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

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

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

As a NICU nurse for more than 10 years, I can honestly say that about 95% of the time, I absolutely love what I do. It’s an incredible privilege to care for the tiniest patients and to witness the amazing things modern medicine can do to help them survive and grow. I never take that for granted. But this is about the other 5%. The 5% that comes with heartbreak. The 5% that stays with you long after your shift ends. The 5% that reminds you just how fragile life can be. Recently, I was part of the team caring for a baby and their family during one of those moments. It was one of the cases that really settled deep into my heart. The kind that follows you home, that sits with you in the quiet, that makes you pause and reflect on everything we see and experience in this work. When I need to process things, sometimes I write. And this time, the words just poured out. I don’t know if the family this was written for will ever see it. But I hope that maybe another NICU family will. Or another NICU nurse, respiratory therapist, doctor, or provider who might need it. Because that 5% is real.And no one should have to carry it alone. the angels you did not ask for You’re not supposed to know me. You’re not supposed to need my name. I step in quietly, gloved and steady, Then leave before the daylight comes again.   Some say we play God, In a world of black and white. But here, in the NICU, We live our lives in grey, especially at night.   Most nights blur into muscle memory: Deliveries, admissions, care times, charting, and scars. But some patients carve their names into us, Constellations we’ll carry long after they’re gone.   The hardest truth of what we do Is knowing we can’t fix it all. We can’t make every ending gentler Or silence every loved one’s call.   We are trained to mend and soften blows, To make it better, to restore. We are healers by design — But feelers, always asking for more.   This job asks us to pocket tears, To translate chaos, stand upright in fear, To armor up when the room collapses, Smile steady, then disappear.   Most days the shield fits just fine We tuck sadness neatly away. But some nights crack the surface, And grief refuses to stay contained.   This was one that etched my mind Lines and tubes, a careful design. Ventilator humming lullabies, Pumps in rhythm, all care plans aligned.   Everything where it should have been, Every protocol in sight. But what do you do when fixing it Is no longer an option tonight?   They saw you frozen in the corner, Disbelief written across your face. Your whole life shattered in a second, Time stopping in that sacred space.   Words left you. Movement failed. Your breath caught somewhere deep inside A silence louder than alarms, A scream you swallowed just to survive.   The adrenaline drained from our veins, The room exhaled, the chaos stilled. We watched a tiny fighter rest, Praying hope would bend to will.   Sometimes the world is set ablaze, And there’s nothing left to do. No medication, no miracle— Just sitting in the ache with you.   Facing life without your person Is more than any heart should bear. Gaining angels wasn’t the bargain It’s cruel, uneven, devastatingly unfair.   They say there’s God. They say there’s reason. I don’t know if I believe that’s true. Some losses feel senseless, brutal — And you lost not one, but two.   “They’re angels now,” the whispers say. But you never asked for this. Know we hold your grief with reverence— Because this one shattered all of us.   Walking out of the unit felt heavier, Like gravity had learned my name. Nothing makes life feel more fragile, More sacred, more unbearably plain.   The suddenness of one moment A before-and-after split in two. I wish I could stitch your heart back whole, And undo what that night put you through.   But maybe all I can offer Is this small, honest truth: This broke us too. We wanted to heal. We wanted the impossible for you.   Some say we play God In a world of black and white. But here, in the NICU, We survive in shades of messy grey light.   Moments like this make me wish We had the power to rewrite To take the pain, erase the loss, And give you back your light.   Most days this job feels light and meaningful, Purpose stitched into every breath. And other nights I numb the edges, Trying not to carry death.   To my NICU nurses, Who give your whole heart to the work: Please tend to your grief with tenderness, And let healing find you first.   To the parents who lost an angel, Or maybe even two. Know you live on in our quiet moments, Our hearts still heavy, holding you. INSTAGRAM VIDEO - read it aloud https://www.instagram.com/p/DUW17Imj4Lq/ dedicated to the patient and loved ones of this hardship. and to NICU parents who have endured the same as well as the NICU teams caring for them. xo Tori Victoria (Tori) Meskin, MSN, RNC-NIC, has been a NICU nurse since 2012, caring for critically ill newborns in acute and high-acuity neonatal settings throughout Southern California. Board-certified in neonatal intensive care and experienced as a travel NICU nurse, she is also the co-founder and CEO of NICUity, a modern resource hub supporting NICU professionals and families through practical education, tools, and community. Outside of the bedside, Tori is a mom, wife, content creator and concierge wellness nurse who shares the honest, relatable side of motherhood, nurse life, and entrepreneurship, offering practical tips and encouragement for healthcare providers and modern moms alike. Discover her latest resources and recommendations at www.tipsfromtori.com  or reach out at tipsfromtorimanagement@gmail.com .

Whether you are a new mama, future mama, or baby caretaker, this is an up-to-date baby basics blog to help guide you with the best newborn practices! These are a few basic hospital practices mixed with professional practice TIPS to help you in your newborn journey. 3 GOALS To Prepare Before Discharge Home: Research and choose a Pediatrician! Depending on your birth hospital/setting, they may have a list of Pediatricians in network. Create an emergency contacts list including a Pediatrician, Police/Fire Departments, you and your partners’ (if applicable) work/cell phone numbers, and the poison control center. Talk to your discharge planner (MD, Nurse or Midwife) for follow-up appointments. HOT TIP: It is never too early to start getting organized! You will most likely be exhausted and overwhelmed. Start creating a list and calendar to help stay on top of important things such as feeding and medication schedules, well-baby checks, immunizations, etc. You can create a note on your phone with important phone numbers, dates, doctors etc. SAFETY While you can’t anticipate every situation that could arise regarding your infants’ safety, there are some tips you should know and share with others who will be care taking for your baby. A FEW SAFETY BASICS ♡ Properly support your baby’s head and neck ♡ Do not heat breast milk directly on the stove or in the microwave Instead: Place the bottle or sealed container of milk into a bowl of warm water or hold it under warm, but not hot, running water for a few minutes. Test the milk's temperature before feeding it to your baby by putting a few drops on your wrist. ♡ Explain your baby’s needs to older siblings ♡ Lock away all medicine cabinets and household cleaners ♡ Practice crib safety by not using drop-down cribs or putting stuffed animals or pillows in the crib ♡ Practice toy safety (balloons are the leading cause of toy-related deaths) ♡ Maintain a smoke-free environment for baby and install smoke detectors BABY ESSENTIALS FOR FIRST 3 MONTHS Car seat Onesies, or other soft outfits Baby sleepers or sleep sacks Baby socks Newborn hats, depending on climate Disposable diapers or cloth diapers (and detergent for washing) Disposable wipes or 12 cloth wipes Diaper rash cream Waterproof pad for diaper changes Diaper pail or receptacle Baby washcloths Hooded towels Baby sponge Baby bath wash Baby lotion Baby bath tub Baby nail clippers Digital thermometer Medicine dropper Bulb syringe/nasal aspirator Crib, cradle, or bassinet Fitted sheets and mattress cover for crib, cradle, or bassinet Burp cloths Bottles, if you're bottle-feeding and bottle brush A variety of bottle nipples, in different sizes Breastfeeding pillow, nursing pads, and nipple cream Breast pump Newborn Essentials on Amazon SAFE SLEEP "DO'S AND DON'TS" Setting up a safe sleep area for your baby can be done before baby is home. It is recommended that the baby’s sleep area is in the same room, next to where parents sleep for observation. The sleep surface should be firm and flat, such as a mattress in a safety-approved crib, covered by a fitted sheet. For the safest environment, babies should never sleep in an adult bed, on a couch, or in a chair alone, with you or anyone else. When putting your baby to bed, remember to keep soft objects, toys, and loose bedding out of the sleep area and that nothing is covering the baby’s head. Do not use a loose blanket, (to avoid occluding baby's airway and be sure not to over-bundle. A wearable blanket (sleep sack) is great for sleepwear and swaddling is recommended for safe sleep. ALWAYS PLACE BABY ON THEIR BACK TO SLEEP FOR NAPS AND NIGHT SAFE SLEEPS DO'S TO REDUCE SIDS RISK ♡ Always place baby on their BACK to sleep. ♡ Use a firm and flat sleep surface. ♡ Share your room with baby but on a separate surface designed for infants, ideally for baby’s first year but at least for the first 6 months. ♡ Breastfeed your baby if possible for the many health benefits and to reduce the risk of SIDS. ♡ Give your baby a pacifier for naps and nighttime sleep. ♡ Give your baby plenty of tummy time when they are awake and someone is watching. SAFE SLEEP DONT'S TO REDUCE SIDS RISK ♡ Do not smoke during pregnancy or allow smoking around your baby or in their environment. ♡ Do not put soft objects, toys, crib bumpers or loose bedding under baby, over baby, or anywhere in baby’s sleep area. ♡ Avoid products that go against safe sleep recommendations and exercise special caution on products that claim to prevent or reduce the risk for SIDS. ♡Do not use heart or breathing monitors in the home as a way to reduce the risk of SIDS. ♡ Do not let your baby get too hot during sleep. HOW TO PERFORM CPR ON A BABY It is always good to feel prepared in case of an emergency. Here is a great video to help you understand and practice CPR in case you may need it for your baby. This is also a skill to share with other caretakers of your baby (grandparents, family members, sitter etc.) SWADDLING Swaddling is a traditional practice of wrapping a baby up gently in a light, breathable blanket to help them feel calm and sleepy. A swaddle helps your baby feel safe and secure as she adjusts to life outside the womb. Swaddling helps prevent her from flailing her arms and legs, which can trigger her startle reflex and potentially cause her to wake up. A swaddle keeps your baby cozy and warm until her internal thermostat kicks into gear. The idea is that being swaddled will help your little one feel snug and secure, just like in your womb. It’s true that swaddling isn’t entirely risk-free. But the American Academy of Pediatrics (AAP) says that swaddling can encourage your newborn to snooze better — as long as it’s done correctly and practiced in accordance with other safe sleep guidelines . To encourage healthy hip development, the bottom of the swaddle should be loose enough for your baby’s legs to stay bent up and out, like they naturally would in a newborn lying on her back without a swaddle. You'll also want to ensure the swaddle allows your baby to straighten and stretch her legs at will. Wrapping your baby the right way will encourage your little one to sleep more soundly while giving you peace of mind (so you can get some sleep yourself!). Some important swaddling safety tips to keep in mind: Swaddle snugly, but not too snugly. At the top of the swaddle, you should be able to fit two to three fingers between the blanket and your baby’s chest. The bottom of the swaddle should be loose enough so your baby’s legs stay bent and flared out. Always put your baby to sleep on her back. It’s the safest position, whether you’re swaddling or not. Be sure to tuck the bottom of the blanket underneath your baby too. Keep your baby normothermic. Swaddling could cause overheating, which can raise the risk of sudden infant death syndrome (SIDS). Keep the room at a comfortable temperature (between 68 and 72 degrees Fahrenheit year-round). And resist the urge to bundle your baby in extra layers — a pair of pajamas and the swaddle blanket are likely enough to keep her comfy. Sweating, damp hair, flushed cheeks, heat rash and rapid breathing are all possible signs that your baby might be too hot. As a general rule of thumb, dress your baby in one more layer than you would wear. Swaddle for nighttime sleep and naps. Swaddling can help your baby sleep more soundly during the day and at night. If tucking her into a little burrito blanket for hours overnight makes you nervous, know that as long as you stick with safe swaddling and sleep guidelines, swaddling at bedtime isn’t any riskier than swaddling during naps. You’ll also have plenty of built-in opportunities to check on her, since she’s frequently waking to eat. But if checking her swaddle while she sleeps gives you extra peace of mind, feel free to peek more often. Here's a step-by-step guide below for how to swaddle a newborn like a pro, the keys for sticking with safe swaddling techniques. Day to Day Feedings Cues your baby is ready to feed: Rooting (baby turns his/her head when the side of the cheek or face is stroked) Baby demonstrates a good, strong suck on the pacifier Baby is calm and stable during care time Baby is awake or wakes up during care time Baby demonstrates appropriate strength in their body (tone) alone or with swaddling and support, and can remain awake for several minutes at a time. BREASTFEEDING (FIRST FEW WEEKS) Nurse until baby self-detaches (some babies will need to be time-limited due to diagnosis and overexertion). Nurse from one breast to ensure that your baby gets enough of the hind milk. If your baby is still hungry, offer the second breast but be sure to burp the baby when they switch breasts. The breast should feel softer following a feed. You may need to pump after breastfeeding until at least your baby’s due date (NICU) Breastfed babies will have at least 8-12 feeds in 24 hours (every 2-3 hours). TIPS FOR TRANSITIONING FROM BOTTLE TO BREAST The key to a successful transition is to give it time, patience and persistence! In fact, it takes some women several weeks to transition from bottle to breast. I can’t recommend a lactation consultant enough if you are transitioning from bottle feeding to exclusively breastfeeding. They are a great resource, as each situation is unique! BOTTLE Bottle-fed infants will feed every 3-4 hours (which is 6-8 feeds in 24 hours). Like breastfed infants, bottle-fed infants should sleep well between feeds and have 6-8 wet diapers daily. Burp your baby both during and after feeding (or every 1-2 ounces.) The air can cause gas and make the baby uncomfortable. If doing a combination of bottle and breast, breastfeed first, offer a bottle after breastfeeding and pump for 10 minutes (triple feeding protocol). If you are exclusively pumping, pump for 20 minutes both sides 8x in 24 hours. HOT TIP: use your phone. Place a timer on every 3 hours to help keep you on track TIPS FOR PROPER BREAST MILK STORAGE Before expressing or handling breast milk: Wash your hands well with soap and water. If soap and water are unavailable, use an alcohol-based hand sanitizer containing at least 60% alcohol. Mothers can express breast milk by hand or with a manual or electric pump. If using a pump, inspect the pump kit and tubing to ensure it is clean. Discard and replace moldy tubing immediately. If using a shared pump, clean pump dials, power switch, and countertop with a disinfectant wipe. (NICU) BREAST MILK STORAGE TIPS Clearly label the breast milk with the date it was expressed. Do not store breast milk in the door of the refrigerator or freezer. This will help protect the breast milk from temperature changes from the door opening and closing. If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk. When freezing breast milk: Store small amounts to avoid wasting milk that might not be finished. Store in 2 to 4 ounces or the amount offered at one feeding. If you deliver breast milk to a child care provider, clearly label the container with the child’s name. Talk to your child care provider about any other requirements for labeling and storing breast milk. Breast milk can be stored in an insulated cooler with frozen ice packs for up to 24 hours when you are traveling. At your destination, use the milk right away, store it in the refrigerator, or freeze it. Safe Thawing of Breast Milk Always thaw the oldest breast milk first. Remember first in, first out. Over time, the quality of breast milk can decrease. There are several ways to thaw your breast milk: In the refrigerator overnight. Set in a container of warm or lukewarm water. Under lukewarm running water. Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth. If you thaw breast milk in the refrigerator, use it within 24 hours. Start counting the 24 hours when the breast milk is completely thawed, not from the time when you took it out of the freezer. Once breast milk is brought to room temperature or warmed, use it within 2 hours. Never refreeze breast milk after it has thawed. Swirl the breast milk to mix the fat, which may have separated. If your baby did not finish the bottle, use the leftover milk within 2 hours after the baby is finished feeding. After 2 hours, leftover breast milk should be discarded. TRANSITION TIPS FROM A LACTATION TEAM Massage your breasts or hand express to start milk flow before putting the infant to breast. Pay close attention to the position, especially supporting the baby’s head to your breast. Place your baby’s belly to your belly while holding them close for a great deep latch. Ensure your baby has an effective latch by listening for swallowing. Allow baby to self-detach. For example, if baby pulls away from breast after 10-15 minutes of sucking and appears to be content and satisfied. Log the baby’s output during this transition and get frequent weight checks by either your pediatrician or lactation consultant. After baby self-detaches, your baby may be given pumped breast milk if they show hunger cues. Pump after breastfeeding as you may not completely empty. You may need to do this the first few weeks or until the baby’s due date. As your baby matures and becomes more efficient, you will be able to increase the length of time at the breast and the number of feedings in 24 hours. SHOP NEWBORN ESSENTIALS ON AMAZON BURPING While feeding, if your baby doesn’t burp after several minutes, continue feeding, and don’t worry. When the feeding is finished, attempt again and keep the baby upright for 10-15 minutes to prevent spit up. Make sure you don’t bounce baby after feeding. If the baby cries a lot before the feeding, it may be beneficial to burp the baby before the feed or early in the feeding. DIAPERING Let’s talk about diapering your baby, diaper rash and elimination patterns. Start the habit early of checking your baby’s diaper with every feeding. When changing, clean genitals with a washcloth and warm water or fragrance-free baby wipes. For girls, remember to wipe baby from front to back (or TOP to BOTTOM) and for boys to start at the tip of the penis and then wipe the rectal area last. If the baby is uncircumcised, do not attempt to pull back from the foreskin of the penis. After cleaning, lift the scrotum and clean underneath. Keep the skin clean and dry with frequent changes to avoid diaper rash. If a rash does occur, wash with mild soap only after a bowel movement while avoiding wipes with alcohol or fragrances. Expose the bottom to air. (Oxygen can help heal the skin). WHAT ARE TYPICAL ELIMINATION PATTERNS WITH A NEWBORN? Your baby should have 6-8 wet diapers daily, many stool with diapers but some once a day (or every few days). The color and consistency may vary from bright yellow (breast milk-fed infants) to light greenish-brown (formula-fed infants). Monitor the diaper for blood, pus, or diarrhea. Call your pediatrician if your baby has fewer than 6 wet diapers a day or has two dry diapers in a row, has diarrhea, or is constipated for 48 hours. BATHING TIPS Once the umbilical cord or circumcision site heals, you can give your baby a tub bath. Bathe baby 2-3 times a week. Avoid lotions and powders. Bath before a feed or at least one hour after bedtime. Gather all of the supplies you will need before beginning the bath. Never leave a baby alone in a bath, not even for a minute. Babies can drown quickly in a few inches of water. Make sure the room is warm as babies get cold easily. Fill the tub BEFORE you put the baby in it. Water should feel warm, not hot on the inside of your wrist. Ensure your water heater is set no higher than 120F (if you can control the temperature). Never put a Qtip in your baby’s ear. For preemies, bath time can be stressful. Swaddle and wash one area gently at a time. BATHING: WHAT YOU NEED 3-5 baby washcloths 1-2 towels (hooded if you have one) 1 baby sponge 1 bottle of baby bath wash 1 bottle of baby lotion A baby bathtub TEMPERATURE-TAKING AND SUCTIONING I encourage you to ask your bedside RN how to take your baby’s temperature and how to use a bulb syringe! They are there to support YOU and answer any care questions you may have. HOW DO I USE A THERMOMETER? Take temperature when the skin feels warmer or cooler than normal, when your baby is not acting like their usual self and before calling your doctor. (They will want to know the baby's current temperature) Place the tip in your baby’s armpit. Hold the arm in the position for 5 minutes or as long as the thermometer instructions say. For newborns, do not use the pacifier, forehead, or ear thermometers per AAP. HOT TIP! Bring your thermometer into the hospital to practice with the nurse. Practice with it at the bedside to get a feel for the device and how to properly use it. Normal temperature range for baby should be 97.6 - 99.6 TIP: Dress your baby according to how you feel! Use a bulb syringe to suction your baby’s mouth and nose when necessary (stuffy nose, baby vomits, spit up, etc). Sneezing is normal for a baby, but coughing is not. If your baby vomits, remember to suction the mouth then the nose. To prevent gagging place the tip of the bulb into the side of cheek to suction. Clean the bulb syringe after using warm water and mild detergents. BEDDING AND SLEEP NEEDS Whatever bed you choose for your newborn (crib, cradle, bassinet, co-sleeper), it is recommended by the American Academy of Pediatrics that your baby sleeps in the same room with you for the first 6-12 months of life. In addition, bumpers, blankets, pillows, and soft toys are no longer recommended in baby beds. Think minimalistic. BEDDING: WHAT YOU NEED Crib, cradle, bassinet, co-sleeper, or other safe sleep space for baby. If the crib has been used before, make sure it has all of its pieces and meets current safety standards Crib mattress, or a mattress that fits properly in the cradle or bassinet Fitted sheets for crib, cradle, bassinet, or co-sleeper Waterproof crib mattress cover, unless your crib mattress is already fully sealed, or a waterproof pad to lay under the crib sheet Baby monitor DEVELOPMENTAL CONSIDERATIONS There are three common terms when it comes to developmental age (especially for Preemies!) Gestational age is the fetus’ age (calculated as the first day of mom’s last period) Chronological age is counted from the day of birth (baby’s birthday) Corrected age is defined as the chronological age minus the number of weeks or months baby is born early. TO POSITION YOUR INFANT FOR OPTIMAL DEVELOPMENT: KEEP THESE IN MIND ♡ Hold baby with legs bent and arms forward ♡ Avoid leaving baby flat on back for long periods ♡ Wrap baby snugly with legs bent and hands placed close to face ♡ When awake, lay baby on their side rather than on their back with a large blanket roll for body support (only when supervised!) Your baby should start rolling anywhere between 2-6mos old corrected gestational age and sitting up without support between 5-7mos old (corrected age). Make time for tummy time! Tummy time should be when the baby is awake only, and should last 10-20 minutes once or twice a day. Start slowly and work your way up if baby dislikes it at first! You can use a rolled towel or blanket under the shoulders and upper chest to provide support. When should you schedule a time to talk to your doctor about your baby’s development? If your baby does not use one of their arms, legs or one side of body, their legs feel stiff when not actively stretching, they don't roll over or bear weight on legs, or if they don’t sit while supported or reach for objects-make an appointment with your pediatrician. WHEN TO SCHEDULE A DOCTOR'S VISIT Vomits repeatedly or forcefully two feedings in a row. Refuses to eat more than two feedings in a row. Has less than 4 wet diapers-24 hours in spite of frequent feedings. Goes 48 hours without a bowel movement. Has diarrhea or more than 12 large stools/day or has blood in stool. If abdomen is distended and does not go down. If difficulty breathing or makes unusual sounds when breathing. If baby is lethargic and doesn’t arouse with touching or handling. Excessive swelling or drainage around eyes. Blisters or pustules on body. Thrush or patches of white in mouth. Congested cough, running eyes or nose. Drastic behavior changes include extreme irritability, excessive crying without a known cause, extreme sleepiness, or floppy arms and legs. CALL MD: Temperature under 97.6 or over 99.6 and doesn’t change with adding or removing clothes or blankets. EMERGENTLY CALL FOR HELP CALL 911 if blue lips and tongue If you are uncertain or feel urgent care is necessary I hope these Baby Basics help you as you transition to caring for your baby at home! Share these tips with a caregiver who wants to see babies THRIVE through best practices :) REFERENCES: American Academy of Pediatrics (AAP) Centers for Disease Control and Prevention. (2021). Sudden unexpected infant death and sudden infant death syndrome: Data and statistics . Retrieved June 1, 2021, from https://www.cdc.gov/sids/data.htm. Shapiro-Mendoza, C. K., Camperlengo, L., Ludvigsen, R., Cottengim, C., Anderson, R. N., Andrew, T., et al. (2014). Classification system for the Sudden Unexpected Infant Death Case Registry and its application. Pediatrics, 134 (1), e210–e219. Retrieved May 3, 2021, from https://pubmed.ncbi.nlm.nih.gov/24913798/. https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm#:~:text=Place%20the%20sealed%20container%20into,stove%20or%20in%20the%20microwave. Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

