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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 MSN RNC-NIC. I have been a NICU nurse since 2013. Before 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 tailor 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 an 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. 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. 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 who 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 a 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 possess 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 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 lily@smallscreenmarketing.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 lily@smallscreenmarketing.com.

It’s an exciting time to become a NICU nurse. 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 Instagram. As a NICU nurse, blogger, educator, and content creator, 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 job, 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 about 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 basic 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 more smoothly 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 lily@smallscreenmarketing.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 apnea and bradycardia; 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 lily@smallscreenmarketing.com.

"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, patient population, and . 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 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 lily@smallscreenmarketing.com

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 are 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.Medication 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 me, a comfortable baby carrier has been 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 lily@smallscreenmarketing.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 lily@smallscreenmarketing.com .

Hello! Welcome to my little space on the internet where I share all things NICU nursing and NICU life. If you’ve found your way here, chances are you’re curious about what it’s really like to be a NICU nurse. Over the years, I’ve been asked so many questions about this specialty. Below are some of the most common ones, along with advice and insight from my past decade of experience working in the NICU. Hi, I’m Nurse Tori! (Victoria Meskin, MSN, RNC-NIC). I’ve been a neonatal intensive care unit (NICU) nurse since 2012, caring for some of the smallest and most fragile patients: newborns who need extra support to grow and thrive. I have worked in Children's Hospitals, University Hospitals, small and large NICUs, where I take care of premature and critically ill infants and support their families during some of the most emotional moments of their lives. I also earned my Master’s degree in Nursing Leadership, and I’m passionate about not only caring for my patients but also educating and mentoring others. I’m also the co-founder of NICUity, a company focused on creating better education and resources for NICU providers and families. NICU Nurse Q/A 1. What education or training did you have to get in order to do this work? To work as a NICU Nurse, you must obtain your nursing license. In order to sit for the Nursing Boards, you have to complete a nursing program. There are 3 main degrees: ADN (Associate's Degree in Nursing), BSN (Bachelor's of Science Nursing), and MSN (Master's Degree in Nursing). You can work in any NICU with these degrees. However, I typically recommend obtaining your BSN if possible as many new grad NICU programs require this or hiring managers tend to favor the bachelor's degree as potential candidates. ADN (Associate Degree in Nursing) ⏱ Time: ~2 years🎯 Level: Entry-level nurse (RN) An ADN is the fastest way to become a registered nurse. You’ll learn the core skills needed to safely care for patients and can start working in hospitals, clinics, or long-term care settings after passing the NCLEX (nursing license exam). How to get it: Apply to a community college nursing program Complete prerequisite classes (like biology, anatomy) Finish the nursing program (~2 years) Pass the NCLEX-RN → become a licensed RN Good to know: Great starting point, but some hospitals prefer or require a BSN. BSN (Bachelor of Science in Nursing) ⏱ Time: ~4 years (or 2 years if you already have an ADN)🎯 Level: RN + more advanced training A BSN includes everything in an ADN program plus deeper education in leadership, critical thinking, research, and public health. Many hospitals (especially NICUs, ICUs, and larger medical centers) prefer BSN-prepared nurses. How to get it: Attend a 4-year university nursing program OR Get your ADN first → then complete an RN-to-BSN program (often online) Pass the NCLEX-RN Why it matters: More job opportunities, higher earning potential, and better preparation for specialty units (like NICU 👶) MSN (Master of Science in Nursing) ⏱ Time: ~2–3 years after BSN🎯 Level: Advanced practice or leadership An MSN takes your nursing career to the next level. This is where you can specialize, like becoming a nurse practitioner, educator, or leader. Why it matters: Some colleges and universities offer direct-entry MSN programs for students who already have a bachelor’s degree in another field. This means you can bypass earning a separate BSN and go straight into a master’s program, allowing you to become a registered nurse and earn your MSN in one streamlined path. 2. Can you outline some of the things you do during an average day as a NICU nurse? General list of NICU Nurse Duties ♡ Full head-to-toe assessments & direct patient care ♡ Monitor vitals, labs, and overall stability ♡ Assist with imaging (CXR, ECHO, MRI, etc.) ♡ Support line placements (PICC, UAC, UVC, central lines) ♡ Assist with procedures (intubations, extubations, bronchoscopies) ♡ Start IVs & obtain labs (central lines, PICC, heel sticks) ♡ Maintain and manage central lines (sterile changes, caps, tubing) ♡ Place feeding tubes (NG/OG) ♡ Prepare infants for surgery ♡ Provide post-operative and surgical site care (trachs, ostomies, chest tubes, etc.) ♡ Administer medications  (IV, oral, IM, rectal, buccal, etc.) ♡ Collaborate with respiratory, providers, therapy, and ancillary teams ♡ Communicate changes in patient status ♡ Feed, bathe, and comfort babies ♡ Support breastfeeding and pumping ♡ Advocate for each infant’s needs ♡ Provide patient- and family-centered care ♡ Educate and support parents and caregivers ♡ Coordinate resources for families ♡ Participate in research and evidence-based practice ♡ Precept and mentor new nurses ♡ Contribute to unit and hospital improvement initiatives 3.What kinds of diagnoses do you see in the NICU? There are many reasons why a baby would end up in a NICU. The reason could be as simple as dehydration from breastfeeding difficulties, or it could be as complex as a life-threatening diagnosis or congenital disease. The type and complexity of the diagnoses you may see depend on the level of NICU you work at. Acuity levels range from I-IV, with level IV facilities providing the most comprehensive and complex care. Diagnosis Includes: Prematurity (babies born before 37 weeks of pregnancy) Early term infants (babies born between 37-39 weeks of pregnancy) Low birth weight (babies that weigh less than 5.5 pounds) Micro-preemies, Sepsis (serious infections) Respiratory Distress Syndrome (RDS) Heart Defects Congenital anomalies Respiratory failure Birth defects Trauma Seizures Gastroschisis Hypoglycemia Intrauterine Growth Restriction (IUGR) Intraventricular Hemorrhage (IVH) Jaundice Necrotizing Enterocolitis (NEC) Multiples (Twins, Triplets) Neonatal Abstinence Syndrome (NAS, drug addicted mothers) Unknown pregnancies Precipitous birth Placental Abruption, etc. Learn more here....NICU 101 4. What is the work schedule like? Most NICU and hospital nursing jobs are built around 12-hour shifts. That usually means either 7:00 AM–7:00 PM or 7:00 PM–7:00 AM. Full-time nurses typically work three shifts a week (36 hours), which gives you four days off. Some hospitals still offer 8-hour shifts, but that’s becoming less common. Most units have moved to 12s because it simplifies scheduling and reduces the number of times care gets handed off between nurses. Working longer shifts also means you spend more consistent time with your patients, which many nurses (myself included) really value. But it’s not perfect,12-hour shifts can be physically and mentally exhausting, especially in high-acuity areas like the NICU. At the end of the day, both schedules have pros and cons. It really comes down to your lifestyle, your unit, and what works best for you. 5. What are some of the most important skills you had to learn to do this job well? Being a NICU nurse is a mix of science, heart, and adaptability. These are some of the biggest skills I’ve learned along the way: 1. Passion for the neonatal population. You have to truly love working with babies. In the NICU, you’re caring for neonates from birth through the first year of life. It’s a small, specialized (and honestly very “boutique”) population—but also incredibly dynamic. You’re not just caring for the baby, you’re constantly supporting and educating families. In the NICU, you build really close relationships with parents in a way that’s unique compared to many other units. 