatosis, Is Clonic Pneumotosis real?, Treatment and feeding decisions, Guidelines, Antibiotics, Parenteral Nutrition, Vascular Access, Imaging Modalities, Hemodynamics, disease entity, restriction of systemic blood flow, generalized cyanotic state, Congenital Heart Disease (CHD). https://www.nature.com/articles/pr2016215 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181543/ SMALL BABY STANDARDIZATION OF CARE The formation and focus on standardizing ELBW and VLBW care. Guidelines, standardization, and streamlined care. Feedings, humidity, positioning, weights, lab draws central line management, RDS management, guidelines for incubations/extubations, weaning from isolette to crib, developmental considerations by gestational age. https://engagegrowthrive.com/small-baby-care-specialist-program/ https://pubmed.ncbi.nlm.nih.gov/34330869/ PROBIOTICS! The use of probiotics in practice (to use or not to use them). Gut flora. The pros and cons. Latest research in preventing NEC. Is this a preventative measure? Which probiotic products to consider? Lactobacillus, dual strains, and possible side effects or contraindications. https://www.sciencedirect.com/science/article/abs/pii/S0378378219302932 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303425/ https://www.degruyter.com/document/doi/10.1515/jpm-2019-0268/html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805101/ PDA TREATMENT Treatment of PDA. When to treat it and what modalities to treat it with…Indomethacin, PICCOLO PDA closure device, PEEP, etc). Risk vs Benefit. Clinical signs and symptoms. https://www.sciencedirect.com/science/article/abs/pii/S0022347618309181 https://www.sciencedirect.com/science/article/abs/pii/S0146000518300326 SKIN TO SKIN Skin to skin (myth-busting nicu dynamics when parents can’t hold). Developmental considerations. How to support families during the initial times with inability to hold baby. https://www.sciencedirect.com/science/article/abs/pii/S1751485118302356 https://connect.springerpub.com/content/sgrnn/37/6/343.abstract?implicit-login=true https://connect.springerpub.com/content/sgrnn/36/2/89?implicit-login=true PAIN MANAGEMENT IN THE NEONATE Anesthesia / Sedation! What is too much? What is not enough? Neurodevelopment perspectives with Gestational age & disease process. Nociceptive stimuli. Neuroapoptosis. Pain consequences with unrelieved pain, sleep, fatigue, and inflammatory response. Pre and Post-op considerations. The first line of pain relief modalities. Benzodiazepines, Opiates, Alpha 2 Agonists (Dexmedetomidine, Clonadine), Sweeties, Positioning etc. https://journals.lww.com/advancesinneonatalcare/Abstract/2009/12000/Exploring_Barriers_to_Pain_Management_in_Newborn.10.aspx https://www.nature.com/articles/jp201788 https://www.sciencedirect.com/science/article/abs/pii/S0146000516301161 BLOOD PRESSURE GOALS & STANDARDIZATION Lack of standardization within the NICU patient population. What is too low? What is too high? Treating symptoms. What line of hemodynamic modalities to turn to? (Epi / Vasopressin / Dopamine) https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0041-1726123 https://www.sciencedirect.com/science/article/abs/pii/S0022347620302869 VENTILATOR STRATEGIES Specific considerations for Gestational age, disease-specific treatments. Optimal PEEP, Low peak inflation/TV. Use of surfactant. Surfactant deficiencies (RDS), Corticosteroids, Alkalosis etc. https://www.nature.com/articles/s41372-022-01399-1 SATURATION TARGET GOALS Optimizing neurodevelopment, Target pre ductal SpO2. Oxygen should be used like any other drug; with potential benefits and side effects. Positioning considerations. https://fn.bmj.com/content/96/2/F93.short https://publications.aap.org/pediatrics/article-abstract/136/2/e496/33808/Balancing-the-Tension-Between-Hyperoxia-Prevention PALLIATIVE CARE Multidisciplinary approach. Women facing pregnancies with a diagnosis of complex congenital or life-threatening conditions. Limitations in choices. Support during pregnancy, delivery, post-partum, and beyond. https://journals.lww.com/advancesinneonatalcare/Abstract/2020/04000/Preparing_Nurses_for_Palliative_Care_in_the_NICU.9.aspx?context=LatestArticles https://journals.lww.com/co-pediatrics/Abstract/2017/04000/Neonatal_palliative_care.3.aspx PRETERM INFANTS WITH CHD Congenital Heart Disease issues. Cyanosis (TOF & TGA), pulmonary venous obstruction, (TAPVD, MS), Preoperative care, Preoperative pulmonary vasculature/reactivity (Trisomy 21, post RSV, transitional circulation). Neurodevelopment risk associated with prematurity. Restricted oxygen and insufficient nutrient delivery in utero. https://assets.researchsquare.com/files/rs-1741684/v1/9490f182-82ce-4cc9-b3f9-40689bd5b67c.pdf?c=1655971172 BREAST MILK PRODUCTION & BREASTFEEDING INITIATIVES The push for breast is best (doesn’t always work in the NICU). Breast milk production, the latest Evidence-Based Research to support mothers. Hope this list helps you in your NICU Research! These are all very relevant in our NICU care with continued improvements in Evidence-Based Research! The more minds and research we can put to these topics the better. Feel free to drop your suggestions and comments below! Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012 and works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey in married life & juggles work, school, and content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