Empowering Neonatal Care: Unleashing the Power of S.T.A.B.L.E. and ENCCO Dive in with me today on the importance of consistent Neonatal Education and my favorite resources for empowering nurses with specialized Neonatal Expertise. HealthStream is a game changer for equipping all healthcare providers with the essential skills and knowledge to make a difference in NICU care and I am SO excited to share with you two of their amazing partner programs- S.T.A.B.L.E. and ENCCO Imagine a world where the tiniest heroes among us receive the highest level of care from a team of dedicated healthcare providers. In the fast-paced realm of neonatal care, every second counts, and the well-being of these fragile infants relies on the synchronized efforts of a skilled and compassionate team. If you are a nurse, nursing student, nursing assistant or tech, respiratory therapist, pre-hospital provider or a physician, then you NEED to know about two groundbreaking programs—S.T.A.B.L.E. and ENCCO—that are revolutionizing neonatal care and empowering nurses with the knowledge and skills to deliver exceptional care to our smallest patients in the nursery and neonatal intensive care unit (NICU). S.T.A.B.L.E.: Building the Foundation for Safe and Stable Infant Care! S.T.A.B.L.E.’s mission is to provide evidence-based education to help reduce infant mortality and morbidity, improve neonatal outcomes and most importantly, improve the quality of life for infants and their families. S.T.A.B.L.E. targets the majority of problems that will be encountered when taking care of both well and sick infants, with a special emphasis on understanding the underlying pathophysiology of various neonatal conditions. Picture this: a neonatal care program that encompasses six essential components of infant stabilization, forming the bedrock of a holistic approach to caring for these tiny warriors. Let's go over the parts of care and the acronym: Sugar Module Infants require optimal glucose regulation and a nurturing environment to thrive. S.T.A.B.L.E. emphasizes the significance of monitoring and maintaining appropriate blood sugar levels to protect the vulnerable immature brain from hypoglycemia. . Temperature Module Preventing hypothermia and maintaining the perfect body temperature is vital for newborns who are unable to regulate it independently. S.T.A.B.L.E. equips healthcare providers by understanding how heat is lost and how vulnerable babies are to cold stress. These foundational concepts promote the infant’s well-being and reduce the risk of complications. Airway Module Superheroes need clear pathways to victory. Proper airway management is vital for stabilizing infants in need. S.T.A.B.L.E. empowers healthcare providers with the knowledge and skills to assess respiratory distress and support breathing, thus, ensuring adequate oxygenation and ventilation for critically ill neonates. Blood Pressure Module Monitoring blood pressure and perfusion are the secret weapons for assessing neonatal circulatory status. S.T.A.B.L.E. emphasizes recognition of shock and how to treat shock, and guides healthcare providers in promptly recognizing and addressing abnormalities, helping our tiny heroes keep fighting. Lab Work Module Laboratory tests hold the keys to unlocking vital information. S.T.A.B.L.E. educates healthcare providers on interpreting laboratory results, enabling informed clinical decisions and appropriate interventions. With this knowledge, providers can make strategic decisions to help support infants in need. Emotional Support Module Every superhero needs emotional support to conquer challenges. S.T.A.B.L.E. explains the crisis that families face when their infant is sick and in need of care in an intensive care unit. Understanding the emotional impact on families helps underscore the need for compassionate care. Healthcare providers learn how to provide emotional support and guide parents through the challenges of having an infant in the NICU. 15% off S.T.A.B.L.E. discount on NurseGrid. Learn with code: TORI15 ENCCO: Guiding Nurses to Neonatal Mastery Imagine a program designed to empower nurses with specialized knowledge and skills in the NICU, providing them with the tools they need to bridge the knowledge gap and provide top notch care in various Neonatal settings- hello, ENCCO! Benefiting from ENCCO: Empowering Nurses in Various Neonatal Settings Nursing is a dynamic profession that demands continuous learning and adaptation. ENCCO recognizes the gap between academic training and the care of critically ill neonates. It collaborates with clinical content specialists and Pediatric Learning Solutions to bridge this gap effectively, empowering nurses with the knowledge they need to succeed. ENCCO offers a tailored orientation program for nurses in the NICU, focusing on refining assessment, planning, and evidence-based implementation strategies. Nurses gain a profound understanding of the complexities associated with neonatal patients, enabling them to deliver optimal care and improve patient outcomes. Bridging the Knowledge Gap in Neonatal Care with ENCCO ENCCO's mission is to enable nurses to evaluate assessment data and develop effective care plans for neonates. Through evidence-based strategies, nurses learn to identify and address the unique needs of critically ill infants. This knowledge integration empowers them to anticipate potential complications and provide timely interventions, resulting in improved patient outcomes. ENCCO places significant emphasis on developing a comprehensive understanding of common conditions experienced by neonatal patients. Nurses acquire in-depth knowledge about prematurity, respiratory distress syndrome, congenital anomalies, and other prevalent issues. Armed with this expertise, nurses can promptly recognize signs of distress and provide the best possible care for newborns. We love this for us ! In the fast-paced environment of the NICU, evaluating the effectiveness of care interventions is crucial. ENCCO equips nurses with the skills to assess the impact of their care plans on critically ill neonates. By continuously monitoring and adapting their approach, nurses refine their strategies and improve patient outcomes, emerging as true superheroes of neonatal care. Join the Journey Towards Neonatal Excellence With Healthstream! I hope you feel invigorated and inspired after reading this blog about the impact of S.T.A.B.L.E. and ENCCO in the world of neonatal care. These programs have provided standardized frameworks and comprehensive training to healthcare providers, empowering them to deliver safe, consistent, and exceptional care for vulnerable infants. I can’t recommend them enough for continued education! Working in the NICU we have an amazing opportunity to nurture a generation of tiny heroes who will thrive and flourish against all odds. Explore the power of S.T.A.B.L.E. and ENCCO programs, share this post with others passionate about neonatal care, and together, let's unleash the full potential of neonatal care and create a brighter future of care for our tiniest patients and their families. Will you join me in this mission to make a lasting impact on the lives of our smallest and most courageous warriors? By prioritizing continued education regarding Neonatal Care, we can be the start of change and advancement that our healthcare system desperately needs! More About HealthStream HealthStream understands the challenges that come with navigating an ever-evolving and intricate healthcare landscape. They are your trusted partner in maximizing resources and elevating the quality of care provided by your organization. With HealthStream, your organization gains access to the most innovative and proven applications, content and solutions available in the healthcare industry. They understand the importance of empowering staff to excel in their roles and have meticulously crafted solutions that facilitate operational improvement and efficiency. They shape a brighter future for healthcare, where resources are optimized, staff members are empowered, and the highest quality of care is delivered. Join HealthStream, where they are united with clinicians with passion to make a difference. HealthStream, Inc. (NASDAQ: HSTM) provides workforce and provider solutions for healthcare organizations in the United States. Find out about these programs and more on healthstream.com ! To learn more about how ENCCO and S.T.A.B.L.E. can benefit your organization, please visit HealthStream's Child and Maternal page: https://hs.healthstream.com/Nurse-Tori-Child-Maternal To purchase S.T.A.B.L.E. for yourself at a 15% off discount, visit HealthStream's NurseGrid Learn page. https://hs.healthstream.com/Nurse-Tori-NurseGrid *Secure your 15% off S.T.A.B.L.E. discount on NurseGrid Learn with this code: TORI15 Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