2. Attention to detail. Everything is small in the NICU, including the margin for error. Medications, doses, and changes in condition can be subtle but critical. The little things matter here more than anywhere else. 3. Teamwork. NICU care is never done alone. You’re constantly working with nurses, respiratory therapists, doctors, and families. Being a strong, supportive teammate makes a huge difference—for both patient outcomes and your day-to-day experience. 4. Critical thinking. These babies are in the NICU for a reason, they’re medically fragile. You have to think beyond the task in front of you and understand the “why” behind everything. How is this affecting the lungs? The brain? The heart? What are the long-term implications? Every action has a cause and effect. 5. Flexibility. No two shifts are the same. Patient conditions change, staffing shifts, new technology is introduced, and practices evolve with evidence-based care. You have to be able to pivot quickly and stay grounded in the middle of change. 6. Creativity. NICU nursing often requires thinking outside the box. Whether it’s positioning a baby just right, using the resources you have in new ways, or helping parents feel more confident and involved, you learn to get creative. 7. A sense of humor. This job can be intense. Having a sense of humor helps you stay balanced, connect with your team, and get through the tough days. 6.Did you get your job as a new grad nurse? Did you have prior experience? YES, I did! I was hired as a NICU New Grad Nurse, and NO, I did not have prior NICU nursing experience. However, I interviewed for several different Nurse Residency Programs all over California & Arizona. It took me 8+ months and multiple interviews to land my first job out of nursing school. This is why I am so passionate about helping you all through the interview process. We don’t really learn interview skills in nursing school, despite them being a key factor in getting a job offer. If you are in the process of interviewing or want to know what to expect and how to prepare, I highly recommend our E-book and Podcast episode to help you in your process! 7. What are some problematic things that come up that you didn’t know about beforehand? How did you handle those things? There are definitely things about NICU nursing that you can’t fully understand until you’re in it. These are some that really stand out to me: 1. Learning when to speak up and trust your gut. One of the hardest skills to develop is knowing when to involve the medical team. Early on, you question yourself a lot, “Is this a real change or am I overthinking it?” Over time, you learn to recognize subtle differences and trust your instincts. That confidence only comes with experience. 2. Burnout. This is something I don’t think we talk about enough. At this point in my career, I’ve experienced burnout more than once. The NICU can be emotionally and mentally heavy. What’s helped me is shifting, learning something new, stepping into a different role, or making sure I’m filling my cup outside of work. 3. Feeling overwhelmed in new roles. Whether it’s bedside, charge nurse, educator, resource, admissions, critical situations, or learning specialized skills like vascular access, every new role can feel overwhelming at first. That’s normal. These skills take time to build. You are not expected to master everything overnight. Pace yourself and be kind to yourself while you’re learning. 4. Accepting that you can’t fix everything. This one is tough. We are in healthcare to help, heal, and create positive outcomes—but that isn’t always the reality. There are bigger system challenges we face every day: staffing, resources, evolving technology, and the complexity of patient care. Learning to focus on what you can control, while letting go of what you can’t, is key. I’ve found a lot of strength in that mindset—doing your best for your patients and families, while also recognizing that change in healthcare often happens slowly over time. 8.Is the NICU a good unit to start in as a new grad nurse, or should I get more general experience before working with neonates? Everyone will give you a different answer to this question, so it can be tough to know who to believe! In my experience, the NICU is a great place to start! I began my nursing career in a NICU nurse residency program and have never felt like I needed any other experience to be happy and successful. However, I know plenty of amazing NICU nurses who started elsewhere and transitioned from other units like adult ICUs, L&D, postpartum units, PACU, or OR. In fact, when I was applying for jobs, I truly thought I wanted to be a CVICU/CTICU Cardiothoracic Pediatric Nurse. That was my passion and I felt so drawn to that population and their families! However, due to application process & job strategy, I opted to apply to NICU! At the time, the NICU was hiring more new grads and I thought I had a better chance of landing one of those jobs. I did get the job, and it was then that I discovered my love for preemies. Not only that, but I also have the opportunity to work with cardiothoracic patients within my level IV NICU! I’ve gotten the best of both worlds. 7. If given a chance, would you choose this type of work again? Why or why not? Yes! Over and over again. I truly love being a NICU nurse. It’s challenging, emotional, and demanding, but it’s also incredibly meaningful work. Getting to care for these babies and support their families during such a critical time is something I don’t take for granted. Over time, I’ve learned that I personally thrive in higher-level NICUs (Level III and IV), where you see the most complex cases, ECMO, cardiothoracic surgery, and other life-saving interventions. That’s where I feel most challenged and fulfilled, but it definitely took time and experience to get there. That said, every NICU is different. Some nurses prefer community-based hospitals or units with lower acuity, and that is equally important and valuable. There is no “one right path” in NICU nursing. I was intentional early in my career—I applied far and wide and even moved to get into the type of unit I knew I wanted. I’ve also worked in smaller NICUs, and those experiences pushed me in different ways. With fewer resources and less immediate support, I had to grow quickly—strengthening my IV skills, learning how to stabilize critically ill babies for transport, and supporting families in a more hands-on, independent way. Every setting taught me something different. And looking back, I wouldn’t change any part of that journey. 8.Do you have any good new grad nurse pointers? Too many to count! I have compiled 10+ years of NICU nurse experience, crowd-sourced from NICU colleagues, and combined it all here for you in this blog. Starting a new job can be challenging, and our very unique patient population can make the whole experience more nerve-racking! Whether you’ve just landed your dream job in the NICU, are thinking about applying to nursing school, are studying for the NCLEX, or are a new grad considering where to apply, here’s some hot tips for you if you’re considering starting out your career in the NICU! 8. What is your best general career advice? Don’t let anyone tell you it’s not possible. I started in the NICU as a new grad and made it happen but it took preparation, persistence, and a lot of intention. I practiced my interviews over and over, built a strong portfolio, and made sure I could clearly show my passion for working in the NICU. Be diligent in your NICU job prep. Research the unit. Know as much as you can about where you’re applying. Network with people in the field, nurses, respiratory therapists, PT/OT, and ask questions. Use your time in nursing school, clinicals, or preceptorships to learn as much as possible. Be curious. Get a little “nosey.” That’s how you grow. Be open to change. Healthcare is always evolving, and the best nurses are the ones who stay flexible and willing to learn. I still ask questions all the time, and I’m very honest when I don’t know something. And always ask questions. It is always better to be safe than sorry. Double-check orders. Verify everything. Mistakes can happen, and part of your role is to advocate for your patient by speaking up. Most importantly, don’t forget your why. If you find yourself in a situation where you’re unhappy, you are not stuck. Nursing offers so many different paths. You can change units, try a new role, go back to school, or find fulfillment outside of the hospital. I love bedside nursing, but I’ve also built a life outside of it that fills my cup. You can have both. I hope this blog was helpful for you! I’m so excited for you as you start your journey. Take a look around. I have more blogs, podcasts, and resources here, and NICUity is an amazing place to dive even deeper. If you’re looking for more in-depth NICU education, we offer a masterclass you can take anytime. It’s fully loaded with the “how-tos” of NICU nursing, bedside practice foundations, and a strong understanding of the role, plus CEUs. Thank you so much for being here and supporting this space. Wishing you the best of luck on your NICU journey. And if you have any questions, feel free to reach out or drop them below. xo 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 lily@smallscreenmarketing.com.