There are so many things that come to mind when I tell someone “I am a NICU Nurse” Normally their response goes something like, “Wow, that must be so hard and so sad to work with sick babies. How do you do that?” Yes, that is a true statement. I could tell you about the babies born VERY early struggling for their lives. Babies Born: Far too early, To drug addicted mothers, With life altering diagnosis, Requiring emergent surgeries, Parents who don’t always care, Requiring harsh procedures our tiny patients must endure, Needed many surgeries (more than most adults), The micro preemie “death spells” each preemie faces any time their bodies face discomfort, The clinical trials we must try (to help more babies in the future), The diagnostic tests: Heart ECHO’s, Head Ultrasounds, & Chest X-rays etc.! Our preemies must endure all of this in order for us to monitor their well-being! Add the sterile line changes we must do to protect our most vulnerable, The meticulous scrubbing, chlorhexidine wiping, sanitizing, sterile gloving, painful hand washing so much so because I don’t’ want to be the reason a baby gets a blood stream infection. I could tell you about the many orgiastic and nasogastric tubes I have inserted over and over due to little hands pulling them out (or retching them out), and the sadness I have experienced sitting in on a family conference while parents try to comprehend their new babies life altering diagnosis. The many conversations I have had with mothers over the phone at 2AM asking “how is my baby doing, will she survive this?” I could tell you about the frustration I have had with Attendings, NNP, PAs, Surgeons, Specialists, or Practitioners when I advocate for my baby “Something is wrong,” only to have a reply of “Tell the Resident,” or “Continue to monitor the baby.” I could tell you about the nights & days I literally don’t sit or drink an ounce of water trying to complete a septic work up because my baby is going septic and needs my full attention. The amount of codes where a baby is truly hanging on for dear life. I could tell you about the tears I have wiped from a mother’s cheek while taking a baby off of life support as her baby passes in her arm. And the wailing from her lungs as she asks “Why is this happening to my baby?” Where the pain is so hard I have to escort other family out of the room to relieve the parent’s personal anxiety. I could try to explain to you how hard it is to maintain professional boundaries when you have invested so much time, love, and tender care to my “special baby.” And how hard it is, when “due to staffing” I can’t care for the baby and must take another assignment. And the times I feel I didn’t do enough for my patient, cry in the break-room or in the hall, to take a few minutes to compose myself. ​ BUT I COULD ALSO TELL YOU The feeling of giving a baby it’s first bath with mom and dad (helping them with wires, and tubes) and making it feel special! I could tell you about the hugs, happiness, and smiles when I walk into the room as the Nurse coming on to care for their baby. I could tell you about feeding a baby his or her first bottle with mom or attempting to breast feed for the first time after 3 months! And laughing as dad burps the baby for the first time. I could tell you about my stealth moves tiptoeing in the darkness to check my baby in their isolate and the Cirque du Soleil moves I make to prevent breaking a sterile field. I could tell you about Kadence, Faith, Talia, Christopher, and so many more patient’s where I build long lasting, loving, relationships with my families as their “favorite nurse,” or “mommy nurse” and the feeling I get being able to care for their baby. ​ I could tell you about the feeling of being able to SEND YOUR BABY HOME, and the immense happiness I get from being the nurse to take the last pulse ox & wires off their bundle of joy. I could explain the feeling of a babies tiny hand wrapped around my finger as I assess the pulses or change the leads on his/her chest. I could tell you about the immense pride I have for working at a leading Children’s Hospital where research, newest therapies, and outcomes are the BEST. I could tell you about the bonds I have created with co-workers, Respiratory therapists who are like family, OT/PT kindest sweetest most effective therapies provided, or Music Therapists (who I’m pretty sure I love just as much as the babies), & of course Doctors who know you by first and last name (and High Five you on your way into the unit). I could try to explain the happiness of the last hug before the family leaves the hospital & the amount of Thanks I receive someone seems my badge or NICU logo on my jacket. I could tell you…..but it wouldn’t be enough. These words would never fully explain what it is like to work with these tiny lives. Nothing can prepare you for the physical & emotional investment into this vocation. And that is the beauty of being a NICU Nurse. If you are seeking a more "in depth conversation" head over to check out my podcast! Episode 1, 2, and 10 are all great resources for you to hear more details about being a NICU Nurse, NNP, and the working dynamics of a level IV NICU! THE CELLFIE SHOW. CLICK HERE . Another great resource for you BELOW. I was featured on The Morning Rounds and talked all things NICU Nursing. Dynamics, my personal journey, NICU Nurse Tips & Tricks! NICU Nurse Essential Resources American Academy of Pediatrics Academy of Neonatal Nursing Childhood & Adult Immunization CDC Guidelines March of Dimes! Resources for parents & providers Access 1,300+ Drugs with Easy-to-Understand Lactation Risk Categories National Association of Neonatal Nurses National Certification Corporation - NICU National certifications for experienced nurses NICU University & Peds University Vermont Oxford Network - 1,300 hospitals collaborating around the world! Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, S ponsored Capella University MSN student , a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

If you have been a nurse for any length of time, you definitely have accumulated items that you routinely use for every shift. I have had some consistent items on my must-have shift list but have discovered some of the BEST products that have been a lifesaver in recent months. Let me put you on to 6 products that I feel every nurse should own. 1. Comrad Socks Comrad’s cute and comfortable compression socks are a game changer for anyone who is standing for long periods of time! Hello healthcare workers! There have been quite a few studies showing that compression socks should be worn in order to help prevent fatigue and blood clots. Our body’s blood circulation also has a direct effect on keeping our immune systems strong, so these compression socks are something I value more than ever while working amidst a pandemic. My personal favorite styles from Comrad are the Knee-High Striped Compression and the Knee-High Ombre Compression in Berry! I love how well they hold up after repetitive wearing and washing. With the amazing health benefits that these compression socks bring, I have been conscious to wear them beyond my hospital shifts. I started wearing them around the house post work-outs to aid in recovery and also wear them under my boots to horse- back ride. I am grateful to have these socks to keep my feet from hurting while I'm taking care of my patients! I especially LOVE that I don’t have to sacrifice style for comfort with these socks. Check out Comrad Socks here! https://www.comradsocks.com 2. Barco Scrubs Quality scrubs make a statement. Comfy and flattering scrubs are a nonnegotiable for nurses in 2020! Barco provides nurses with exceptional value and quality control. I love their eco-friendly fabric that utilizes temperature-regulating technology to keep me incredibly comfortable while feeling cool and fresh throughout my shifts. Barco’s Gray’s Anatomy Line are my absolute favorite! The feminine fit, custom tailored look, color array, and overall professional theme of their scrub lines have always attracted my eye which is why they have been my “GO TO” since day 1.  Find a Barco store near you here! https://www.barcouniforms.com/ store-locator/ 3. Sanita Clogs The most essential part of our day as nurses are our footwear. Pair Comrad socks with stylish Sanitas for happy feet! If you are looking for the most comfortable and stylish shoe for work you need to try a pair of Sanitas, the original Danish clog. Clogs have always been my choice of shoe with their easy slip-on, durable, and supportive style. As a brand new nurse I purchased my first pair of Sanitas clogs, fell in love, and still wear that original pair to this day. Not only is the durability and comfort there, but the look that a clog offers is so classy and professional. You can shop their latest styles here and use code NurseTori for 15% off your order! https://www.sanita.com 4. Mouthwash!! YES!! Mouthwash!! Masking up for 12-14 hour shifts has my skin breaking out like crazy even with my skincare product regime in full force! The hottest tip right now to combat maskne is to rinse your mouth out with disinfecting mouthwash every couple of hours. Exhaled bacteria through your mouth gets trapped under the mask and causes breakouts on the surrounding skin. I wear the same mask most of the day so this tip has truly saved my skin. I pour some mouthwash from my larger container at home into smaller, travel size bottles to carry with me in my workbag and car to use on the go. 5. Button Headbands Save your mask ear breakdown with a stylish headband! You can give your ears a rest by attaching your mask to the buttons on the sides of a cute headband instead. An L&D nurse at one of the hospitals I work at made me my first several button headbands and started my latest obsession. I have always loved wearing headbands paired with a bun to keep stray hairs out of and away from my face while working, but now have been enjoying the utility of these specially designed headbands that give my ears a break. Pick a pattern that expresses your unique vibes! 6. Stethoscope Being an L.A. nurse myself, I love that MDF Stethoscopes are also Los Angeles based. I have found MDF stethoscopes to provide optimal performance with premium, unparalleled sound. These stethoscopes come in a multitude of beautiful metal a