When I was first starting out my NICU journey, I found it difficult to find reliable information on the NICU and the types of tasks NICU nurses were responsible for. In this blog, I’ve collaborated with NICU nurses from different facilities around the country to identify common shift patterns, workflows, and patient care duties. Here, I’ll answer some NICU nursing FAQs , explain some NICU nurse basics and review what we do on a daily basis. Let’s dive in!  What do NICU Nurses Do? NICU nurses care for premature or critically ill newborns  during their first few moments of life. We support their organ systems while they adjust to life outside of the womb and ensure they develop and mature appropriately. The complexity of care a facility offers depends on their NICU acuity level (Level I units provide the simplest interventions, and Level IV NICUs deliver the most intense). In simple terms, we’re in the business of growing & healing the world's tiniest humans. What are some concepts I’ll need to be familiar with? No matter your NICU unit’s size or acuity level, there are certain concepts and terms  you’ll need to be familiar with: Measurements:  Our patients are measured in grams & centimeters. We frequently measure head circumference, abdominal girth, length, and weight to ensure our patients are growing appropriately.  Gestational Age : In the NICU, the baby’s actual age isn’t the only factor that drives the care plan. We also consider their gestational age, meaning how old they are from the moment of conception. A baby that was delivered at 24 weeks would require completely different care interventions (feeding plan, respiratory support, medications, "touch times") from a baby that was delivered at 40 weeks (term), even if they were born on the same day.  Medications : NICU medications are often measured in tenths of mLs, so we have to be very careful about medication safety to ensure we don’t provide too much or too little medication. Respiratory Support/Oxygen : 2L of oxygen is considered “high flow" because our babies noses and lungs are incredibly small. Also, don’t panic if you see a patient with oxygen saturations in the high 70s. In the NICU that might be acceptable for that patient, depending on their cardiac status, level of maturity, or secondary diagnosis.  Diet : We measure our feedings in mLs as well, sometimes only giving a few drops. Most NICUs will provide infants with mother’s milk, donor milk, formula, or parenteral nutrition (TPN), depending on their diagnosis and nutritional needs. Extra-Small Sizing : We use the smallest blood pressure cuffs, diapers, IVs, nasal cannulas, and breathing tubes you have ever seen. NICU nursing is delicate work. What types of patients will I care for? ♡ NICUs usually care for infants from birth - one year old. Infants that still require intensive care after one year will transition to a pediatric intensive care unit (PICU) setting for developmentally appropriate interventions.  ♡ Most babies are admitted directly from L&D, postpartum (mother/baby), or are transferred from other facilities for a higher level of care. Common NICU diagnoses  include: Respiratory Distress Sepsis  (Maternal Fever, Pre-Ruptured Membranes for several days/weeks, etc.) Multiples ( twins, triplets, etc ). High-Risk  Deliveries  (drug-related births, STD exposure, unknown pregnancy) Medical Conditions (cardiac issues, GI/GU, IUGR, etc.): some are pre-diagnosed, some are unknown until the time of delivery Traumatic Delivery ( body cooling ) Premature Birth  (22-37 wks) a.k.a “preemies” Congenital Defects and Chromosomal Abnormalities Intrauterine Growth Restriction (IUGR)   Jaundice  Necrotizing Enterocolitis ( NEC )  Feeding Issues What is the Typical NICU nurse workflow? While each unit has unique schedules and care practices, the foll owing NICU nurse schedule outlines general timelines and duties for a nurse who be gins work at 0700 or 1900.   0645 or 1845 Before our unit meets for a safety huddle, we "scrub in." Huddle usually involves a meeting between the oncoming nursing team, respiratory therapists & unit leadership. During this meeting, the charge nurse will give a "brief" on any safety events, pending deliveries, or staffing updates for the upcoming 12 hours. It allows you time to prepare for any patient safety concerns while also letting you bond with your team. It’s important to remember to leave your jewelry and watches at home, as your arms will need to be bare from the elbows down. Be sure to scrub with soap and water and clean under your fingernails. This ensures that you don’t bring any outside bacteria, germs, or dirt to the vulnerable patients in the NICU. 0700 or 1900 After attending huddle, you’ll head to the bedside to get a patient report from the offgoing nurse. NICU handover report  looks a lot different than report in other units.  Typical Patient Report Topics: HISTORY OF PREGNANCY & DELIVERY Age (gestational age and current age) Weight (review gain/loss trends) Head circumference Length of the patient from head to toe VITAL SIGNS Temperatures (normal range: 36.5-37.5 C) Heart rate (normal range: 100-200) Respiratory rate (normal range: 10-100) Blood pressures (normal range: MAP 20-70) Apnea/bradycardia/desaturation episodes DIET NPO or PO eating Type of nutrition (donor milk, mother’s milk, formula, or TPN) OG or NG tubes and their sizes (normal size: 5-6 Fr) Necessary feeding support (slow flow nipple, positioning, feeding rate, history of emesis, etc.) GI/GU Urine output (all diapers must be weighed) Most recent stool (size and consistency) Ostomy, if present (most recent bag change date & skin care plan) Foley catheter, if present (french size, reason for placement, date of placement, catheter placement measurement, & recent output) GI surgical tubes (size & type: Salem Sump or Replogle) IV OR CENTAL LINE ACCESS Umbilical lines PICC lines Peripheral IVs IV fluids (location, rate, and fluid type) Broviac  TPN and lipids D10W, NS, or other TKO Any replacement fluids, like sodium acetate? Many units require nurses to “walk the line” together with the off going RN during handover report. No matter what type of line the patient has, whether it’s a feeding tube, IV access, or ET tube, you should confirm proper placement, proper infusions/settings and appropriate connections at the start and end of the shift. RESPIRATORY SUPPORT ETT size Placement of ETT Ventilator Settings (HFOV, SIMV, BCPAP, NIMV, etc) Suctioning needs Nasal Cannula size and O2 flow rate FiO2 Requirements How to respond to baby “spells” (desaturations, apnea, bradycardia, etc.) CARDIAC Hemodynamic stability Review recent blood transfusion requirements Pulses (goal: +2 in the brachial, femoral, and distal) Color (pink, pale, appropriate for ethnicity, etc.) Review cardiac medications and infusions (dopamine, epinephrine, atropine etc). NEURO Neuro baseline (sedated, somnolent, active) Sutures and fontanelle status Reflexes (sucking, moro reflex, ability to console) Head ultrasound status MRI review when necessary PAIN Pain is assessed with the NPASS pain scale   ( Neonatal Pain, Agitation, & Sedation Scale ) Pain treatment regimen (what scheduled and PRN medications are available, when/how often they can be given, etc.) SKIN Last bath Products to use (Mepitel, Mepilex, gauze, sterile water, etc.) Skin tears, bruises, wounds, rashes LABS: Recent lab trends  (bilirubin levels, H/H, chem panels, CRP, INR, etc.) DIAGNOSTICS: Chest x-rays Head ultrasounds Echocardiograms Any pending procedures or diagnostic testing ORDERS: Finally, we take a look at all of the physician/NNP orders that have been completed within the last 24 hours, as well as those that have been scheduled for the upcoming shift. How you spend the rest of your shift depends on the acuity of your patient assignment. To give you clarity, we’ll review a common shift schedule for a critical 1:1 assignment and one for a 2:1 feeder/grower assignment. 1 to 1 ASSIGNMENT Example diagnoses for this type of assignment include: pre-op cardiac surgery, body cooling, micro preemies (22-26 weeks), pre- & post-op surgical patients, complex chronic patients, etc. Let’s say a 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 infusing a variety of medications, a vital signs monitor (displaying heart rate, oxygen saturation, respiratory rate, and BP level) and possibly a Bili-light to assist the body in breaking down bilirubin (increased levels cause jaundice). 0730 or 1930 After you finish getting report, you’ll want to prepare for your first round of “cares”. After assessing the safety of the bedside, checking orders, and assessing lines, you would sanitize the bedside. Be sure to clean the isolette/warmer, buttons, IV pumps, work areas, and charting areas.  After touching base with the RT (Respiratory Therapist) we would establish a plan for our assessments & care interventions.  Example:  While listening and counting the heart rate and respiratory rate, the nurse is working on their head to toe assessment as well. Additional tasks include changing the infant’s diaper, taking their temperature, feeling their pulses, assessing the baby’s vigor, and re-swaddling the infant. This is called “clustered care”.  If the nurse knew they had a scheduled chest x-ray & labs to draw, they would time them together. They could help the RT draw labs, perform the chest x-ray at bedside, AND make sure the neonatologist knows about the “touch time” so they can assess the baby during this period. 0800 or 2000 The neonatal assessment is possibly the most important part of your shift. If you’ve never taken care of this baby before, you’ll want to be extremely thorough. If you’ve cared for the infant for a few shifts in a row, it’s important to identify changes since your previous assessment. Example:   When assessing a NICU patient, a nurse asks themself questions like: What does the baby’s head feel like? Are the sutures separated or overlapping? Do I hear a murmur?  What do the lungs sound like? Any crackles or wheezing? How are the bowel sounds? What’s the color of the baby’s abdomen? Is their belly soft or distended? Are there any bowel loops visible? How is the patient’s muscle tone? Does the Infant have full range of motion with their limbs? Is the patient vigorous and “fighting” me, or are they flaccid? After obtaining blood pressure measurements and an axillary temperature, the nurse will work on several other checks from head to toe. They’ll perform oral care with any colostrum available, check the OG tube to remove any air from the stomach, suction out the ETT tube and make a mental note of the secretions. Finally, before closing up the isolette, the nurse would change the infant’s diaper. We weigh diapers from admission to discharge. In a few minutes, the nurse should have their ABG results back along with the x-ray image, which may result in changes to the HFOV settings. 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 not enough starves the body of much needed oxygen. You’ll be monitoring the oxygen levels all shift. 0900 or 2100 Once you’ve completed your assessment, you’ll want to weigh in on rounds. During bedside rounds, the interdisciplinary team (neonatologist, NNP , RN, RT, PT, OT, SLP, social work, the unit charge nurse) discusses the plan of care and changes necessary to meet clinical goals. Be sure to include parents whenever possible. 1000 or 2200 Around 1000, vitals are recorded and charting begins! Most units require nurses to chart hourly vitals  for 1:1 assignments. These would include the infant’s heart rate, respirations, blood oxygen levels. 1100 or 2300 - 1900 or 1900 For critically ill 1:1 assignments, assessments and touch times would vary based on the patient’s stability and gestational age.  Example: A 23-week neonate might have “touch times” every six hours at 0800/2000 & 1400/0200. A more stable infant might have a touch time every three hours at 0800/2000, 1200/0000, and 1600/0400.  In addition to scheduled touch times you may need to provide interventions like blood product transfusions (blood, FFP, cryo, platelets), medication administration, new IV initiation, or assisting family members hold their baby. Bedside procedures may also need to be performed at the bedside. These could include PICC line insertion, lumbar puncture placement, chest x-rays, and head ultrasounds to name a few. Of course, all of this is dependent on the acuity of the patient. Vitals may be collected more often or the RN may have to assess the infant more frequently to keep them safe and free from harm. As the bedside RN, the only time you leave the bedside is for a rest or meal break. You’ll be continually watching the patient’s vital signs, reporting changes in status to the neonatologist or NP, explaining changes to the parents, and charting EVERYTHING. 2:1 Assignment Example diagnoses for this type of assignment include: mild prematurity (30+ weeks), multiple gestation (twins, triplets, etc.) or well-developing infants who previously presented with complex problems but are currently doing well. Just like with a 1:1 assignment, for 2:1 assignments, you’d get report, clean the bedside, and prepare for touch times. The main difference, besides having to juggle care times for more than one baby, is that these infants will require cares/feeding more often.  Infants that are close to going home are usually cared for and fed on a 3-hour schedule: Example: Baby A Touch Times: 8, 11, 1400, & 1700 / 2000, 2300, 0200 & 0500 Baby B Touch Times: 9, 12, 1300 & 1800 / 2100, 0000, 0300, & 0600 *** Sometimes, a baby may require care “Ad Lib,” meaning they are allowed to eat and get held whenever they want! This could potentially throw your whole shift in a tizzy, but it’s ultimately a sign that the baby is almost ready to go home. Managing 2 or more babies usually involves additional tasks like: Coordinating care times with speech or occupational therapy. Assisting parents with feeding skills. Completing discharge teaching with family members (car seat education, baths, diaper changes, feedings, follow-up appointments, well-baby care, etc.). Conducting hearing screens. While caring for three infants may not seem as stressful as caring for 1 critically ill baby, juggling multiple babies can be just as busy and hectic. 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, doing that on repeat until 1900/0700. 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, those of us familiar with the NICU call this a “feast or famine”! We slow down a lot to discharge babies home and then all of a sudden L&D wants to hand the NICU multiple high-risk admissions. No matter where you work, you’re sure to witness 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, seeing babies get healthy enough to go home is addicting! You get to help families through some of the hardest times of their lives & see the tiny babies you cared so much for turn into “line-backer” toddlers! Lots of happy tears and sad tears, but in the end, most of us NICU RNs think the NICU is the most magical place to be a nurse. Ready to Start Your NICU Journey? Now that you know what a day in the life of a NICU nurse could look like, you’ll have to decide if NICU nursing is the right path for you. If you’re ready to take the next step, we’ve got tons of resources, educational materials, and bedside tools to make your transition to the NICU  a positive and rewarding experience. Check out the latest merch on NICUity and be sure to subscribe to our free newsletter  to get the inside scoop on the latest NICU happenings. 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, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com . ​