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

So you want the “Real Tea” on Nursing? I’m spilling it all here for you! I am talking Degrees, Certifications, Modern Day Nursing Perspective, No filter here! Let me start at the beginning. My name is Tori Meskin BSN RNC-NIC. I have worked bedside as a nurse since 2013. Since then, I have seen a large shift in healthcare as whole. I have worked bedside (Full time, part time, days/nights, staff & travel RN, as a NICU, Pediatric CC Float RN CVICU, Oncology, PICU, NICU RN) etc. I have met many nurses, MDs, DOs, NPs, PAs, RTs, RDs, OTs, etc. along the way and have been gathering so much knowledge along the way. And I want to share it all here with YOU!! But I didn't want to do this alone, I wanted to bring along another expert in the field. Someone who has seen the Nurse world like I have, but in different ways. Therefore, I recruited my co-host / guest of the Cellfie Podcast Show & dear friend Samantha MSN RNC C-NPT, or better known on Instagram as @heysamanthaa! We collaborated to bring you guys nothing but the best of all things Nursing 101! She is a Nurse, Professor, and Blogger! She graduated with her Bachelor of Science in Nursing (BSN) in 2011 and began working in a Level IV NICU. Collectively we decided to bring you the latest. The "Real Tea" and a Birds Eye view of the Nursing world, with a 2020 modern day perspective!! Raw, Real, Unfiltered! We are Servin it up real! I am joined by fellow nurse, professor, (Pediatric Flight Nurse) blogger, instagram curator, Samantha Manassero. We are giving all the juice on the current state of nursing, 2020 real tea nurse perspective, Degrees, Certifications, Mindset, Resources, Tips & Tricks to land that job, and much more! We discuss the who, what, how, & why with a Bird’s eye view of Nursing today. 20 Things to Know About Nursing in 2020 1. 2020 Whelp that was a Sh*T Show.... "Year of the Nurse & Midwife." Not sure if that was what we had in mind! Proving our love of nursing via World Pandemic. Honestly guys, this past year has been nuts. ANYONE working in healthcare can attest to this. To this day, as I am writing this, things are changing. (August, 2020) (Policies, Evidenced-Based Research, standards, priorities, etc). And to be honest, this isn't going to stop anytime soon. We are going to keep learning, shifting, changing plans. Thus is healthcare. No fluff here my "Tipster" fam, healthcare is a BEAST! And apparently it took a pandemic to expose its true dragon size. 2. Good Things Are Actually Happening, Yes I said that. This might be hard to believe. I have spoken on the podcast about it a few times, but good things are happening. This pandemic has really forced the world to come together. For heatlh care to expose itself. One of the greatest things I was able to witness was a daily update from healthcare providers from around the world contributing to a private FB group. MDs, NPs, PAs, DOs, Internal Med, Surgeons, RNs, RTs, all collaborating to beat this virus. Ok long story short, it sparked something. Let's keep it going. Your innovation is needed here. 3. It is Overwhelming to Choose a Nurse Specialty Trust me, modern day Nursing is vast!!! AND No one who comes into Nursing knows (exactly) what they want to do! Even nurses who are "Die Hards" for a unit in the beginning part of their career might experience Burnout. Nursing is one of the few careers that offers an OVERWHELMING amount of options. It's ok, deep breaths. Hustle hard, move forward, and your career will unfold. Trust me, I have had opportunities I never thought of when I started my career 8 years ago. Also, It’s also ok to change your mind! If you try something and hate it, it's ok to change your mind. 4. I don't like Nursing, What Else Can I Do?! Thank God! There are so many different paths to consider. You guys nurses are literally taking over the world. Literally and figuratively. There are soooo many specialties to choose from in the Nursing world. Where can you find nursing jobs away from the bedside? Here are some places to look for alternative nursing careers, along with the non-bedside nursing jobs you may find yourself taking: Physician offices, if you’re looking for an administrative role with limited patient care responsibilities Research laboratories, if you want to study diseases, test new medicines, and work closely with scientists, physicians, and patients Nursing care facilities, hospitals, and clinics with open administrative and managerial positions Pharmaceutical companies, if you are looking for patient education or sales rep roles Private and public education institutions, if you want to become a nurse educator State, public and government institutions, if you’re looking for public health roles such as School Nurse, where you work to educate entire communities Insurance and law firms, if you want to specialize in medical laws and assist in legal claims related to malpractice, accidents and workers’ compensation Private companies, for occupational nursing roles Non-bedside Nursing Careers Options Nowadays there are increased opportunities for nurses to leave traditional patient care environments and work as informaticists, analysts, and consultants, as well as project management, implementation, sales, and leadership roles. Nurse Health Coach Nurse health coaches work one-on-one with clients to help them achieve wellness goals, maintain healthy lifestyles, and prevent future health conditions. Working in healthcare facilities, insurance companies, and social service agencies, their duties include developing diet plans, establishing safe exercise routines, and monitoring and motivating their clients. Depending on the employer, nurses may enter this field with an associate degree, although the best paying positions require a bachelor of science in nursing (BSN) and/or a certificate in nutrition. Median Salary: $47,000 Legal Nurse Consultant The field of legal nurse consulting offers well-paying alternative careers for registered nurses. These specialized nursing professionals research medical and disability cases, employment records and other relevant documents, prepare summaries, and make recommendations that inform legal proceedings, law enforcement investigations, and insurance cases.Licensed RNs who have completed at least an associate degree may enter this field. Employment options increase for RNs who hold a BSN and a record of clinical and case management experience, paralegal training, or specialized legal certification. Median Salary: $78,000 Occupational Nurse Employed primarily in businesses, occupational nurses work with executives and managers to ensure the health and safety of employees. They investigate and treat work-related injuries and illnesses and identify workplace hazards. Occupational nurses help management develop safety policies and provide workshops for employees on healthcare issues and prevention.Licensed RNs who have completed a BSN earn the most competitive salaries for this role, one the best nursing jobs outside hospital settings. Employers generally prefer to hire professionals holding specialized certifications from the American Association of Occupational Health Nurses. Median Salary: $69,000 Nurse Midwife Advanced practice registered nurses looking for unique nursing jobs with a specialized focus find rewarding opportunities and high salaries in nurse midwife positions. Employed in hospitals, obstetric clinics, and increasingly in private practice, nurse midwives specialize in prenatal care, labor and delivery reproductive health, and gynecological care.Although each state maintains its own licensing and certification regulations, nurse midwives typically hold an RN license, a graduate degree with a nurse midwife concentration, and certification from the American Midwifery Certification Board. Median Salary: $97,000 Nurse Educator The demand for nurse educators has expanded as more students enter nursing school and as working nurses seek out continuing education credits to fulfill licensing renewal requirements. Working in academic institutions and training hospitals, nurse educators design and teach curriculum for diploma, associate, bachelor’s, graduate, and continuing education programs.Careers in nursing education generally require a graduate degree, increasingly at the doctoral level. In addition to clinical experience and advanced graduate training, candidates for nurse education positions must obtain the certified nurse educator credential. Median Salary: $76,000 5. You have JOB SECURITY (to a point) The projected need for nurses continues to rise. Our patient populations are getting sicker and sicker. There is always a need for nurses and pretty much anywhere you look (Indeed, Monster, Linkdin), you will see nurse jobs. Mk, well you know I give nothing but the real tea here. In my 8 year career, there were two times I experienced that stomach drop, where I knew my job was on the line. The first time was 6 months into my career. My hospital went through a house wide lay off due to budget cuts. The second time was actually during this pandemic. At the beginning of the pandemic the Pediatric population was not affected by this virus. While our friends in the adult world were running around like chickens with their heads cut off, Pediatric world was SLOW. So slow some of us (including Per Diem Nurses) were in jeopardy of loosing our jobs! Fortunately, things picked up and it turned around for our shifts. BUT I think it is silly to say we are untouchable. Anyone can loose a job! 6. Use LinkedIn to Your Advantage! I personally think this is one of the most under estimated tools you have. Spruce up that Linkdin account! Linkdin acts not only as a platform but also search engine. I think it is always a good idea to have that thing up to date! You never know the opportunties a recruiter want to offer you. After you get the year or two of experience, the world is your oyster. Head over to check out jobs, and network with people! 