I’ve worked in nursing for over 10 years and let me tell you — I have spent what feels like months of my life applying and interviewing for new grad programs , travel nurse positions, per diem roles, and staff nurse jobs. Filling out online applications can be overwhelming and exhausting, but finally landing an interview definitely gives you the boost you need! In this post, I’ll review some tried-and-true nursing interview tips and tricks  I have learned along the way. 12 NURSE INTERVIEW TIPS & TRICKS! Interviews are nerve-racking no matter how experienced you are! However, keeping calm under pressure is a true skill that takes time to master. If you’re smart, you’ll learn and practice these skills before your first official interview. Here are a few insights that helped me land my favorite jobs. INTERVIEW BASICS 1. DRESS THE PART! While it would be nice to think that nurse managers don’t judge a candidate's professionalism by how they present themselves, it’s simply not true. However, this doesn’t mean that you need to spend a month’s salary on a designer outfit or briefcase. The best thing you can do is wear something that makes you look and feel confident. Here are some nursing interview outfit ideas  to get you started. 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 Black or brown socks, avoid wearing white socks with dark dress shoes Black or brown dress shoes Natural hair color and neat haircut Mild cologne or none at all Neat and natural fingernails 2. PORTFOLIO For some nurses, a nursing professional portfolio   could mean a binder with a resume, cover letter, and career-boosting documents like Daisy Awards, research papers, and certifications . Other nurses may prepare an electronic portfolio that can be accessed on LinkedIn.  Whether you’re a new graduate or have years of clinical experience, you’ll want to show your interviewer that you’ve prepared and are genuinely interested in the position. Show them that you’re qualified for their role and don’t be afraid to boast about your successes! 3. DO YOUR RESEARCH Know the company & position you are interviewing for! You can start by familiarizing yourself with the organization’s mission, vision, and values. Next, learn a bit more about the patient population they serve. Again, the purpose here is to demonstrate that you’ve taken the time to prepare for this unique position — this is your opportunity to take your interviewer by surprise and get a leg up on other competing applicants. 4. ONE-MINUTE PITCH When introducing yourself in the interview, be sure to share a bit about your personal and professional background. Why did you choose nursing?  How do your experiences prepare you for this role? These are the questions interviewers will be looking for you to answer. 5. PRACTICE ANSWERING COMMON NURSE INTERVIEW QUESTIONS While each position is unique, interviewers don’t reinvent the wheel for each candidate. Most interviews start out with a basic interview question like “Tell me a bit about yourself” and go on to ask critical-thinking and behavioral questions later in the process. You can’t know the exact questions you’ll be asked, but you can guess what they’re going to want to know about you. Prepare by drafting answers to frequently asked nursing interview questions. That way, you’ve got a repository of answers you can use for a variety of interview questions. It can also be helpful to practice your interview with a friend or family member to perfect your flow, speed, and volume. CHECK OUT OUR E-BOOK COMPLETE WITH INTERVIEW TIPS & TRICKS. BONUS QUESTIONS, PORTFOLIO BREAKDOWN, RESUME AND COVER LETTER RESOURCES, SOCIAL MEDIA CONSIDERATIONS AND MORE! 6. ARRIVE EARLY Nothing adds extra stress to an interview like running behind. Be sure to arrive with plenty of time to avoid traffic, park, and figure out where you need to be. Managers will want to be sure that the employee they hire will show up for their shifts on time — be sure to put your best foot forward! 7. SMILE & MAINTAIN GOOD EYE CONTACT For some reason, there’s a common misconception that smiling during an interview isn’t professional. In nursing, this is definitely not the case. The interviewer will want to know they’re hiring someone who’s caring, kind, and compassionate. Be sure to demonstrate these signs of strong communication skills and showcase your passion and enthusiasm. Keep it natural, like you’re talking to a trusted mentor or colleague. 8. TAKE NOTES The interview process isn’t one sided. This is your opportunity to get to know a bit more about the hiring manager, unit, and facility as well. Taking notes can show interviewers that you’re interested in learning the details and logistics of the position. It can also help you remember points you want to get clarity on later in the interview, like scheduling expectations and onboarding requirements. 9. KEEP YOUR PHONE TURNED OFF AND TUCKED AWAY How embarrassing would it be if you worked hard to earn and prepare for your interview, only to be distracted by a loud call or text message? The best thing to do is to keep your phone in the car and avoid the problem altogether. If you need your phone with you for safety or navigation, be sure to turn it off prior to entering the interview room.  From the moment you step foot in the building, you want your focus to be on landing the job. Your family, friends, or significant other can hear all about it AFTER it’s over and done with! 10. BRING ALONG EXTRA COPIES OF YOUR RESUME AND COVER LETTER Some interviews may be held by a panel of hiring managers, educators, charge nurses, and HR personnel. You’ll want to make sure that everyone at the table receives your resume and cover letter. Bring along extra copies and offer them at the start of your interview. 11. PREPARE A SET OF QUESTIONS TO ASK YOUR INTERVIEWER At the end of your interview, you’ll most likely be given the chance to ask questions before concluding. Take the opportunity to get additional insight on any professional development or research opportunities   the position may offer. It’s also important to thank the interviewer for their time. Consider sending a follow-up email or note to show your appreciation for the opportunity. 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? 12. RELAX - YOU'VE GOT THIS! Trust me — if anyone knows about pre-interview anxiety, it’s me! However, I’ve learned over the years that the worst thing I can do for myself is to worry and overanalyze how things will go on the morning of the interview. At this point, you’ve put in the time and hard work. Now is when it all pays off.  Eat a good breakfast, get your favorite coffee, and listen to some pump-up music. Take a few deep breaths and remember that you deserve all of the great things coming for you.  Envision yourself getting your dream job and let that vision come to life in your interview. You are going to kill it! 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. Get Help for Every Stage of Your Nursing Journey At NICUity , we’re so excited for you to land your dream job! We want to make sure your nursing career starts off strong, which is why we’ve got educational materials, resources, and guides to support and empower you at every step. Check out our Complete Nurse Interview eBook  for additional strategies to help you ace your interview. Good luck! ​ Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

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 Masterclass - Earn Contact Hours 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, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

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, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

Congratulations on passing your NCLEX and landing your first job ! You’re probably feeling a mix of nervousness and excitement — don’t worry! We’ve all been there. A lot of what you’ll need to know about patient safety you learned in nursing school. However, most of the practical skills you’ll need will be taught during your first few weeks on the job.   Looking to make your transition to practice a positive learning experience? I’ve collaborated with colleagues, professors, and nursing school friends to come up with this list of tips to help your new grad career   get started on the right foot. 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 if you’re unsure of how to do something or why your patient needs a particular medication or test. You’d be surprised how many seasoned nurses may have the same question — you  can help your coworkers learn too!   2. Admit when you’ve made a mistake. In the healthcare world, mistakes happen every day. When you’re just starting out, don’t make a habit of covering up a mistake, blaming others, or trying to argue your way out of it. Your colleagues will understand if you admit to your mistake and ask for help in reducing the consequences of your error.  3. Don’t hesitate to take a few minutes for yourself. If you need to use the restroom, ask a coworker to cover for you. If you need to hydrate, drink before continuing with your tasks. Most nurses delay the little things they need because they’re in a rush to finish a task but in reality, if you are too hard on yourself the work you do will be affected.  4. Always perform routine safety checks after receiving handover report. Before diving into shift tasks, it’s always important to make sure you have the necessary equipment at the bedside in case of an emergency. You’ll want to verify that you have items like a suction catheter, ambu bag, code sheet, functioning oxygen canister and tubing, IV initiation set, alcohol/chlorhexidine wipes, saline flushes, and gloves.  5. Know the SIZES of all tubes & lines in your patient. In the NICU, our patients are tiny and delicate. You’ll want to make sure you know what size lines and tubes your patient has. As part of this assessment, you’ll also want to know how deep these tubes are and keep track of those measurement numbers as well. Important lines and tubes include NG/OG tubes, IVs, ETTs, UVCs/UACs, PICCs, chest tubes, Foley catheters, etc. 6. Keep up with your charting. If you save your documentation for later, you might be rushing to finish before your shift ends. You can’t fully anticipate when you will be really busy, so stay up-to-date on your charting as often as you can. It’s also important for the multidisciplinary team to be able to review your charting and trend the data, so you’ll want the most recent assessment and vital signs readings to be updated in the chart as soon as possible. 7. Don’t be too hard on yourself. You’ll learn hundreds of new things each shift. What’s important is that your coworkers and managers won’t expect you to remember everything or perfect every skill after your first try. Having patience with yourself will help others have patience with you as well. Take your time, you’ve got a long career ahead to master your skills! 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. I like to make little notes of the things I need prior to calling or paging the doctor so I don’t forget any important details. For example, if you call and ask to increase a vasopressor dose, make sure you have a set of recent vitals to share with the doctor. They’ll want this information as well! 9. Invest in comfortable footwear. You will take thousands of steps every nursing shift, so wear appropriate nursing shoes that are made for comfort and durability. I also recommend getting a pair of shoes that can be easily washed or wiped. Check out my favorite brand, Sanita Clogs, here! PS: You can use the code “ Nurse Tori” for 20% off your order. 10. Learn to be assertive. Building confidence takes time. Watch and learn from seasoned nurses how they give report, ask questions, take phone calls, and communicate with family members. While these skills are practiced throughout your career, it’s important to start practicing while you’re just starting out. 11. Avoid being involved in workplace gossip. We’ve all witnessed this sort of catty behavior in school, in clubs, or in the community. Being known as one of the unit’s gossip queens will do nothing good for your career as a nurse. Instead, try to get a reputation for being kind, helpful, and intelligent.   12. Always research new medications before you give them. You may have never heard of some of the medications that you’ll be administering in the NICU. Before giving them to your patient, take the time to understand why you’re giving the medication, potential side effects, IV compatibility, and the appropriate dosing range. If you’ve researched and still don’t know why or how to give the medication, ask a coworker for advice. 13. Read the doctor's notes . Nursing report can get busy, and you don’t always have time to relay every single part of a patient’s history. Make a habit of reading through the doctor’s notes and plan of care after receiving report. These notes are comprehensive and could help you find extra details or information that you weren’t aware of. 14. Make your statement short and precise when calling a doctor in the middle of the night. When calling a doctor, you’ll want to have a short and sweet request. You might think that providing a long detailed story or explanation could help, but it usually makes your request more confusing and complicated. Get straight to the point and ask for what you need. Doctors will respect this and thank you for it! 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. The more often you show that you’re willing to help your neighbor, the more likely it is that they’ll help you the next time you need it! 16. When in DOUBT, take the line OUT ! NICU IV’s only usually last 24-96 hours depending on the baby’s size and vasculature. If their IV site looks puffy, red, swollen, is difficult to flush, or blanches, take it out! 17. Don’t fully trust an IV pump or other piece of equipment. Make sure to manually check the rate, volume, and concentration of the IV fluid you’re infusing during rounds and before starting a new drip. This will keep your patients safe and will also help you understand how much fluid volume is going into your patient every hour. 18. When calculating the volume for new medications or narcotics, always ask an experienced RN to double check your work. This will give you confidence and security that you have drawn up the medication the right way. If you’re not sure how to prepare the medication, ask how they would reconstitute and administer it. You’ll notice a trend here — ask all of the questions!! 19.   Be careful with your charting. Remember that in the medical world, if it is not charted, it was never done. Your charting will be significant if a lawsuit is brought against you or the hospital. This is important to consider when having conversations with doctors and family members as well. If you relay an important assessment finding or vital sign, chart who you told and when you had the conversation. This might seem unnecessary, but trust me, you’ll always want to cover yourself, especially during critical moments.  20. When you are about to do a procedure like dressing change or Foley catheter insertion, make a list of all of the supplies you’ll need so you don’t forget anything. If you’re placing a new IV, have a couple sets open and ready. Even if you’re only changing a baby's diaper, make sure to have everything you need at the bedside before opening the isolette. This will save you time if something unexpected happens during the procedure. 21.   Always get the right size of gloves for your hands. Gloves work better when they fit your hands perfectly. Don’t rush and grab a size that’s too large or small, especially during a crisis situation. You’ll want to make sure your dexterity is as good as it can be. This starts with wearing the proper size of gloves! 22. Show the world what professional nurses look and act like. Just remember that wherever you go, you are representing the nursing profession. Especially when you’re in your work scrubs, your actions, appearance, and attitude should reflect the nursing profession you have worked hard to enter.  23. Always try to appear calm and relaxed, even if you’re freaking out on the inside. If you appear calm and coordinated, it’s more likely that your patient and their family members will read your calm energy and relax a bit. This skill can be especially helpful during emergency situations.  24. Treat yourself at the end of a tiring shift. 12-hour shifts can be long and exhausting, especially when you work more than one in a row! When your shift ends, always remember to # TREATyoSELF !  This could mean getting yourself a nice dinner on the drive home from work, or it could mean enjoying a cup of herbal tea before heading to bed. This will give you the energy and motivation you’ll need to continue through the challenges during your next shift.  25.   Wear compression stockings. Nursing involves a lot of time on your feet. Take care of your legs early on in your career so you can   avoid developing varicose veins  down the line. There are tons of cute nurse compression socks  out there to make you feel less like a granny — check them out here !  26.   Be open to advice. If a preceptor or other senior nurse recommends an easier way to do a task, try it. Experience is the best teacher and your senior nurses know what they’re doing! 27. Take advantage of the time you have with your preceptor. When you are working under a preceptor, ask for suggestions and tips! Your hospital is paying you to learn, so this is the perfect time to ask ANYTHING you’re unsure about. You are new and your coworkers know that. 28. Organize your shift and make a tentative schedule for the things you need to do. I recommend making a tentative hourly schedule on the back of your nursing report sheet to organize your shift. Prioritize which needs to be done first and make sure those tasks get completed before things get busy. 29. Get to know everyone in your unit. You’ll want to become familiar with all of the employees who work on your unit. This includes the respiratory therapists, doctors, techs, secretaries, and janitors — not JUST the nurses. You don’t need to become best friends with everyone, but getting to know them will help you adjust to your new unit and feel more comfortable asking for help. 30. Relax — things do get easier! All NICU nurses  who are new in the profession undergo the same period of adjustment, so be patient. Being nervous is a good thing at first, but everything will get more comfortable with time :)  31. Avoid complaining. Complaining at work affects the mood of your co-workers. Try to stay positive and minimize negativity. If you have a legitimate concern or issue with the way something on your unit is done, bring it up to your manager or supervisor instead of ruminating about it. 32.   Delegate tasks. Some nurses think they can get everything done themselves. In the NICU, it’s impossible to do all the work alone. Delegate simple tasks to others in a respectful manner and reach out for assistance if you’ve got a busy shift and need a hand.  33.   Develop your own support system. It can be helpful to talk about your problems at work with someone who understands the challenges and stresses of nursing. A mentor can help you work through difficult days and keep your spirit alive.  34. Set goals. What do you want your career to look like in 5 years? Setting nursing goals  will help you maximize what you achieve as a nurse. These could include objectives like becoming certified , going back to school, or becoming a charge nurse on your unit. 35.   Find a hobby to enjoy on days off. Joining a club or hobby can help direct your attention away from your job while you’re at home. It’s easy to worry about patients or think of your coworkers when you should be relaxing and recovering from your shifts.  36. Take the opportunity to watch procedures while you’re on orientation. Seasoned nurses have their own tricks for doing procedures like Foley catheter insertion, dressing changes, sterile line changes, and admitting a patient. Offering a second pair of hands will show that you’re not only looking to help your team, but that you’re also looking to take the initiative to learn from the best.  37. Be flexible. If you are asked to float in another unit for extra help, accept it. If your unit has a difficult assignment that you’d like to learn from, offer to care for the patient. You’ll learn a lot by taking on challenges and being flexible.  38. After experiencing a tough shift, you’ll have nothing to fear. If you run three codes in a single shift, the next time you have a code you will know what to do and won’t have the same level of fear you had the first time you handled an emergency. The same thing applies when inserting IV lines, helping with a high-risk delivery, and admitting a patient After doing an IV insertion  hundreds of times, you’ll find venipuncture easy.  39. When receiving verbal orders, right down what you hear and read the order back to clarify. There’s an old saying that we forget 80% of what we hear within a few seconds of hearing it. When having a discussion with a doctor, take notes so you can feel confident knowing you're taking the right action. This can keep patients safe and also protect your license. 40.   Don’t dwell on mistakes. Like mentioned earlier, making mistakes happens to everyone, even in high risk settings like the NICU. What’s important in these situations is that you learn from your mistakes  and move on. 41. Don’t apologize for doing your job. If you need to call the attending physician in the middle of the night, do it without hesitation. If you need to assess the baby while the mother is holding their child, don’t be afraid to tell her what needs to be done. It can be awkward and uncomfortable, but you’re just doing your job to protect your patient.  42.   No matter how tired or stressed out you are, always approach your patients with positivity and a gentle touch. Patients are in the NICU because they have illnesses. While they can’t thank you for your attention and devotion, they have a future because of you. If you’re having a tough personal day or can’t bring your best to work, consider taking a sick or mental health day. This is celebrated these days, not looked down upon. This can help you show up with your best foot forward every day.   43.   Get a NICU reference guide  to use on your first few months of the job. In nursing school, you’re tested on your ability to remember medications and side effects. Now, you’re allowed to use “ cheat sheets ”. Don’t be ashamed to carry a bedside nursing reference book  or drug guide during your first shifts. 44. When you’re faced with a crisis and you don’t know what to do, always start with the basics. If you’re faced with an emergency situation but aren’t sure where to start, begin with what you know. Collect the patient’s vital signs , perform a head-to-toe assessment, visualize your lines, tubes, and support the baby’s breathing if necessary. The other important assessments will stem out from here. 45.   Listen to your “gut feeling”. Trust your instincts. As you develop skills and an understanding of infant anatomy and physiology , you’ll develop gut feelings that will help you along the way. If something doesn’t feel right, it probably isn’t. If you feel uncomfortable about something and want to ask a doctor about what to do, your discomfort is what will save your patient.  46.   Leave your work stress 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. The great thing about nursing is that there’s always someone at the hospital handling the patient workload. While you’re off, enjoy being off. It’ll be your turn to go back soon enough, so enjoy the peace! 47. If a seasoned nurse grills you when you’re giving report, don’t take it personally. Some nurses may come across as demanding and rude when getting report. While this may seem personal, they’re there for the same reason as you are: to care for patients and get babies home to their families. Those that have worked in the NICU for years probably know more than you do, so take every opportunity to learn from them and thank them for their tips and support. Soon enough you’ll be the seasoned nurse giving pointers :)  48.   When giving medications, double check your six rights. When administering a medication, even if you’ve given it one hundred times, you’ll want to review the six rights of medication administration  – right medication, right patient, right time, right dose, right route, and right documentation.  - NICU Common Meds & Code Meds at Your Fingertips - NICUity Bedside Comprehensive Companion 49.   If no one see ms to be taking your concerns seriously, raise them to the medical chain-of-command. As a new grad, you may feel like doctors aren’t taking your concerns or worries seriously. If you’re not getting the attentive response you need, consider raising your concerns to the chain-of-command. Start with a resident or fellow, and go up to the neonatal nurse practitioner  and neonatologist after that.  50. Do your 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. When you feel comfortable performing an assessment, you’ll gain a load of confidence  in recognizing changes and abnormalities. 51.   Use proper body mechanics!  When pushing equipment, lifting objects, moving isolettes, and charting, protect your body. Stand with good form and avoid bending at the waist. Your future self will thank you! 52. Take (and appreciate) your breaks when you’re allowed them. When you’re new, you might feel compelled to chart through your break or say “no” to someone covering you for a few minutes while you grab a bite to eat. Experienced nurses will tell you to TAKE YOUR BREAK! You’re entitled to at least a few minutes of rest during your 12-hour shift. Whether you use that break to rehydrate, eat, or take a nap is up to you, but be sure to use your time to find some peace in the middle of your shift.  53.   Never forget the reason you became a nurse. Think about why you became a nurse  whenever you are feeling tired, run down or burned-out from work. It will help you get through the rough times of being a nurse and will keep you motivated to improve your practice and the lives of those you care for.  54. Put compassion into everything you do. Remember, when you’re a NICU nurse, you’re caring for someone’s most precious gift. You’re caring for a neonate/preemie or infant at their most vulnerable moments. Speak softly, act with a sensitive touch, and listen with attention. Families will never forget it. 55. It’s never too early to save for retirement! Most organizations provide employees with a retirement savings plan in their benefits package! Whether you are able to contribute 5% or 15%, start contributing money towards your retirement fund early! This always seems to be put on the back burner, however it should be one of the top things you prioritize! Looking for more ways to get ahead? Being a new nurse is hard, but here at NICUity , we’ve got your back! Our educational guides and resources can support you during the first few months of your career and beyond.  ​ Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com . ​

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, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

A neonatal nurse practitioner (NNP) is an advanced practice nurse who cares for infants that require intensive care immediately after birth. They expertly manage newborn conditions like respiratory distress, low birth weight, congenital heart diseases , and electrolyte imbalance. These healthcare providers usually work in a neonatal intensive care unit (NICU) alongside neonatal nurses, neonatologists, respiratory therapists, and other clinical staff.  Curious what it takes to become one of these providers? In this article, we do a deep dive into the role of NNPs, explain what they do, and review the necessary schooling and clinical experience required to start your NNP journey.  What do Neonatal Nurse Practitioners (NNP) do? Neonatal nurse practitioners perform a variety of duties relating to providing care to sick and premature neonates and newborns. Specific duties include: ♡ Ordering and interpreting diagnostic and laboratory tests. ♡ Monitoring vital signs .  ♡ Performing bedside procedures like intubation and central line placement. ♡ Starting and maintain IV lines, specifically central catheters and umbilical lines ♡ Diagnosing and treating acute and chronic conditions. ♡ Documenting a thorough maternal medical history, along with any perinatal diagnoses  and symptoms. ♡ Detecting changes in a patient’s health and altering the treatment plan when necessary. ♡ Educating patients and family members on their newborn’s disease process and plan of care. ♡ Monitoring and adjusting specialized equipment like incubators, ventilators, heart/lung bypass machines, total body cooling, and dialysis equipment to help patients meet their clinical goals. ♡ Leading neonatal resuscitation efforts alongside other team members. ♡ Communicating with other frontline clinicians and bedside nurses. ♡ Prescribing medications (independently or in a collaborative agreement with a physician, depending on the state of practice). ♡ Assisting with patient admission and discharge.  ♡ Participating in post-discharge primary care management. ♡ Participating in high-risk newborn transport. ♡ Leading staff education programs. NNPs, like other nursing professionals, often work 12-hour shifts in acute-care hospitals. They are often expected to work day and night shifts and may be required to work on-call shifts for emergency deliveries or patient decompensation on a non-acute unit.  What Steps Are Required to Become an NNP? A neonatal nurse practitioner is an advanced professional nursing position. This process takes around 6 years from start to finish. Below, we outline the general steps required to become a licensed neonatal nurse practitioner.  Steps to Become a Neonatal Nurse Practitioner: Go to nursing school  to get your nursing degree (ADN or BSN). Pass the NCLEX. Work as an RN (it’s best to get experience in a labor and delivery unit, postpartum unit, birthing center, or NICU to prepare for your NNP journey). Most NP programs prefer applicants with at least 1-2 years of bedside experience.  Apply to a master’s nursing degree program (MSN or DNP). Pass your boards to get your advanced practice registered nurse (APRN) nursing license. Start working as an NNP! Which Degree Program Should I Choose to Become an NNP? You’ll need to earn either your MSN or DNP from an accredited program with a specialty in neonatal nursing. There are three main degree pathways you can take to become a neonatal nurse practitioner: MSN-NP: One of the most common options for NP programs, the MSN-NP is for students who already have their BSN and enroll directly into the program at the graduate level. These programs usually take 2-3 years to complete.  - Basic requirements:  The applicant must possess a BSN degree. DNP: Doctorate Nurse Practitioner programs allow students to receive their doctorate degrees while meeting the requirements to become an NP. The DNP is generally suited for nurses who plan on working in an academic or research-based setting or want to go on to teach nursing courses in a university or college. These programs usually take 3-4 years to complete.  - Basic requirements:  The applicant must already possess a BSN degree. Postgraduate Certificate: If you have a graduate degree that is different from the area that you wish to specialize in, you can search for a school that offers a post-graduate certification option to allow you to enroll directly into the program. - Basic requirements:  Post-grad certificate programs require you to either possess your Master’s Degree of Science in Nursing (MSN) or have a Nurse Practitioner qualification in another specialty. What Are the Top 10 NNP Programs in the U.S.? Now that you know what it takes to become an NNP, you may be curious — which colleges and universities offer NNP specialty programs? Below, we list some of the highest-rated NNP programs across the country.  Vanderbilt University University of Pennsylvania University of Virginia Ohio State University Duke University Case Western Reserve University University of California- San Francisco Emory University University of Connecticut University of Alabama- Birmingham Resources for Every Step of Your Nursing Journey The first step to becoming a great NNP is becoming more comfortable and confident as a bedside nurse. At NICUity , we’ve got tons of educational materials, online review courses, and bedside tools to boost your career and improve your clinical practice.  Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

Those who know me know that I absolutely love Tucson, Arizona . As a proud University of Arizona nursing school graduate ( #beardown ), I’m always looking for ways to brag about the college, the town, and all that it offered me as a new nurse entering the healthcare world.  I lived and worked in Tucson for five years, taking in all that the city had to offer. I loved every second of living there, and was sad to have to leave the vibrant community, natural beauty, and incredible weather that comes with living in this special place.  Many of my close friends, nursing, and social media followers have been discussing high nurse burnout rates at the hospitals where they work. The increased costs of living in many of the fun, vibrant areas have made it challenging to afford the work-life balance and adventure that so many nurses are looking for. Many of my healthcare friends look to balance an exciting career with a fun and healthy lifestyle but can find it challenging to make that a reality. I’ve read a lot in the news recently about how Tucson is investing time, money, and resources   in developing healthcare growth and opportunities in the region, which makes me so excited for my beloved town and the lucky nurses who’ll get to live and work there.  What makes living and working in Tucson so great? Here, I’ll review my top five favorite things about being a nurse in Tucson and showcase the reasons this special city is so close to my heart. Top 5 Reasons to Move to Tucson for Nursing ♡ Tucson is a hustling healthcare hub with incredible career and educational opportunities Whether you’re a new nurse, looking to go back to nursing school, or are a seasoned pro looking for a new adventure, Tucson has so much to offer young professionals working in the healthcare field. The city houses three main medical centers: Banner-University Medicine , El Rio Health , and TMC Health . These hospitals offer robust emergency/trauma, medical and surgical services and specialties.  In addition to these facilities, The University of Arizona  is home to dozens of state-of-the-art science departments, including a school of nursing and a college of medicine. There is a large amount of funding going into making the Tucson medical industry an exciting and supportive place to work, making it the perfect time to consider moving to the area.  ♡ The affordability of the city makes it easy to balance finances and fun.   The cost of living in Tucson is 6% below the national average , making it easier to afford a lifestyle of fun and sun while working in a healthcare role. The average home price in Tucson sits at around $318,000, making it a prime place to live for first time home buyers.  In my opinion, Tucson is truly a hidden gem. The city is very dog and family-friendly, full of good public schools and parks. The college-town vibe makes it feel like new and exciting things are always popping up, while the small-town charm keeps the city warm and inviting as the population grows and expands . Traffic is light for most commutes, which makes it easier for residents to choose where they want to live in town without having to consider how far from the hospital their drive will be.  ♡ There are limitless opportunities for outdoor fun and exploration on days off.  As a night shift nurse, my days off are everything to me! With our long shifts, crazy sleep patterns, and stressful working environments, nurses need to live somewhere that they can find work-life balance. The top healthcare employers in the Tucson area offer top-quality benefits, vacation time, and flexible scheduling, making it easier for you to enjoy days off your way.  Living in Tucson, I knew that every day would be warm and sunny, which meant I could optimize my time with friends and family while I was away from the NICU. Because the town is nestled in the Sonoran Desert, there are so many things to see and do here to rest and recover on days off. Some of the most popular outdoor activities here include: Playing a round of golf  at one of the 40 beautiful courses in the area. Hiking through the desert, forests, and mountains ( Saguaro National Park  and the Coronado National Forest  are two of my favorite sites to explore). Biking on the protected 131-mile trail called “ The Loop ”.  Grabbing fresh produce or artisan goods at a farmers market .  Going horseback riding  through one of the local ranches.  ♡ Tucson is a cultural hub of music, art, food, and drinks.  Known as the Old Pueblo for its Spanish and Native American history, Tucson has an incredible heritage and culture full of art and music. It’s also been rated as the sixth best food city  in the U.S. by Travel+Leisure — you know I love good tacos and margaritas! The three main hospitals in the area are located in the heart of the city, which make it easy to grab tasty food on a lunch break or listen to a local musician after a long shift! Nursing can be tough, and everyone needs a bit of fun on their days off! Events like the Tucson Folk Festival  and the Tucson Mariachi Conference  are fun to visit with friends and family. On easier and more relaxed days, it’s easy to step out and grab fresh produce or artisan goods at a farmers market . ♡ There are endless networking opportunities to help your nursing career flourish. Networking is the name of the game when it comes to finding a new job  or taking the next step in your nursing career. With three major medical centers and The University of Arizona on your doorstep, you’ll be presented with a variety of conferences, seminars, and other education events  that can help you envision yourself in the next stage of your professional nursing journey. Become a Nurse in Tucson and See Your Career Thrive It’s easy to talk about a place you love. For me, my time in Tucson was invaluable and it made me the clinician I am today. If you’re stuck in a rut, are feeling burned out, or are just looking to take the next step in your nursing journey, I fully recommend transforming your career in Tucson. Here, you can find out more about nursing opportunities in Tucson  and discover additional perks of living and working in this bustling and beautiful city.  Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