7. Nurses Make Money Honey! Yep we do! Not even guna lie about that one. Now, keep in mind, rates & salaries vary from state to state and even region. Every hospital organization is different. For example, I have worked two NICU per Diem jobs simultaneously & one job made $16 more than the other job. In addition, I must say this. As a bedside nurse, the way to increase pay is in "Lateral" moves. Meaning, I left my Clinical Nurse II job, and took another Clinical Nurse II job making $10 more an hour. Same position, but the organization viewed my experience and therefore my starting pay was valued higher. Hence why so many nurses move jobs nowadays. (For those who seek increased pay opportunities). 2020 Top Paying Nurse Jobs Certified Registered Nurse Anesthetist - $167,950 General Nurse Practitioner - $107,030 Clinical Nurse Specialist - $106,028 Psychiatric Nurse Practitioner - $105,658 Certified Nurse Midwife - $103,770 Neonatal Intensive Care Nurse - $102,487 Pain Management Nurse - $101,916 Nursing Administrator - $99,730 Family Nurse Practitioner - $98,408 Registered Nurse First Assist - $96,418 Gerontological Nurse Practitioner - $89,637 Nurse Educator - $81,350 Informatics Nurse - $79,014 Critical Care Nurse - $74,588 Health Policy Nurse - $71,703 8. COVID isn’t FUN! FULL SHADE here. You guys, its hard. No lie. Regardless of the setting we work, working throughout this pandemic is HARD. No lies here, this is the most difficult time so many nurses have ever (and fingers crossed) will ever see in our nursing career. Nurses have been asked to step up to a plate we never asked for...I am not shying away from this conversation. Nurses have quit their job. Yes, that has happened. Honestly, I don't blame them. I feel fortunate, I never felt that my care to a patient or family felt that it jeopardized my health. However, so many nurses around the country felt unsupported in protecting their health. This is where I caution you...make sure you feel safe and supported in your working environments! That includes PPE, patient ratios, pay, and overall work environment. COVID will pass....make sure your work supports you in each way. Trust me, if it doesn't, there are plenty of places to try!!! 9. Becoming A Nurse = Lifelong Learning For some reason, I never realized this while deep in my studies at U of A, #beardown! I guess I never realized this aspect of nursing. We are in the business of humans. Things have changed drastically since I started as a nurse 8 years ago. New practices, evidence based research, equipment, priorities of care, etc. Not to mention the fact that you must obtain 30 CEUs every 3 years to maintain your license. Trust me, it's not as bad as you think. (COVID aside), going to a conference with my friends for a weekend away from the hospital is actually kind of fun. Often times hospitals require classes for specialties (Cardiac, Surgery, ECMO, practice updates, etc) where you can also earn CEUs. 10. You Are Going to Battle “BURNOUT” For some reason, the modern day nurse is feeling this more and more. Whether it is the pressures of bedside care, patient ratios, human energy exchange, physical labor, long commutes, demands from management, working with humans at their best & worst, demands from families, working during a pandemic, okkk you get it. This is something you will face. And trust me, it is hard to overcome. Working as a nurse is honestly quite glorified. Like anything there is good with bad. Yes, we can work 3 days a week, but more than likely every nurse will tell you at least 1 or 2 of those days is recovery. Yes, we make good/decent money, but there are shifts you can’t even break to pee, sit down, or drink water. Yes, we have the gift of helping someone daily, but there are patients/families who cuss, spit, kick, yell, bite (yes bite). Yes, there are a lot of opportunities for us in the nursing world, but the expectations are also going up (certifications, patient satisfaction, outcomes, appeasing management). Yes, we are the most trusted professions, but we are often one of the least respected/valued. But, we still love it. We are still here showing up for our patients & families. We are still advocating for those orders, plans of care, the extra blanket, sneaking the cup of coffee, explaining that thing one more time, calling that MD for that “gut feeling,” speaking up for the parent who doesn’t understand, calling the lab one more time, catching an incorrect dose before it affects a patient, running to supply one more time for XYZ, paging the consult MD again to update patient bedside, comforting a family member who is helpless, precepting the new generation of nurses, advising the new generation of MDs, etc. You get the point. 11. Treat Yo Self. Self Care is Essential! It is really hard to explain the deep core exhaustion you feel coming home. Whether it is from clinicals or your crazy unit, I can truly speak to the pure fatigue you feel walking in the door. Heart pounding, slip the shoes off, deep breath as you walk in the door. Hand me a shower beer as you try to lift your leg over the bath tub in the shower kind of tired. You guys, I live it. I get it. Which is why I am a FIRM believer in fillin that cup. I get it, we all have stages of life. Maybe you are a mom, and you don't have an option for my favorite (pre-COVID massage or facial), maybe its a trip to target (without the kids!), a manicure, the burger you were craving, a hike, a picnic, a drink with a friend, etc. Bottom line, make sure you are feeling like a human. Because trust me! Nothing worse than a crusty nurse caring for patients. Doesn't go so well. 12. If You Hate Your Nurse Job, Change It! I talk about this all the time via Instagram (@nurse.tori_) & podcast (Nurse Tori Cellfie Show) If you hate your job, change it! There are wayyyy too many Nurse jobs & opportunities out there to complain, bitch, moan about a job. If you are unhappy, figure out a way to change that for yourself. I am very pro "Gary Vee" way filled with opportunity and the idea that YOU HAVE ONE LIFE TO LIVE! HOW DO YOU WANT TO SPEND IT?! 13. Get Nosey!!! Ask people around you....You guys I don't think this generation appreciates it enough! People around you are full of advice, life adventures, pieces of wisdom. I can not explain to you the amount of times I have learned something from someone just by asking "How is your day going," "Do you have kids," "Have you always worked here," ....the things that pop up in conversation always surprise me!!!! 14. Fun Nurse Jobs! Burned out? Whelp good news for you! There are plenty of jobs to consider. I did a little research & discovered these jobs in a search. Just had to show you that there is something out there for every nurse! Here we go........ Camp Nurse The Association of Camp Nurses (ACN) believes that there is a camp for everyone. As a nurse, determine what type of camp would benefit most from your expertise and background. Some camps focus on youths with cancer, adults with mental disabilities, or other special populations. Camps may also specialize in a type of activity (e.g. horsemanship, trip camping), offer high adventure programs (e.g. white-water canoeing), or provide a broad, general program with waterfront activities, archery, crafts, tenting experiences, and/or various sports. Camps are administered by churches, agencies (such as Girl/Boy Scouts or the YMCA/YWCA), and even private corporations or individuals. NASCAR Nurse It takes a lot of people to run the NASCAR races and that includes medical staff. As senior director of NASCAR’s Medical Liaison Department, Lori Sheppard, RN manages the day-to-day operations of her department and focuses on the medical needs of the racing series. “Our team provides a constant line of communication with race teams, monitors their progression through follow-up care and their return to competition. We also work with NASCAR’s Research and Development team in the never-ending effort to improve safety,” she says. She works with several other full-time nurses at the NASCAR headquarters in Daytona Beach, FL. During the season, her duties also include visiting nearly 30 race tracks in 25 states and in Canada. Medical Script Nurse Have you seen how many new medical television shows are running on network and cable stations? And think of all of the movies you’ve watched which have dramatic scenes in hospitals. In order for these to look and feel authentic, nurses and other healthcare professionals are often consulted to make sure their usage of medical equipment, vocabulary, and procedures is correct. While this job is certainly glamorous, like most Hollywood jobs, it’s about who you know. Greg Spottiswood, creator and executive producer of the Canadian drama, Remedy explains. “What you do is you meet with that person, you talk about the show and you take their temperature in terms of their interest in doing this kind of work. It’s not like one puts an ad in the newspaper.” This is a great career if you can keep getting work, but you would probably be wise to keep your day job as well. Disney Nurse Can you think of any other type of nursing specialty where you can call on Mickey Mouse or a princess to make a patient feel better? Cheryl Talamantes, RN, BSN serves as the Guest Service Manager for the Disneyland Resort. She has been a nurse for 34 years and describes what it’s like to work at the theme park: “Guests come from all over the country and the world, and there are situations where we are working through language barriers as well as cultural traditions,” she says. “In addition to having First Aid locations in each of our parks, we have a response location for our hotel guests.” In the job as a Disney nurse, you may find yourself climbing down into a submarine or up the stairs to a treehouse to treat someone. “We work around the entertainment and also support four marathons a year. We have a large population of people in the resort on any given day which means we can see and respond to just about anything. So our nurses need to have strong assessment skills and be comfortable in the first responder roles while working with all age groups,” Talamantes adds. Yacht Nurse The staff on chartered luxury yachts must provide first-class service to all their guests. One of these services is on-demand medical care. The crew on a yacht is generally small, requiring nursing skills on a limited basis, so nurses choosing this career should be prepared to also act as a stew or deckhand. Most crew nurses live in very cramped quarters while on charter, but the money they make and the experiences they have on days off, more than make up for it. A similar specialty is being a Cruise Ship