As a New NICU nurse, I was so overwhelmed by the amount of medical "jargon"  I needed to learn in addition to mastering working at the bedside. Below, I’ve defined a set of common terms we use daily to prepare you for your first few weeks on the job !  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! Common NICU Nursing Terms When you’re new to working in the Neonatal Intensive Care Unit , you’ll hear members of the medical team  using NICU-specific terminology and abbreviations to describe a patient’s status or condition. Understanding the meaning of these terms can be quite a challenge. The list below can help you navigate this process!  A's & B's An abbreviation referring to episodes of a pnea and b radycardia; see APNEA and BRADYCARDIA ANEMIA A lab reference signifying that there is a lower than normal number of red blood cells a sample of blood APNEA The cessation of breathing for greater than 20 seconds ASPHYXIA A condition referring to a lack of sufficient oxygen to the tissues of the body; the brain and the kidneys are the most sensitive organs to low oxygenation and show damage quicker than other body parts ASPIRATION Breathing a foreign material (milk/formula, stomach fluids, meconium, etc.) into the lungs ATTENDING PHYSICIAN The doctor who is responsible for coordinating the medical care for a patient; in the NICU the attending physician will generally be a neonatologist “BAGGING” A slang term used to reference the pumping of air into an infant’s lungs using oxygen and a rubber bag; “bagging” is most often implemented to assist a patient who needs help breathing BILIRUBIN A yellow-pigmented waste product that forms when the body naturally eliminates old or damaged red blood cells. It often makes a patient’s skin and eyes look yellow or brown. Premature infants are often put under fluorescent light or a lighted blanket to safely remove bilirubin from the body; see BILI LIGHTS and JAUNDICE “BILI LIGHTS” or “BILI BLANKET” This term is used in conjunction with the term phototherapy and refers to the lights used to treat jaundice; see BILIRUBIN and JAUNDICE BLOOD GAS This term is shorthand and refers to an arterial blood gas or a venous blood gas. These tests are used to evaluate an infant’s level of blood oxygen, carbon dioxide, and acid. This helps clinicians evaluate an infant’s respiratory status and determine a plan for managing long-term oxygenation "BLOW BY”:  A slang term that refers to the practice of giving a patient a small amount of oxygen by holding an oxygen tube or mask a centimeter or two from an infant’s nose  BP:  This is an abbreviation for the term blood pressure and refers to pressure experienced exerted against the walls of the arteries during each pulsation of the heart "BRADY" This term is shorthand for the word bradycardia and refers to an infant heart rate below 100; it can also refer to a rapid slowing of a baby’s heart rate, even if the number sits above 100 CARDIOLOGIST A medical doctor who manages heart functioning CASE MANAGER A staff member who collaborates with insurance agencies to clarify the reason for hospital admission and the length of stay required; they also help with discharge planning and arrange for medical equipment required for discharge; when necessary, they also initiate referrals to funding agencies for medically and financially eligible infants; this team member is different from the insurance company case manager who is assigned to customize and individualize benefits for those with extensive or complex health care needs CBC This is an abbreviation for the lab test complete blood count; this test the volume of various types of cells present in the blood, chiefly: red blood cells (oxygen-carrying cells), white blood cells (infection-fighting cells), and platelets (clot-forming cells) CENTRAL CATHETER or CENTRAL LINE A thin, flexible tube (catheter) placed in a vein or artery to deliver medications, vitamins, and fluids to the body; broviac catheters are usually placed in the upper chest and tunnel under the skin to enter the vena cava; PICC (peripherally inserted central catheter) lines are usually threaded through a vein in the arm to the vena cava; this term also refers to umbilical venous and umbilical artery catheters that are inserted into the vein or artery of the umbilical stump (belly button) shortly after birth 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 CHRONOLOGICAL AGE A baby’s age based on their actual birthday (not considering their gestational age/time in utero) CIRCUMCISION Known colloquially as a “circ”, this term refers to the surgical procedure performed to remove the foreskin of the penis; this is usually done just before the baby goes home and is only performed on request CONGENITAL Refers to a condition existing at the time of birth CORRECTED AGE A baby’s age based on their gestation; this value is calculated by adding the time spent inside and outside of the mother’s uterus CPAP This is an abbreviation of   Continuous Positive Airway Pressure, a form of ventilator assistance used to keep an infant’s lungs properly expanded; CPAP does not breathe for the baby, but allows the baby to breathe into a "forward moving wind." CT SCAN (of the head) This is an abbreviation for the imaging method called computerized tomography; this imaging is usually performed in the NICU to identify skull or brain damage, though CT scans can also be done on other parts of the body; the baby must be transported to the hospital radiology department to get their CT scan "CULTURE" This is shorthand for a laboratory test called a blood culture. Here, a collection of blood, spinal fluid, urine, or other specimens identifies the presence and type of germs present in an infant’s blood CYANOSIS Blue color of the skin that occurs when there is a lack of 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 and can help establish a plan for treating the infection; for example, polys and bands usually will predominate in bacterial infections, while the number of lymphs usually will increase in viral infections ECHOCARDIOGRAM Also known as an “echo”, this term refers to a test used 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 to infants EDEMA Puffy and inflamed skin that results from a build-up of intra and extracellular fluid in body tissues and spaces ENDOTRACHEAL TUBE Commonly referred to as an “ET” tube by NICU nurses, this refers to a plastic tube which goes from the baby's nose or mouth past the vocal cords and into the upper trachea (windpipe); see INTUBATION EXCHANGE TRANSFUSION A treatment which removes the baby's blood in small quantities and replaces it with donor blood; this procedure is most frequently used to lower the level of bilirubin in an infant’s blood, but may also be used to raise or lower the number of red blood cells to improve the blood’s clotting ability EXTUBATION The   intentional or unintentional removal of the breathing tube that goes from 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 (neonatology) GAVAGE FEEDINGS Also known as tube feedings, this practice refers to nutrition that travels through a plastic tube inserted through a baby’s mouth or nose and into the stomach; this is used to nourish extremely premature newborns or babies who are too weak to suck and swallow GENETICS The branch of medicine that deals with heredity and the variation of individuals; these doctors can provide family members with a prognosis for development and function, and assess for risks of recurrence of certain genetic conditions HEAD ULTRASOUND  An imaging technique that uses sound waves to look at a baby’s brain; this painless test can be done at the NICU bedside and is often completed while a baby is sleeping HEART MURMUR A rushing sound made by the blood within the heart, usually heard with a stethoscope  HEELSTICK A quick prick of the heel with a sharp needle to obtain small blood samples for tests; this is the method of blood collection for a blood sugar or capillary blood gas HEMATOCRIT Known casually as a “crit”, this lab test is completed to determine the amount of red blood cells in a patient's blood HIGH-FREQUENCY OSCILLATORY VENTILATOR  Casually referred to as an oscillator, this special ventilator provides breaths at a rate that exceeds the maximum rate of a normal ventilator HYDROCEPHALUS An abnormally large accumulation of cerebrospinal fluid (the 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; while there is now standard value used to identify hypotension, this term usually refers to a blood pressure reading that falls below the 5th or 10th percentile for the infant's gestational age, postnatal age, and weight HYPOGLYCEMIA A low amount of sugar (glucose) in the blood; this value will be different for each infant, but can generally refer to any blood glucose of less than 40 mg/dL "I's and O's”  A slang abbreviation often used in the NICU to refer to the amount of fluid a baby takes in compared to how much the baby pees and poops out; this is why NICU nurses document all diaper weights 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 The inappropriate accumulation of IV fluid in body tissues; this most often occurs when an IV is misplaced or falls out of the vein INSPIRATORY TIME  Casually called “i-time” by NICU nurses, this value refers to the length of a forced breath provided to a baby by a ventilator INTRAVENOUS LINE  Casually called an IV by NICU nurses, this is a small plastic tube or hollow needle placed into one of the baby's veins, used to infuse fluids, medications, and vitamins can be given when a baby cannot take all of their nourishment by feedings INTRAVENTRICULAR HEMORRHAGE (IVH)  A collection of blood in and around the ventricles (hollow portions) of the brain INTUBATION The insertion of a tube into the trachea (windpipe) through the nose or mouth to allow air to reach the lungs; see ENDOTRACHEAL TUBE ISOLETTE Sometimes referred to as an incubator, this is a type of enclosed bed for an infant who is not mature or healthy enough to maintain their body temperature in an open crib JAUNDICE A yellow coloration of the skin and eyes that results from an increased amount of bilirubin in the blood; treatments for jaundice include phototherapy and (rarely) exchange transfusion; see EXCHANGE INFUSION and BILIRUBIN and BILI LIGHTS KANGAROO CARE A cute way to describe   skin-to-skin care where the baby is placed on the bare chest of the mother or father for comfort LUMBAR PUNCTURE   Sometimes called a "spinal tap, this procedure involves a small needle being placed in the small of the back, between the vertebrae (back bones), to obtain spinal fluid for bacterial cultures and other lab tests MECONIUM The first bowel movements that a baby has; these are thick, sticky, and range from dark green to black in color MECONIUM ASPIRATION (Meconium Aspiration Syndrome or MAS)   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 An infection of the fluid that cushions and surrounds the brain and spinal cord MONITOR A screen that displays the heart rate, respiratory rate, blood pressure and blood oxygen saturation of the baby 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. 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 IV nutrition until he recovers; see also PARENTERAL NUTRITION and SEPSIS NEONATOLOGY The medical specialty that focuses on managing diseases and conditions of newborn infants (neonates); neonatologists are pediatricians who have received several years of additional specialized training NEPHROLOGIST A medical doctor who specializes in disorders of the kidneys NEUROLOGIST A medical doctor who specializes in the brain and nervous system NPO A Latin abbreviation for “nothing by mouth”; if the baby is kept NPO, all nutrition will need to be given intravenously OPHTHALMOLOGIST A medical doctor who specializes in managing eye disorders OTOLARYNGOLOGIST A medical doctor who specializes in conditions of the ear, nose, and throat PARENTERAL NUTRITION (Total Parenteral Nutrition or TPN) Protein, fats (lipids), sugars, and salts are provided by IV to babies who cannot tolerate complete feedings by bottle or gavage PATENT DUCTUS ARTERIOSUS (PDA)  A small vessel that 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 surgical intervention may be required 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 provides care to infants and children 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; these are placed when IV therapy, antibiotics, or nutrition (TPN/lipids) are administered for a long period of time PHOTOTHERAPY Light therapy to treat jaundice; bright blue fluorescent lights called bili lights are placed over the baby’s incubator or around the baby as a lighted blanket; see also BILIRUBIN and JAUNDICE. 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 before discharge from the hospital; this test is required by law PNEUMOMEDIASTINUM Leakage of air from the normal passageways of the lung into the space surrounding the heart; a pneumomediastinum is usually harmless, but can be associated with a pneumothorax which is often more serious; see PNEUMOTHORAX PNEUMOTHORAX A collapsed lung causes a collection of air to form in the space around the lungs; this buildup of air puts pressure on the lung, so it cannot expand normally when a baby tries to breathe 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 health outcomes are expected for a baby given the nature of their condition 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 health outcomes are expected for a baby given the nature of their condition RED BLOOD CELLS The cells in the blood which carry oxygen REFLUX A return or backward flow of fluid; gastroesophageal reflux (GERD) occurs when feedings or other stomach contents flow back up into the esophagus REGIONAL CENTER A network of state-funded agencies that help to coordinate community services and resources to infants at risk of having a developmental delay; these teams also provide services and coordinate resources for children and adults with specific developmental disabilities RESIDENT A medical doctor who is training to become a pediatrician; a residency program is usually three years long; first year residents are referred to as interns; third year residents are called senior residents RESPIRATORY DISTRESS SYNDROME (RDS) A common breathing problem of premature infants caused by insufficient levels of surfactant in the 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, which can cause involuntary muscle activity or stiffening SEPSIS A potentially fatal and dangerous condition during which the body is fighting a severe infection that has spread to the bloodstream; see also MENINGITIS and 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 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 substance secreted by special cells within the alveoli (air sacs) of the lung that makes the lung flexible and keeps it from collapsing; surfactant deficiency is the main cause of Respiratory Distress Syndrome (RDS); commercial products are available which can be put into the lungs through the tube in the windpipe; these products are frequently used to treat RDS in a premature baby TACHYCARDIA:  A fast heart rate TACHYPNEA:  A fast breathing rate TRACHEOSTOMY A surgical opening in the trachea, below the larynx (voice box) that allows air to enter the lungs TRANSFUSION Giving donor blood to a baby by IV infusion 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, this term is often used to describe the process of removing an infant from a ventilator or incubator Want to Ensure a Strong Start to Your NICU Career? Now that you’re familiar with the NICU lingo, you might be looking for more ways to prepare for your first nursing job. At NICUity , we have all of the educational resources you need to ensure your first shift is a great experience! 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, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

I’m often asked on Instagram: "How do I prepare for a NICU interview?" The answer might be easier than you think.  The scary part about interviews is that if you’ve never worked in a NICU before, you probably aren’t very familiar with the workflow. This can be daunting and can leave you feeling underprepared and underqualified.  However, hiring managers for these departments know this, and tend not to ask many questions that only experienced NICU nurses would know the answers to. Rather, they want to know why  you want to work in their unit and how you’ve prepared to be successful in the role. They ask situational questions, like how you handled a challenging family member or how you responded during an emergency. They’ll be looking to hire someone who’s a great fit for their team, not just someone who has loads of NICU bedside experience.  Most interviewers have a short list of skills they’ll be looking for in a nurse: Will they jump in and help a patient or coworker? Are they open to learning and growing? Can they stay calm and handle high-pressure situations? Do they have the confidence to speak up and advocate for a patient’s needs? Do they know how to prioritize and delegate? Are they equipped to support and comfort an infant and their family members? Are they interested in leadership roles?  It’s important to remember that nurse interviewers don’t reinvent the wheel each time. They usually have a repository of questions to ask, many of which are similar to questions you’ve been asked in previous interviews. Let’s review a few common questions to give you a sense of what hiring managers will ask.  12 Common Nurse Interview Questions 1. “Tell me a bit about yourself.” Most hiring managers will start with a basic introductory question like this one. You’ll want to share a bit about your personal and professional background, your education, and your career goals. This is your time to share your excitement and enthusiasm for the NICU. 2. “What made you interested in our unit?” When answering this question, you’ll want to highlight any relevant nursing experience that has prepared you for the role. Maybe the unit you're interviewing for has won an award for its healthy work environment or is known for its high quality teamwork. Be sure to reference what you’re looking for in a nursing job and share why you think this particular unit is a good fit for you.  3. “How do you plan to help us meet our organizational goals?” Here, your interview will be checking to see if you’ve done your homework on their facility. Each unit has its own set of unique clinical goals. Prepare for your interview by conducting background research on the institution. You can check out their nursing website, read up on patient feedback and reviews, and talk to friends who work there.   During the interview, you’ll want to show them that you’re familiar with NICU nursing quality indicators like infection rates and pressure injuries and know what it takes to keep patients safe.  4. “Tell me about a time when you made a mistake. How did you handle the situation?” Mistakes happen in nursing everyday. What’s important is that you learn from your mistake and work to minimize patient harm. When answering this question, you’ll want to be honest and open about a mistake you’ve made. Interviewers can smell a fake answer like “I’ve never made a mistake” from a mile away.  5. “What strengths will you bring to our nursing team?” Managers who ask this question want to know what you’ll bring to the table. Share behaviors and skills like time management, strong communication, compassion, and attention to detail. Telling a story about your strengths in action can give more meaning to your experiences and bedside expertise.  6. “How would you handle a patient emergency?”  Answers to this question can reveal whether you have the skills and experience to handle a patient who is decompromising fast. Show that you know how to communicate concerns to the physician and step in when things get hectic. 7. “Describe a time when you went above and beyond for a family member.” Patient and family advocacy  is so important to improving health outcomes. Managers want to make sure they hire nurses that go the extra mile to get patients the care and treatment they need.  8. “Have you ever had a conflict with a coworker? How did you handle the situation?” Unfortunately, disagreements arise in healthcare. What’s most important is that you can handle yourself professionally and manage the situation in a calm and composed manner. Show that you prioritize patient safety and satisfaction over your own personal pride. Managers won’t want to hire someone that’s petty or argumentative.  9. “How would you communicate with a family member who was unhappy with the team’s care plan?” Sometimes, a parent or family member is unhappy with the quality of care their loved one receives. It’s often our duty as nurses to listen to their complaints and work to resolve their concerns as quickly and painlessly as possible.  10. “How do you plan to de-stress after a challenging shift?” Nursing can be challenging and it’s important to demonstrate you have the skills necessary to bounce back after a tough shift. Can you compartmentalize and complete the tasks that need to be done? Will you have the strength to come back day after day? Answers to this question can showcase your resilience and dedication to patient care.  11. “What are your professional goals for the next 5 years?” Hiring managers want to know if you’re driven and motivated to improve your professional practice. Do you plan to work in their organization long-term or if you are on the fast track to an advanced degree? Interviewers care less about what your goals actually are  and just care that you’re thinking about your future in nursing.  12. “Do you have any questions for us before we finish up?” An interview allows you to ask clarifying questions about the logistics of the position. If you don’t ask any questions, the hiring manager may assume you’re not that interested in the position. Here, we provide a list of example questions you can ask during the final minutes of your interview:  LIST OF QUESTIONS TO CONSIDER: 1. What is the size and organizational structure of your unit? How many patients does your unit hold? 2. What is your nurse-to-patient ratio? 3. Can you discuss your take on the hospital's culture and philosophy? 4. What does the transition period look like? Would I be expected to work days or nights?  5. What does the orientation period look like? Will I have a designated preceptor? 6. What are some recommendations for getting involved and growing within your unit? 7. What will be the greatest challenge of 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 best about working in this organization? Download your Interview E-Book today! The Complete Nurse Interview E-Book Here is our fully loaded E-Book. This E-Book is a digital download that provides you with NURSE PRO TIPS to help you land that dream job! This is a fully loaded guide complete with the strategies to help you master your job application and interview process. We cover all of the juicy details to help you perfect the art of interviewing. Topics included: ♡ INTERVIEW PREP ♡ JOB INTERVIEW 101 ♡ THE THINGS THEY DON’T TELL YOU ♡ NURSING INTERVIEW QUESTIONS AND RESPONSES ♡ BONUS INTERVIEW QUESTIONS! ♡ PORTFOLIO BREAKDOWN ♡ RESUME AND COVER LETTER 101 ♡ THINGS YOU CAN DO EARLY ♡ SOCIAL MEDIA CONSIDERATIONS Tips for Every Stage of Your Nursing Journey Whether you're interviewing for a position or are looking to develop your professional practice in your current role, NICUity  has you covered! We’ve got educational resources , guides , and supplies  to get you through every step of the way. Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

Becoming a mother is truly  life-changing. It’s that kind of moment you dream about, talk about, and yet—when it happens—words somehow still fall short. When I gave birth to my daughter, it was the most emotional, sacred, and surreal experience of my life. And like many new moms, I wanted something meaningful to mark that moment forever—a push present  that wasn’t just beautiful, but symbolic and lasting. As someone who’s always been sentimental (and a low-key jewelry collector since my early twenties), many of my favorite pieces are tied to milestones—graduating nursing school, getting married, family heirlooms passed down. So when it came to celebrating the birth of my daughter Sloane, I knew I wanted something next level . Graceful. Simple. Timeless. A piece I could wear every day, layer with ease, and one day hand down to her. My Favorite Push Present: A Morse Code Necklace by Elliot Young Jewelry I’ve loved Elliot Young Jewelry for years—they’ve always struck the perfect balance between edgy, fine, and meaningful. While searching for the perfect push present, I came across their Morse Code Collection  and instantly had an idea: Elliot Young x Nurse Tori: Let’s Make it Personal Could we customize a piece to spell out Sloane’s name in Morse Code?  The answer: Yes. And it turned out even more stunning than I imagined. This necklace is more than just jewelry—it tells a secret story. ✨ Each bead represents a dot or dash in Morse Code. To the world, it’s a sleek, two-toned piece. But to me? It holds my daughter’s name—close to my heart, in the most subtle, sentimental way. Sleek, personalized, and Two-Tone. Morse Code Necklace! They curated the perfect neclact that spells Sloane's name in mores code! How special is this. When translated, these sequences reveal a hidden message. This hidden aspect adds an element of surprise and mystery, and unique storytelling. Morse Code Necklace Details: ♡ Spell out your baby’s name, initials, or a special word  in Morse Code ♡ 14K yellow and white gold beads  in a custom Morse pattern ♡ S parkly 14K gold chain   (18") ♡ Lobster clasp closure ♡ Arrives with a Morse Code translation card  and logo gift pouch ♡ Made in the USA ♡ Perfect for stacking or wearing solo Every necklace is handmade and totally one-of-a-kind—so each piece is as unique as your journey into motherhood. To see the pattern of the word you choose before you purchase, you can type in your word on this website Why I Love It: ♡ It’s not just jewelry—it’s a story. ♡ It feels private , like a love letter in code. ♡ It’s fine jewelry (aka no green neck or fading chains here). ♡ It’s something I can pass down to Sloane someday. Elliot Young x Nurse Tori: Let’s Make it Personal I was so excited to team up with Elliot Young Jewelry  to help other mamas create their own custom Morse Code piece. Whether you're celebrating the arrival of a baby, honoring a loved one, or just want a beautiful reminder of your strength—this necklace is it . Plus you can help make an impact! And because I love sharing things that make an impact...Their mission goes beyond style—they’re committed to making a positive impact through their Elliot Young Impact Program , giving back to schools, youth orgs, and communities in need. As moms raising the next generation, we love to see it. ✨ Use code: NURSETORI to save 20% off   your custom Morse Code Necklace! ( P.S. it also makes an amazing Mother’s Day or baby shower gift. ) A Few Notes Before You Order: This is fine jewelry , not costume—so the quality and  price reflect that. Each necklace is custom-made by hand , so be sure to order ahead (especially for a specific date or event!) Every name or word will look a little different, making your piece totally one-of-a-kind. Ready to Shop? Head to Elliot Young Jewelry   and customize your own Morse Code Necklace. And don’t forget to use code TORI20  for 20% off! Because motherhood deserves to be celebrated—and remembered—in the most meaningful way. To see the pattern of the word you choose before you purchase, you can type in your word on this website Tori Meskin, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com

If you work in the NICU, you know that practice guidelines constantly change and adapt to align with new research findings. Research is essential to safe nursing care, and without strong unit-based evidence-based practice (EBP) and quality improvement (QI) projects, it’s difficult to ensure our tiny patients are receiving the most appropriate therapies and interventions! If you’re planning your next NICU research project, paper, or nursing school  capstone project, it can be tough to come up with fresh and creative ideas. Here, I’ll review some of my favorite hot research topics to get you started! NICU Research Project Ideas What Factors Increase the Risk of NEC? How should we standardize assessments and treatments?  What causes colonic pneumatosis? Which antibiotics should be used to optimize outcomes? How and when should we restart infant feedings after NEC diagnosis? How can we reduce the risks of a child with congenital heart disease  (CHD) being diagnosed with NEC? What are some ways to optimize parenteral nutrition? Which imaging techniques should be used to confirm NEC diagnosis? Learn More Here: https://my.clevelandclinic.org/health/diseases/10026-necrotizing-enterocolitis https://kidshealth.org/en/parents/nec.html How Should We Standardize Small Baby Care? Which infant positioning strategies  are best for developmental growth? When and how should oral feedings be initiated? How often should infant weights be measured? What humidity settings are best for ELBW infants? How should we standardize intubations/extubations? When should infants be weaned from isolette to crib? Learn More Here: https://www.sciencedirect.com/science/article/pii/S1744165X22000245 https://dandlelionmedical.com/wp-content/uploads/2023/09/ELBW-Summary-Handout-Web-D5-1.pdf Are Probiotics Beneficial to Newborn Infant Gut Development? Do probiotics prevent the development of NEC? Which strains make the biggest impact on gut health? Should probiotics be used as a preventative measure? Are there any contraindications to probiotic use? Learn More Here: https://www.nature.com/articles/s41372-024-01952-0#:~:text=Almost%20all%20NICUs%20reported%20administering,%25%2C%2034%2F84 ). https://www.cochrane.org/CD005496/NEONATAL_probiotics-prevention-necrotising-enterocolitis-very-preterm-or-very-low-birth-weight-infants How Can We Manage the Comorbidities of Prematurity? How can we prevent sepsis in premature newborns? Which early interventions are effective at preventing bronchopulmonary dysplasia? What medications can help limit the risk of retinopathy of prematurity? What oral feeding strategies are effective at minimizing NEC complications? Which delivery strategies work best to prevent intraventricular hemorrhage? Learn More Here: https://my.clevelandclinic.org/health/diseases/17430-retinopathy-of-prematurity https://www.nhlbi.nih.gov/health/bronchopulmonary-dysplasia#:~:text=BPD%20is%20the%20result%20of,dysplasia%20(BPD)%20lung%20damage . What Is the Best Way To Effectively Treat a PDA?  Is acetaminophen or indomethacin the most effective way to medically treat a PDA?   Does early surgical intervention improve patient outcomes? How should we standardize PDA assessment strategies? Is there anything we can do to improve PDA outcomes prior to an infant’s birth? Learn More Here: https://kidshealth.org/en/parents/patent-ductus-arteriosus.html https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda How Can We Improve NICU Skin-to-Skin Success?  At what gestational age is it safe to hold an infant? How can we prevent accidental extubations during skin-to-skin? Learn More Here: https://nicudesign.nd.edu/nicu-care-standards/ifcdc--recommendations-for-best-practice-for-positioning-and-touch/ https://cps.ca/en/documents/position/skin-to-skin-care Which Pain Management Strategies are Best for Neonates?  Is it better to use pain medications of one class over the other (opiates, benzodiazepines, alpha II agonists, etc.)? What is the best way to wean intravenous pain medication? Which surgical considerations are important when planning pain management? Is sucrose effective at preventing pain in newborns? Learn More Here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8869922/ https://www.hopkinsmedicine.org/-/media/files/allchildrens/clinical-pathways/neonatal-pain-management-12_20_2023.pdf What Is the Best Way to Optimize Hemodynamic Stability? Which vasopressors or inotropes should be used to manage low blood pressure in premature infants? How often should vasoactive medications be titrated? What blood pressure parameters should be used to manage hemodynamic instability? Is there a certain infant positioning that is best for optimizing blood pressure? Learn More Here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204669/ https://starship.org.nz/guidelines/blood-pressure-hypertension-in-neonates/ How Can We Improve Lung Compliance and Development? Which ventilator modes  are most effective at managing certain diseases? Which oxygen saturation goals are best for neurologic development? When should surfactant be initiated? How can we prevent negative side effects from the use of supplemental oxygen? What is the best time to start corticosteroids? How often should ABGs/VBGs be drawn to adjust respiratory care strategies? Learn More Here: https://dontforgetthebubbles.com/neonatal-ventilation-basics/ https://www.paediatricfoam.com/2023/01/blood-gases-in-the-nicu/ What Is the Best Way to Improve Access to Palliative Care? How can we offer palliative care to mothers delivering an infant with a poor prognosis? What is the best way to introduce palliative care to a hesitant family? Learn More Here: https://www.togetherforshortlives.org.uk/app/uploads/2018/01/ProRes-Perinatal-Pathway-for-Babies-With-Palliative-Care-Needs.pdf https://www.childrenscolorado.org/doctors-and-departments/departments/neonatal-intensive-care-unit/neonatology-programs/palliative-care-program/ What Are Some Ways to Assist New Mothers With Breastfeeding? How can we improve privacy for mothers who want to pump in the NICU? What strategies increase milk production? Learn More Here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9500865/ https://www.nationwidechildrens.org/family-resources-education/700childrens/2017/08/breastfeeding-in-the-nicu-how-to-solve-a-unique-challenge 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, MSN, RNC-NIC, has been a passionate NICU clinician since 2012, specializing in acute care and inpatient neonatal settings throughout Southern California. Board-certified in neonatal intensive care, she also brings extensive experience as a travel NICU nurse. Tori is the co-founder of NICUity, a modern resource hub empowering NICU professionals with hands-on tools, education, and community support. As a mother, wife, and entrepreneur, she shares her journey balancing life at the bedside with motherhood, marriage, content creation, and building a brand. Discover her latest tips, tools, and insights at www.tipsfromtori.com  or reach out at abbysocialmgmt@gmail.com .