Nurse. Show Me Nursing Programs Flight Nurse Flight nurses accompany patients as they are being transported by aircraft. Most of these patients require advanced critical care and the flight nurses are ultimately responsible for all direct patient care during transportation. They often work with flight paramedics in rendering basic and advanced life support and treating acute trauma. Because of the unique setting (helicopters and airplanes), flight nurses are also required to complete Department of Transportation Air Medical Curriculum. There are also weight restrictions imposed in order to safely accommodate the rest of the crew and medical equipment. For further information on certification as a flight nurse, see the Board of Certification for Emergency Nursing (BCEN) website. Transgender Youth Nurse With a greater awareness and acceptance of the transgender population, more and more patients are seeking medical care and at younger ages. The Center for Transyouth Health and Development at Children’s Hospital Los Angeles sees many of these young patients. Bianca Salvetti, a nurse practitioner there says,“We usually have a waiting list of 100 now, and have been adding 5-6 patients per week.” “Many young people have had these feelings for a long time and just didn’t know how to articulate them.” The hospital provides hormone treatments, pubertal blockers, chest binders and outpatient surgery. “The best part of this job is helping somebody become their authentic self. They usually don’t see happiness at the end of the tunnel. I like being part of the team that helps them get to a place where they can be who they really are,” she says. She helps educate her patients, making sure they understand how to give themselves their hormone injections, apply binders for their chests, or just deal with their day-to-day issues. Health Policy Nurse With the healthcare system getting increasingly complicated and expensive, some nurses are advocating for change to make it more accessible and affordable. Health policy nurses do not work with patients at a clinical level. Rather, they work to influence and create public policies that will ultimately lead to a healthier population. You can find them in research firms, government offices, and healthcare organizations. With this wide variety of work settings, an average salary for a health policy nurse is difficult to determine. However, one website estimates that average to be around $95,000 annually. In addition, because global health policy requires a broader view of the healthcare system, health policy nurses should hold advanced degrees. Nurse Health Coach Personal coaches have become increasingly sought after. From nutrition and fitness to careers and business, and even relationships and love, coaches can be found in almost any aspect of our lives. With a greater focus on the individual, personal health coaches can promote wellness, resiliency, and quality of life by guiding their patients to strategies for a healthier lifestyle. They serve to bridge the gap between your doctor visits and everyday life. These nurse health coaches work in a variety of settings, including insurance companies, corporations, consulting firms, and many are self-employed with their own practice. Aspiring coaches should complete some form of healthcare or medical degree. Afterward, they should seek additional certification from organizations such as the National Society of Health Coaches or complete a coaching program at an accredited college Cannabis Nurse As more states realize the benefits of medical marijuana and make it legal, desperate patients will need guidance on how to properly use these substances to treat their often life-limiting illnesses and conditions. That’s where the Cannabis Nurse comes in. Because of marijuana’s unique status of federal illegality, cannabis nurses must also assist their patients in navigating these gray areas and empower their patients with information to discuss with the rest of their healthcare team and loved ones. Any licensed nurse can become a cannabis nurse and the American Cannabis Nurses Association offers a thorough education on this emerging specialty 15. There are MANY TYPES of Nursing Degrees! Let’s Break it Down When it comes to nursing degrees, there are many different options to fit your career and income goals, timeframes, lifestyle, and budget. There are so many ways to become a Nurse. From education that takes a few months to several years, and includes fundamental nursing skills to advanced specialized practice, there are few professions that offer more varied opportunities than nursing. CNA LVN ADN BSN ABSN MSN Doctorate (DNP) PhD 1. Certified Nursing Assistant Common job titles at this level include: certified nursing assistant (CNA), registered nursing assistant (RNA), licensed nursing assistant (LNA), direct care worker, care assistant, home assistant or personal care assistant. Time to Completion: A few weeks to a few months, with a combination of schooling and hands-on clinical experience. After completion, students must take a state test to become certified; requirements vary widely from state to state. 2. Licensed Practical Nursing (LPN) or Licensed Vocational Nursing (LVN) Degree Of all the nursing certifications, LPN or LVN programs are the quickest and most convenient options. Because training can be completed at a hospital, vocational technical school, community college and even online, LPN/LVN programs are ideal for students who work or have other obligations. Time to Completion: About one year. Career Paths: This flexible, fast-paced program equips students with the most basic skills for becoming a nurse. Completion of an LPN/LVN program makes graduates eligible for licensure after they pass a state-administered nursing exam called the NCLEX-PN. 3. Associate of Science in Nursing (ASN) Associate Degree in Nursing (ADN) An associate of science degree in nursing program (ASN) provides graduates with more technical skills and, for 30% of graduates, serves as the stepping stone to a bachelor’s degree in nursing (BSN). This degree option is ideal for those who want to begin a career as an RN, but are not currently working as an LPN or LVN. Time to Completion: About two-three years. Night and weekend courses offered at community colleges or vocational schools make this degree another ideal option for students who are juggling other responsibilities. Although often longer due to pre recs prior to applying to the program. 4. Bachelor of Science in Nursing (BSN) (Most common Today) When considering the different types of nursing degrees it’s important to understand that a bachelor of science in nursing (BSN) degree is preferred by most health care providers and offers a broader range of career opportunities in today’s health care field. Time to Completion: Four years. A BSN program involves an extensive amount of coursework and lab time. While some BSN degree programs include a mix of on-campus and online classes, clinical experiences are always completed onsite at a college campus or hospital. 5. Second Degree Bachelor of Science in Nursing (BSN) or Accelerated Bachelor of Science in Nursing A Second Degree BSN, sometimes called an ABSN, is designed for adults with a non-nursing bachelor’s degree who wish to transition their career into the nursing field. Time to Completion: A Second Degree BSN typically takes two years or less, since these programs will give credit for previously completed liberal arts requirements. Online programs are available for students who need more flexibility, and some schools offer an accelerated BSN (ABSN) programs that can be completed as quickly as 12 to 20 months. In addition to challenging coursework, students need to account for time spent completing clinical rotations. 6. Master of Science in Nursing (MSN) A Master of Science in Nursing (MSN) program enables a nurse to specialize in different types of nursing through advanced clinical training and research. Many employers offer tuition reimbursement for nurses to further their education. Time to Completion: Typically 18-24 months. MSN programs—offered online or in a more traditional on-campus format—are very rigorous, as students are learning about an advanced specialty. Most programs require students to complete a final thesis or project. 7. Doctorate Nursing Degree Programs While all levels of nursing are expected to see high growth, nurses with doctoral degrees are projected to have tremendous job demand over the next decade. These programs prepare nurses for careers in health care administration, clinical research and advanced clinical practice. Time to Completion: Three to five years, full-time including summers. Career Paths: A Doctorate of Nursing Education program develops advanced practice nurse specialist skills. A Doctorate of Nursing Practice (DNP) program emphasizes clinical practice-oriented leadership development. 8. Doctor of Philosophy (PhD) Doctor of Philosophy (PhD) programs prepare nurse scholars and researchers to make a meaningful impact on the theoretical foundation of nursing practice and health care delivery as a whole. Time to Completion: Four to five years full time, with part-time options available. While students won’t complete clinical hours, they will be required to complete extensive research and a final dissertation. In general, PhD programs are not suited for juggling coursework with a job.Nurses with a PhD are qualified for many facets of professional and scholarly roles, from research to public policy formation to leadership in health care delivery and education. 16. Advanced Nurse Degrees What is Advanced Practice Nursing? So, for whatever reason. This concept really confused me. Basically what it boils down to is...NOT ALL MSN DEGREES ARE MADE EQUAL. Meaning some MSN degrees are geared towards Leadership/Education/Management and others are in ADVANCING YOUR SCOPE OF PRACTICE. APN Degrees that INCREASE you SCOPE of PRACTICE as a NURSE. And how do you become an advanced practice nurse? A nurse with a master’s degree is called an advanced practice nurse (APN), and they come in four varieties: Nurse Practitioner (NP) – Nurse practitioner’s provide basic care focused on a specific population or health need, with the ability to write prescriptions. Family nurse practitioners are an example of this. Certified Nurse Anesthetist (CRNA) – Certified nurse anesthetist’s administer anesthesia for all types of surgery. Clinical Nurse Specialist (CNS) – Clinical nurse specialists provide specialist care in a number of areas: cardiology, oncology, neonatology, OB/GYN, pediatrics, neurology, and mental health. Certified Nurse Midwife (CNM) – Nurse-midwives provide prenatal care, delivers babies, and provide postpartum care to normal healthy women. Advanced practice nursing is thriving in today’s health care industry with the nursing shortage. APNs deliver services that were previously delivered by physicians. Nurse Practice Acts vary widely among states, and they define just what advanced practice nurses can do. #17 Know Your Intention to Advance the Nurse Degree For those of you unfamiliar, it is very "in vogue" to advance one's nursing degree. (NP, CRNA, Midwife etc). Hospital organizations are encouraging degree advancements, roles in education/leadership etc. require higher degrees. The "anti" keeps going up. Before you go back to school or make the decision to increase that degree I want to get in your ear. I am here to really encourage you to do what is right for YOU! (Not your employer, not your friends or family, not outside voices). Here's what I want you to do: Tune it out! What do you want? Here are things I think are very important to consider when you are thinking of advancing your degree. What Setting You Want Clinic, hospital, outpatient, acute care What is Your $$ Financial Gain $$ Considering loans for school and payoff long term. Will your employer kick in for education? The STATE you Live in CA vs TX (very different dynamics) Are you independent or under an MD/DO supervision How much $ will you make in the role you desire? Time of Your Life AKA Family Planning Time studying/in school Lifestyle You Want 3 shifts/week 5 days a week, 40 hours. Per Diem vs Full time The Setting You Want to Work Office vs. hospital Telehealth vs. home health Private Practice vs. Union Organization Change in the Nurse Role Prescribing, Diagnostics, Reviewing Labs Procedures (Chest Tubes, Intubating, Central Lines etc). Internist role Out patient role Grad School Application Requirements Grades start to expire after 5-7 years. May have to retake classes to apply for school 18. Keep Options Open - Be Open to New Opportunities ! My basic concept here is, be open to ideas! I guess I think, never say never and I am not one for turning down opportunities. If something lands in your lap, go for it! You never know where something may lead. I have had several opportunities come from sought roles, and others presented by management or outside providers/companies. I love this world of healthcare and where we are going...more access to people who need it, more education to the people who need it, in the places (internet, phone, apps) they need it. Our roles as nurses are constantly changing and evolving. Be open to the change and opportunities ahead. 19. Social Media 101 I have so many opinions about this topic. Far bigger than this blog. So much so that I have decided to bring on an expert in the social media field with me!! Oct 2020 I am bringing on a Nurse, Youtube sensation, Instagram curator, and social media expert to help me talk ALL things social media / healthcare 101. 20. You Do You Boo! The bottom line here is you need to do what is right for you! The big world of nursing can be very intimidating and overwhelming. My hope it that this blog, my podcast, and instagram can give you a little insight into the world of nursing! I have multiple episodes featuring the many aspects of nursing (Bedside, NP, NICU, CVICU, CRNA, NNP, Flight Nursing, Cosmetic Nursing etc.) Head over to check it out to learn more.... 21. BONUS Check out PICMONIC if you are in Nursing, NP, PA, Med School! This has been my go to study tool for the past year and WISH I had this during Nursing school (back in my day this wasn't an option). Picmonic was established in 2011 by two medical students to help students retain and recall the large amount of facts studied in medical school. Picmonic name is a portmanteau of Picture and mnemonic. As for 2017, the website contains more than 1000 audiovisual picmonics. Better than flashcards, Picmonic is the study tool of choice for learning thousands of the most difficult to remember and most frequently tested topics, board exam prep and more. Our research-proven methodology incorporates the best study techniques by: Transforming forgettable facts into memorable stories and characters Covering an extensive library of study aids featuring need-to-know facts Providing a comprehensive learn-review-quiz study app system Don’t let anyone sway your decisions. It’s your life 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, Sponsored Capella University MSN student, a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com

What 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? In neonatal care it is recommend to perform 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 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

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 a 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 associate's degree in nursing (ADN). However, many facilities, including academic medical centers and large community hospitals, prefer or require a Bachelor 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 from 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 a 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 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

Nursing is truly a calling & one with rewards far beyond money and three-day work weeks. ♡♡♡♡♡♡♡♡♡♡♡♡♡ While the demands for healthcare providers continue to rise, the "shortage" of nurses continues as well. Why is this?! Money. It takes a lot of time and resources to train a brand new nurse (It took me 6 months before I came off orientation & became an asset to the hospital. With this being said, it is important to make yourself as marketable as possible as a potential candidate, which we will get into later. Before we dive into my tips, let me tell you a little bit about my path to becoming a nurse. I moved out of state to Arizona (from California) where I attended The University of Arizona, Tucson AZ. I started at UofA #beardown as a Pre-Nursing Major, where I completed my 2 years of undergrad and applied to nursing school. But it wasn't all roses! Well, this is how that went…… Applied once, REJECTED. Applied a second time, got an interview, REJECTED. Applied third time, got an interview, REJECTED. Then got a call, I had made the (second) cut of students (someone had dropped out prior to starting school). WAITLISTED My admission to Nursing school was anti-climactic to say the least. ♡♡♡♡♡♡♡♡♡♡♡♡♡ Yes, it took me 3.5 times to get into nursing school! Therefore, I feel you! I have been in the hot seat, and I know what it is like to climb your way into nursing with every ounce of hope and hustle you have. So how did I finally get into nursing school?! I DIDN’T GIVE UP! I PERSEVERED. I HAD SUCH DETERMINATION & FOCUS THAT NOTHING COULD STOP ME. I KNEW I WAS GOING TO BE A NURSE. Here are some personal tips & advice for your first hurdle, getting into nursing school! ♡♡♡♡♡♡♡♡♡♡♡♡♡ TORI'S PRE-NURSING TIPS 1. RE-TAKE THE CLASS If you have to, just do it! If I got the “B” in Microbiology, I went back that summer for the “A." Was it fun? No! Was it time-consuming? Yes! But it was worth it! Boosting those grades was key for my application to Nursing school. 2. PRACTICE YOUR INTERVIEW Many nursing schools require an entry interview. If this is the case for you (and it will be for your first job as well), I suggest you start preparing now! Practice practice practice. I was horrible at interviews! Nerves, overthinking, rambling on, overwhelming feelings of what to say. But I practiced! If I stumbled over words in an interview, I re-practiced questions all the time! In the shower, in front of friends and family, my car, until my brain hurt. 3. BOOST THAT RESUME From activities to boosting grades, I found every way to boost that resume! I added activities (to my already overly busy schedule) to help boost me over the next candidate. 4. VOLUNTEER Find something you are passionate about! Red cross, student leadership, homeless shelters, Hospital help, Veterans causes, etc! There are so many organizations that could use your help. In addition, these are great experiences and resume boosters for your nursing application. I volunteered at “Ride On” Therapy (Equine therapy for Children & Adults with physical & cognitive disabilities), the Workforce Diversity Program at University of Arizona (to help low socio-economic middle schoolers learn about the opportunities in Nursing), and a Veterans cause! 5. WORK IN THE FIELD! CNA, SCRIBE, VOLUNTEER, SECRETARY, HEARING SCREENER, ETC. Working directly in a hospital can give you great "in field" experience, offer opportunities to learn about units firsthand, and most of all NETWORK! You will have opportunities to meet nurses, staff, managers, etc. A face to a name! Not only will you be able to add this to your resume, but you will become a familiar face to the nursing staff! 6. BACK UP PLANS! Make several plans. Personally, I had plan A, B, & C. If the University of Arizona hadn’t worked out, I had backup schools & programs planned out (with classes that transferred to the schools). There are so many options out there! Plan ahead, and if something isn't working, make plans for your next move. 7. GO THE EXTRA MILE Many schools require a different curriculum. One school may require one class or lab, but another may require another class. I opted to take that extra Lab (that wasn’t required for UofA) just incase I needed it for another school. Through this, I actually learned more! Two classes I decided to take actually helped my overall nursing thought process and taught me MORE than I had anticipated! Planning ahead and going the extra mile can make a big difference. 