The neonatal intensive care unit (NICU) is probably the last place you or your loved ones pictured themselves after having a baby. A hospital unit full of alarms, tubes, electrodes, ventilators, and beeps is not quite the cozy nursery vibe you anticipated. Unfortunately, things don’t always go according to plan. This NICU period can be one of the most stressful times of a parent’s life. Each day can be overwhelming, full of happy milestones and moments of grief. From my nursing experience, NICU parents crave one thing during this stressful period — for things to feel “normal” again, or as normal as is possible given their new circumstances. With limited control over their environment, this can be challenging for them to achieve. So, what can you do to help?! While you can’t change their situation, you can help them connect with their new parenting journey. While they may have a fully stocked nursery at home, these items often aren’t able to be used with NICU patients.  With inspiration from my experiences as a new mom and as a NICU nurse, I’ve decided to compile a fun list of things you can gift your favorite NICU baby or family! These items are things that can be used at the bedside and for months and years to come. Let’s dive in. NICU GIFTS FOR YOUR FAVORITE LITTLE FIGHTER 1. Finn the Panda Finn the Panda was developed to help comfort babies during hospital stays, as well as to foster the bond between the baby and their caregivers, even when they have to be apart. It features: Antimicrobial material to help prevent the spread of germs to the baby. A washable heart-shaped scent patch that can be detached and worn then reattached to the bear. A recording device that allows a song or comforting words of up to one minute to be played back once or on repeat.  Contrasting black and white colors that appeal to baby's early vision.  100% cashmere, made to be amazingly soft and cuddly Sealed packaging that reduces microbial exposure during package delivery.  As a mom who spent several months of her son’s first year of life in the hospital, Michelle knew the stress and pressure of hospital parenting. So, she developed Finn the Panda! 1. SCENT: The scent patch can be worn in place of a breast pad, or under any garment, to absorb your smell and can be reattached to the bear to provide your scent in baby’s incubator or crib.  Research has shown that the pheromones a mother exudes after birth are recognizable by her individual baby and can release endorphins in the baby’s brain. 2. SOUND: Your baby has heard the comfort of your voice in the womb and it is the most recognizable sound to their little ears.  Record a lullaby or soft words for your baby and play it back once or on repeat, to help soothe baby to sleep, comfort baby during nurse cares, or just give you a few minutes away. 3. SIGHT: Research has proven that black and white contrasts register powerfully on baby’s retina and send the strongest visual signals to baby’s brain. Stronger signals mean more brain growth and faster visual development. High contrast shapes and patterns provide the baby with something simple and engaging to focus on, and in this focus – or intense concentration – they can allow their minds to rest. High contrast shapes are designed to hold babies’ attention. USE CODE: NURSE TORI (FOR 20% OFF YOUR PURCHASE!) 2. BEB ORGANIC SKIN CARE PRODUCTS When preemies are first born, their skin is extremely thin and delicate, which makes them prone to skin tears, infections, and rashes. One of the most important ways we can protect newborn skin is by keeping it clean! As a clinical skincare brand made with meticulously sourced natural ingredients, BEB Organic serves families by providing luxuriously healthy products and educating parents and professionals on the powerful benefits of a caring and sensitive touch. Chosen by America’s top hospital NICUs for uncompromising standards, all BEB Organic products are packed with PHYTOCURA™ and crafted of pure, luxuriously healthy ingredients. As one might expect, these soothing formulas have proven to work wonders for skin of all ages in need of extra love. I originally discovered BEB products while working bedside as a NICU nurse. After researching the product, speaking with the CEO, and learning about this infant skin care line, I can genuinely say these are (first hand) amazing products for ALL babies. It makes bath time in the hospital extra special for babies and their parents. I have personally used these products and discovered this line while using it at the bedside in a hospital setting who supplied it to their patients. I can say first hand, these products are wonderful! 3. PREEMIE PACIFIERS Sucking is a form of self soothing, especially for preemie babies who might not be able to drink milk yet! While hospitals offer their own preemie pacifiers, it could be fun to spruce up their pacifier game with a cute one!! My favorite pacifier brand is the Ryan and Rose Cutie PAT - this is a NICU baby product I have recommended for years! RYAN AND ROSE The Cutie Pacifier and Teether (PAT) is a multifunctional pacifier made for two different stages of development: Stage 1 and Stage 2. The Cutie PAT pacifier is made with 100% medical grade silicone. It is safe, non-toxic, and free of BPA, PVC, phthalates, and latex. I have watched this family owned company grow for years and have given many Cutie PATs to my favorite NICU families. The gift is always a big hit — as a new parent, you can never have too many pacifiers! 4. SWADDLE BLANKETS Babies (preemies included) crave boundaries. They seek containment and comfort. One way to provide this is bringing everything "back to core" — this means keeping arms & legs flexed inwards in a relaxed manner just as they were in the womb. Although there’s never a shortage of baby blankets in the hospital setting, it can be fun for parents to add a personal touch for their little one with a fun blanket. If you’re looking to gift your favorite NICU patient a new swaddle blanket, I recommend those made of cotton, muslin and or bamboo cotton blends. These materials breathe well and keep from overheating in their little cocoon. I’ve listed a few of my favorite swaddle blanket brands below, but feel free to choose designs or colors that match the little one’s personality the best! 5. PERFECTLY PREEMIE ONSIES It may be a while until your favorite little fighter can wear (or fit into) a onsie, but once he or she does, the fun can begin! Several companies now offer "preemie" sizes and a fun array of colors, patterns, and styles. However, my favorite brand is “Perfectly Preemie.” This is unique line of preemie clothing to help babies (and their nurses) battle the many lines, tubes, and wires involved in a NICU admission. Perfectly Preemie Clothing Since 1993, Perfectly Preemie has conducted medical research, collaborated with NICU staff, and surveyed with NICU parents to determine just what a preemie needs in regard to their clothing and accessories. Their specially designed onesie line meets all of the requirements for babies in the NICU, while still looking cute! 6. BONDING LOVEY SCENT CLOTHS At birth, a baby is drawn to and is soothed by their mother's scent. Building a close connection through scent is a way to create a wonderful bond while the baby is receiving care in the NICU! Bonding scent cloths allow infants to bond with their caregiver’s smell from the comfort and warmth of their hospital incubator. Parents can place these soft pieces of cloth on their own skin and then leave them with their infant to provide scent comfort while they are away. Whether the parent is an adoptive mother, a single father, two mothers, adoptive guardians - it doesn’t matter. If you want to help build a bond between a baby and their caregiver, scent is the easiest way to do it.  7. WHITE NOISE MACHINE Once a baby is an appropriate age (older than 34 weeks), an infant white noise machine  is a great gift to consider! Why? Soft low tones are soothing to an infant and helps them to rest their minds while promoting a healthy sleep pattern. Sounds that mimic a natural environment can help create a relaxing, soothing environment for NICU babies. Adjustable volume settings allow you mask background noise and the craze of the hospital environment. 8. WUBBANUB Babies, parents, and NICU nurses all love WubbaNubs! Why? These stuffed animal and pacifier combinations help to keep the peace when patients need soothing. They’re easy to grasp, offer great support for the pacifier, and provide soft, gentle comfort to little ones. In addition, parents aren’t always at the bedside to hold, comfort, and soothe their little one. WubbaNubs help us nurses at the bedside to maintain an infant’s comfort, keep their pacifier in place, and promote restful sleep.  9. A MIRROR One of the greatest feelings for NICU babies and their parents is the first SKIN TO SKIN contact, what we often call "Kangaroo Care." Skin-to-skin contact involves keeping babies chest-to-chest & skin-to-skin with a parent. The benefits of this close contact include: warmth, stability of vital signs (heart rate, respiratory rate, increased oxygen saturation), increased time spent in deep sleep, decreased irritability and crying, increased weight gain, increased milk supply for mother, and better coordination for feedings! To help parents get the most out of their bonding moment, NICU nurses often encourage the use of a mirror (while they hold their baby) to allow them to see their loved one’s tiny face in full range. This small simple tool is a very helpful & useful gift to use while performing Kangaroo Care. Some NICUs do provide these, but many NICUs can’t afford to offer each family a mirror. While they don’t cost much more than a few dollars, you can make a huge difference in their bonding experience.   10. WATER WIPES New scientific evidence has shown that limiting scents, perfumes, dyes, or other chemicals on infants skin is essential. Our preemie patient population has extremely sensitive skin and skin irritation & breakdown is one of our biggest priorities. Many NICUs have moved to using "water wipes," or some form of wipe with water for all diaper changes. Several companies offer sensitive water wipes that are perfect for tiny NICU patients! I prefer the Pampers Aqua Pure variety. 11. GLASS BOTTLES With new research coming out about plastics & the long-term effects it has on our health, many providers are starting to recommend using glass milk bottles. As a parent and a NICU nurse, I am a BIG fan of using glass over plastic. Many top brands also offer "slow flow nipples," which helps when feeding babies who are new to drinking milk or for those who may be struggling to swallow with normal flow nipples. Best Glass Milk Bottles: Tommee Tippee Closer to Nature Baby Bottles  Baby Brezza Glass Baby Bottle Dr. Brown's Natural Flow Anti-Colic Bottles 12. BOPPY OR "BREAST FRIEND" PILLOW One of the most exciting moments for any new mom is the opportunity to feed her baby for the first time. Nursing pillows  are immensely popular with new moms because they offer comfort & convenience. Figuring out which one to choose can be difficult, especially when many moms are passionate about which one is their favorite. The two most popular varieties are the Boppy pillow and the Breast Friend pillow. Boppy vs. Breast Friend: Key Differences The "Boppy" pillow  looks like travel neck pillows – a C-shaped doughnut. These pillows have so many uses and are well worth the money spent on them. They are most commonly used to prop up a baby while breastfeeding  or bottle feeding, but can also be used to prop up babies during tummy time. You can buy a separate slipcover to allow these pillows to be easily cleaned in the event of a spit up or diaper blowout. Boppy pillows aren’t big enough to go all the way around you, so you’ll need a separate pillow if you want to support your back. Alternatively, the Breast Friend pillow  is a bit different in terms of overall design but is used for the same purposes. Unlike the Boppy, the top side of a Brest Friend pillow is flat, which means your baby stays where you put her without rolling around while trying to feed. The Brest Friend also has two added features that I love – a snap that secures the pillow in place, and a full wrap-around design, giving breast feeding moms much-needed back support.  Whichever support pillow you choose, your gift will surely be appreciated by any new NICU mom! 13. NICU MILESTONE CARDS Welcoming a baby into the world is full of special moments. Although having a baby in the NICU is a difficult time for families, there are many special moments to capture & treasure. Printable milestone cards are designed to help you celebrate all of the successes on your baby's journey. With colorful backgrounds and simple designs, they help to make the challenging journey a little easier. NICU is all about the milestones! Example Milestones Include: - weeks one to six - months one to three - forty weeks corrected - today I am breathing on my own - today I had my first bath - today I was weighed for the first time - I am ventilator free today - today I had my first snuggle with Mom - today I had my first snuggle with Dad - I wore my first outfit today - today I breastfed for the first time - today I had milk for the first time - my first kangaroo cuddle - I had my first pacifier today - today I am wire free - I had my first sleepover - I am all ready for the carseat today - Hooray, I gained weight today - I am going home today 14. Montessori Mobile Just because a baby is receiving care in the NICU does not mean that they don’t need or deserve the brain development and stimulation toys that other babies have. Especially as babies get older and develop from their initial preemie phase, a hanging mobile  can provide the visual distraction and stimulation needed for healthy brain development. These are especially helpful at distracting babies when they require blood draws, dressing changes, or any bedside procedures. I hope you enjoyed this list of Tips and Tricks for your mighty. Now- Go Treat Your Favorite NICU Family! I hope you enjoyed reading about my favorite preemie gifts for your mighty NICU baby! Many of these products are offered on Amazon (Nurse Tori NICU Amazon Gifts & Tips)  and have been linked to my Tips from Tori Amazon page. All products included are my own recommendations and do not represent the views of employers.  This blog includes affiliate links — rest assured that all of my professional partnerships are with companies I love, use  myself and recommend to those I care for most! Feel  fr ee to see my full   disclaimer   if you have any questions or concerns, or contact me with any feedback! NICU 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: 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 Instagram @nurse.tori_

What does the “golden hour” mean in the NICU? What do NICU nurses do in the “golden hour” ? In healthcare, the phrase “golden hour” refers to a period of time during which interventions are made to improve the outcomes of a patient. In the NICU, “golden hour” refers to the first hour of an infant’s life after birth. THE GOLDEN HOUR Preterm infants are a particularly vulnerable patient population, especially during the hour immediately after delivery. During this period, they are at high risk of complications like: Hypothermia Hypoglycemia Breathing challenges Early-onset sepsis Clinicians are responsible for intervening early during an infant’s life to prevent these complications and ensure they get the care and treatment they need. When hospitals around the country recognized that they weren’t meeting benchmarks for early intervention, many perinatal teams developed lean methodologies and process improvement techniques to standardize the care that infants receive immediately after birth.  Studies show that facilities that incorporate the concept of the “golden hour” into their perinatal practices see significant decreases in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) diagnoses. To give you a better understanding of the type of care provided during the “golden hour” we’ll discuss what occurs during this period from the NICU nurse’s perspective. The phrase “golden hour” is used to raise awareness of the risks of birth complications and explain how intervening early can make a significant impact on an infant’s expected outcomes. What Conditions Are Treated in the NICU? Patients are admitted and treated for all sorts of conditions, depending on their gestational age. These include but aren’t limited to: Apnea of prematurity Brain hemorrhage Bronchopulmonary dysplasia (BPD) Cerebral palsy (CP) Complex birth defects or abnormalities Congenital diaphragmatic hernia (CDH) Down Syndrome (Trisomy 21) Extreme prematurity Feeding disorders Gastroesophageal  reflux (GERD) Gastroschisis Hyaline membrane disease Jaundice (Hyperbilirubinemia) Meconium aspiration Meningitis Metabolic diseases (hypoglycemia, hypothyroidism, etc.) Necrotizing enterocolitis (NEC) Neonatal abstinence syndrome Patent Ductus Arteriosus (PDA) Perinatal asphyxia  Pulmonary hypertension Respiratory Distress Syndrome  (RDS) Retinopathy of Prematurity Seizures /Epilepsy Sepsis Spina Bifida Myelomeningocele Transient tachypnea Twin to Twin Transfusion What Tasks Do Nurses Complete During the “Golden Hour”? NICU nurses have a checklist of things  that need to get done to ensure the health and wellbeing of their newborn patients. Generally speaking, this involves preparing for infant delivery, completing a thorough newborn assessment, and ensuring the family is updated on the health of their new baby. Five critical areas are assessed: respiratory status, cardiovascular function, neurological response, fluid and glucose levels, and body temperature.  Based on the nurses assessments in these categories, the infant’s health status and acuity is determined: the red (acute) zone requires immediate interventions, the yellow zone requires close monitoring, and the green zone requires minimal intervention outside of the basic newborn screening.  I review the NICU nurse checklist for the golden hour  that I go through below, but be aware that each facility may tailor their golden hour checklist to their unique department and patient population. Prior to Infant Delivery:  1. Ensure an isolette is present at the bedside. 2. Turn on the isolette warmer to heat the mattress and incubator air. 3. Attach ECG electrodes, pulse-ox probe, and temperature probe to the patient monitor  After Infant Delivery: 4. Collect vital signs (heart rate, respiratory rate, temperature, blood pressure). 5. Intubate or place on oxygen, if necessary 6. Collect newborn measurements (head circumference, length, weight, and abdominal girth). 7. Suction the nose and mouth. 8. Perform a thorough newborn physical assessment. 9. Check for nare/throat patency, the presence of a sacral dimple, and anal patency. 10. Place an IV (UVC/UAC or peripheral IV). 11. Collect labs, if necessary (CBC, Type & Cross, MRSA, Blood Cultures). 12. Draw a blood glucose. 13. Start antibiotics or vasoactive medications, if necessary. Once the Infant Is Stabilized: 14. Review the patient’s maternal history. 15. Review and acknowledge any new orders. 16. Orient the infant’s mother & father to the unit and their infant’s condition. 17. Administer eyes & thighs (Erythromycin and Vitamin K). 18. Document all interventions in the medical record. Are there Any Additional Care Recommendations for Extremely Premature Newborns? Neonatologists recommend performing the following interventions for extremely premature newborns (before 28 weeks gestational age) during the first 72 hours of life: Keep their head in a midline position.  Elevate the head of the bed at least 30 degrees. Complete assessments and cares with two nurses (one person completing tasks, the other keeping the baby contained and warm). Do not raise legs with diaper changes. No daily weights or abdominal girths (usually hospitals will opt to record these measurements weekly).  Minimize handling, suctioning & movement.  With UAC lab draws, 40 second pull/40 second push per 1ml (set a timer!). No peripheral BP’s if UAC line present. No prone positioning or skin-to-skin holding (encourage “hand hugs”).  Swab the infant’s mouth with colostrum.  Administer surfactant to assist with lung development and maturity.  Infuse a loading dose of caffeine in the first 24 hours of life, then a maintenance dose starting the following day. For additional resources on providing safe newborn care, check out the following articles: NICU Resources and CEUs Every Nurse Needs to Know About What is the most common NICU Diagnosis for Premature Babies?! Neonatal Vital Signs 101 Birth: What is an Apgar Score? Common NICU Terms A-Z 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