8. SHOOT FOR A "BSN" DEGREE IF POSSIBLE Although this is not a "hard and fast" rule, most most New Grad Programs in teaching hospitals (Level I trauma Hospitals, Children’s Hospitals, Level IV-III NICUs etc) require a BSN “Bachelor’s of Science in Nursing.” In addition, most hospitals are moving towards becoming "Magnet" certified. Magnet is a nation wide program focused on improving patient outcomes with improved nursing engagement. Part of this includes hiring and having Bachelors prepared nursing staff. Healthcare is focusing on having more educated staff members. Therefore, many are requiring staff to obtain Bachelors Degrees. In addition, opportunities for advancement (Management, Education, etc) require higher degrees. My advice, try to land that BSN degree. 9. NEVER GIVE UP I knew Nursing was my calling. Therefore, I never gave up! My advice to you, is NEVER give up. Find a way to make it work! You may have to go far above the call of duty. Work another job, volunteer more often, take a class over to get the better grade, look into other cities (or states), sacrifice social life, some family time, etc. I did all of the above and it was well worth it! LIST OF NURSING SCHOOLS WITH BSN PROGRAMS (CA & AZ) University of Arizona Nursing School Azusa Pacific Nursing ASU Nursing Concordia University Irvine Grand Canyon University UCLA Nursing UCI Nursing UC Merced Nursing UC Davis Nursing UC San Francisco Biola University Cal State University Chico Cal State Chanel Islands Nursing Cal State University Bakersfield Cal State University Northridge, Nursing Cal State University, Long Beach Nursing Cal State University, Fullerton Nursing Cal State Fresno Nursing Cal State University Stanislaus Cal State University Northridge Cal State University Los Angeles National University Nursing West Coast University Nursing Mount Saint Mary’s University Los Angeles Nursing Point Loma Nazarene University San Diego State University Nursing San Francisco State University Sonoma State University West Coast University Western Governors University Tori 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

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 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

You might be wondering: What are “normal” NICU vital signs and how do we assess them in our newborn patients? Here, you’ll find out all you need to know! NICU NURSE VITALS Collecting and documenting vital signs is an essential part of being a nurse. No matter what speciality or clinical setting you work in, you’ll be expected to assess your patient’s vital signs to monitor their stability and health status. It’s no surprise that part of being a NICU nurse means collecting vital signs on their newborn patients. However, vital sign parameters are different in the NICU, and we collect our readings differently than nurses in other specialties. Below, I’ll answer the following questions: What vital signs are most important when working in the NICU? How do you conduct a newborn assessment and collect infant vital signs? What equipment is needed to obtain newborn vitals? What Vital Signs Do NICU Nurses Monitor? Similar to nurses in other intensive care unit specialties, most NICU nurses document the following six vital signs: 1. Heart Rate 2. Respiratory Rate 3. Oxygen Saturation 4. Blood Pressure 5. Temperature 6. Pain In addition to these vital signs, assessing newborn measurements is also essential to documenting developmental progress. These include: Head circumference (the distance around a baby's head) Abdominal circumference (the distance around a baby’s abdomen at the level of their belly button). Length (the measurement from crown of the head to the heel) Weight (usually measured in grams) What Are Normal NICU Vital Sign Parameters? The normal ranges for NICU vital signs might look different than those for adults or older children: 1. Heat Rate: 100-200 beats per minute 2. Respiratory Rate: 10-100 breaths per minute 3. Temp 36.5 C - 37.5 C 4. Oxygen Sats - 85-100% 5. Blood pressure: depends on gestation 6. Pain: NPASS scores between 0-4 Collecting Patient Vitals in the NICU: 3 Important Steps Part of what makes working in the NICU so unique is the complexity of our patient population. Each baby will have different “normal” vital sign parameters according to their gestational age. Step 1: Assess Your Patient Before documenting an infant’s vital signs, you’ll want to perform two types of assessments: A full-body physical assessment A maturity/gestational assessment These can give insight into particular findings and can highlight areas of concern. Then, once you’ve done that, you can proceed with vital sign collection. We outline how to carry out these important steps below: a. Infant Full-Body Physical Assessment Before you check a NICU patient’s vitals, you’ll want to take a look at their general appearance. If you’re just starting out your shift, you’ll want to do a thorough physical assessment. If you’re collecting repeat vitals, a quick look-over will suffice. Before you check a NICU patient’s vitals, you’ll want to take a look at their general appearance. If you’re just starting out your shift, you’ll want to do a thorough physical assessment. If you’re collecting repeat vitals, a quick look-over will suffice. When conducting your physical assessment, take note of the following characteristics: 1. General appearance: Physical activity, tone, posture, and level of consciousness 2. Skin: Color, texture, nails, presence of rashes 3. Head and neck: Appearance, shape, presence of molding (shaping of the head from passage through the birth canal) Fontanels (the open "soft spots" between the bones of the baby's skull) Clavicles (bones across the upper chest) 4. Face: Eyes, ears, nose, cheeks 5. Mouth: Palate, tongue, throat 6. Lungs: Breath sounds, breathing patterns 7. Heart sounds and femoral (groin) pulses: Strength and palpability 8. Abdomen: Presence of masses or hernias 9. Genitals and anus: Open passage of urine and stool 10. Arms and legs: Movement and development. b. Maturity/Gestational Assessment In most NICUs, an examination called The Dubowitz/Ballard Examination for Gestational Age is often used to estimate a baby’s gestational age. This exam evaluates a baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery. Information collected from this exam is often used to help estimate babies' physical and neuromuscular maturity. These help us ensure that we’re providing appropriate care and are meeting the infant’s developmental needs. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby. Step 2: Document Infant Measurements Once you’ve completed your assessment, you’ll want to measure the infant's head circumference, abdominal circumference, and length. These are usually measured with paper measuring tapes using centimeters. Next, you’ll want to get your patient’s weight. A baby's birth weight is an especially important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, super small babies and very large babies are at greater risk for problems. To prevent complications, babies are usually weighed daily or every 12 hours to assess their growth, fluid, and nutrition needs. It’s important to remember that newborn babies often lose 5 to 7 percent of their birth weight within the first few days. For example, a baby weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back by 2 weeks of age. However, premature and sick babies may not begin to gain weight right away. Most hospitals use the metric system for weighing babies (grams/kilograms). This chart can help you convert grams to pounds. You can also download a conversion app on your phone! Step 3: Collect Vital Signs Finally, you’re ready to collect vital signs. Most readings will show up on the patient’s electronic monitor, but you’ll need to know how to assess each vital sign. Let’s dive in. 1. Heart Rate Normal Range: 100-200 beats per minute Heart rate & pulse are monitored with 3-lead ECG stickers placed over chest & lung areas. These stickers are usually changed everyday or every other day and remain connected to the patient at all times. You should also manually listen to the infant’s heart rate using a stethoscope to ensure the stickers are reading appropriately. The best time to measure an infant’s heart rate is while they’re sleeping! Equipment Needed: ECG leads/stickers, stethoscope 2. Respiratory Rate Normal Range: 10-100 breaths per minute The same 3-lead ECG stickers you use to collect an infant's heart rate will be used to measure their breathing rate. You can also usually visualize a patient's breathing rate to assess for depth of breaths and breathing effort. Equipment Needed: ECG leads/stickers, stethoscope (same as heart rate leads) 3. Oxygen Saturation A pulse ox probe (attached to hand, wrist, or foot) monitors the oxygen saturation. This tells us how well a baby is perfusing. Equipment Needed: Pulse-Ox sticker and probe 4. Blood Pressure Most NICUs will use automatic blood pressure cuffs to analyze an infant’s blood pressure. These blood pressure cuffs are sized based on weight. For infants who have an umbilical artery catheter (UAC) or arterial line, we can measure their blood pressure continuously, like we do their heart rate and oxygen saturation. Equipment Needed: Blood pressure cuff OR UAC/arterial line tubing/cables 5. Temperature Temperatures are usually taken via the axilla (armpit). If a baby is in an isolette, a skin probe (attached to the baby) displays the baby's temperature. This is how we keep them nice and toasty. Equipment Needed: Thermometer or temperature probe 6. Pain Pain is usually scored every 3-4 hours with some form of the standard pain scale, though it should be measured more frequently for patients on IV pain medication or for those infants who may be withdrawing from long-term/maternal use pain medication. “NPASS” is the most common pain scale used in the NICU. Equipment Needed: None/visual assessment only Looking for More Tips on Providing Great Care? So there you have it — now, you understand how to appropriately collect infant vital signs! If you’re looking for additional information on how to provide safe and effective infant care, check out our other resources, toolbooks, and guides on NICUity’s webpage! 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 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 ​

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

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 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

If you’ve just graduated from nursing school and are starting your first NICU job, you’re probably feeling a mix of excitement and worry. It can feel like you’re drowning in expectations, worried about learning the ins and outs of your unit’s culture, and fear having a tough time keeping up with a never-ending flow of patients. The doubt you may feel about whether nursing is really your calling or not can creep in but I can assure you that is NORMAL and is something we all go through at different stages of our nursing career, especially when we’re just starting out. Sometimes, the fear and trepidation of what’s to come is the worst part of any new journey! What helps me before diving into any challenging life situation is setting realistic goals and expectations for myself and for those around me. Below, I’ll list 11 things I wish I knew before I started my first job to help you prepare for the challenges ahead. 11 Things I Wish I Knew Before Starting In the NICU 1. Some people may NEVER appreciate what you do. This is something you are going to have to settle with right away. The goal is to try not to take the words and actions of others around you to heart. The attitude and frustration aren’t necessarily about something you’ve done, but rather is something that they can’t control when dealing with stress or anxiety. It’s disheartening for all of us when we’re caring for an ungrateful or rude patient, co-worker, or family member. What’s important is that we keep their poor attitude from changing the way we provide compassionate and empathetic care. No matter what, it’s our responsibility to remain respectful to your patients, their family members & colleagues, even when you feel wrongfully questioned or disregarded. It can be a tough pill to swallow to remember that in healthcare, respect is earned, not given. It may take some time to establish this with your colleagues and families when you’re first starting out. If you have a friend or family member who isn’t supporting you in your new role, bring up your concerns and try to have a healthy discussion about it. Advocate for yourself when you can and let go of the rest. Don't let this over-come you, it’s something we all continue to deal with, even after years of being a nurse. We’re all in this together! XO 2. Burnout and work fatigue. It’s not as simple as “self-care”. We all face nursing burnout and work fatigue, but be wary of taking “self-care” advice from those outside of the healthcare field. Unless they’ve walked in your shoes, it’s hard for others to understand the fatigue of a 12-hour night shift, especially when you’re working several days in a row. Not only is our work physically taxing, but it’s also emotionally and mentally exhausting as we do our part to help patients through positive and negative outcomes. Preventing job burnout starts by leaving work at the hospital and living “off the clock” on days off. If you notice burnout creeping in, try to make some changes to your schedule. Try taking on a new role in your unit, look into career development opportunities, attend a conference, network, conduct clinical research, apply for a new job, or even consider going back to school to get your advanced degree. Nursing is far too vast an industry for you to live your life in a career rut. Don't sink into it, instead, get ahead of it. Listen to the Cellfie episode on burnout and lessons learned here! 3. You may love your job or specialty at first, but could then grow to dislike or outgrow it. Yep, this happens all the time. It may feel frustrating to put your heart and soul into a job and then decide it’s time for something new. Ultimately, life is all about growth and change, so don’t be afraid of it! It’s okay to start in love with one specialty and then to grow to dislike it as time goes on. It doesn’t mean that you failed to identify your passion or that you’re in the wrong profession altogether. Make a list of the pros and cons of your unit/specialty, and then work toward making a change if you feel that the cons outweigh the pros. Floating to different units and taking a travel nursing assignment helped solidify in my mind what I wanted to stick with, as it gave me a broader perspective on how other hospitals, units, and specialties operate. If you’re falling out of love with your job, I encourage you to make a BIG change and take a travel nursing assignment. A change of scenery and a new clinical team might help you determine where you feel most drawn to in the long-term. 4. You will work with some very difficult personalities. All types of people work in healthcare. We all have different cultural backgrounds, aspirations, and motivations to succeed. It’s important to remember that not everyone thinks and behaves like you do. This is not always a negative. In fact, I think working with people who are different from you is something that can move you forward in your journey of professional growth. I have worked with plenty of nurses and doctors who I initially STRONGLY DISLIKED but grew to LOVE like no other. Remember, someone could just be having a bad day (or even a hard season of life) and bring that burden to their shift(s) with them. Maybe you and a team member just don't jive, which is okay too! Give yourself enough time to get to know each of your coworkers before judging them. Try to find ways to work together instead of trying to find ways to avoid them. 5. Work culture can affect you professionally AND personally. Work culture plays a HUGE factor in nurse job satisfaction. It’s something we should all ask about during job interviews. Every workplace will have a different culture. Having insight into what makes your unit tick can help you get started on the right foot and adapt if you need to. For example, if you have always preferred to work alone and problem solve independently, a culture that embraces community discussion, bouncing ideas off one another, and problem-solving might feel intimidating to you at first. Instead of trying to fight the system, attempt to change and grow personally and professionally! If there’s something about your unit that you find toxic or negative, try to incite the positive change you wish to see. 6. Rome wasn’t built in a day (or even a year)! Getting experience and developing as a professional takes time. Being ambitious can make you a strong clinician, but don’t get hung up on wanting to be a master right from the start. It took me 3 years to feel "competent" in my Level IV NICU, and even after 9 years, I have moments when I make mistakes and learn something new. There will be things you don’t know, so get comfortable with being uncomfortable. Ask questions, be nosy, get involved, and take the initiative when you want to develop your portfolio. Every shift is an opportunity to dive deeper, become more confident, and make a lasting impact on your fellow shift workers and patients. I have been in my nursing role for many years and still seek out leadership and professional growth opportunities everywhere I can. Try to seek out conferences to attend or certificates to earn that could help you solidify and expand upon your nursing knowledge! On a smaller scale, sign up for a class you’re interested in or eat lunch with a group of experienced nurses to learn how they think about certain things! Every small effort can make a big difference when you add up hundreds of small efforts! 7. Prioritize your own personal "work" so you can show up as your best self This is vital! If you’re struggling personally, it is hard to be 100% present during your shift. Research shows that unchecked mental fatigue results in concentration difficulties, irritability, stress, depression, frustration, forgetfulness, and chronic disease. If you can’t focus on important tasks, mistakes are bound to happen, which puts your babies and your nursing license at risk. These issues also spill over into your relationships with family, friends, and co-workers. I wish someone had told me earlier that it is not only okay to go to therapy but therapy is actually extremely helpful when processing the difficult moments we experience as a healthcare provider. The struggles, disappointments, and fears that come with being a nurse can add up and get really overwhelming. Going to therapy, meditating, exercising, and making fun plans with family & friends are all ways that I put my well-being first. I always try to be the best version of myself and bring good positive energy with me to my shifts. You might know that you’re having a tough time but may not know what to do about it. If you’re struggling with mental fatigue but aren’t sure where to start, I recommend checking out my “10 Tips for Preventing Mental Fatigue” episode on The Cellfie Show! Listen to Cellfie Episode "10 Tips for Preventing Mental Fatigue" here! 8. At some point, you’ll hit a professional plateau. When this happens, SHIFT. Think about what’s next and how you can challenge yourself in a new and exciting way. We all hit a wall at different points in our careers. For some of us, it happens within a few months of starting our first job. For others, it can be years before we start to feel stuck or bored. What’s important to remember is that you’re never stuck as a nurse! Most of us chose this career path because we knew it opened so many doors and opportunities. There are so many options for you to make big moves and changes in your career, whether that includes becoming a travel nurse, changing the unit you work in, switching hospitals or even taking your career to the next level by going back to nursing school and getting an advanced degree. One of the best parts about nursing is the flexibility it offers. If you decide that bedside isn’t for you anymore, there are other nurse roles to look into. Check out my blog “51 Nurse Jobs to Consider” for some inspiration! 9. Doctors make mistakes, too We are all human and make mistakes. There will be high-pressure situations that will require immediate decisions by everyone on the medical team. However, it’s important to remember not to blindly follow orders under pressure, especially those that you question or feel uneasy about. Don’t be afraid to speak up when you think there might be a mistake. Listen to your gut and trust your teaching. Question the appropriateness of orders, especially if you find yourself working in a teaching hospital with medical students, residents, fellows, and interns. It can be so easy to get caught up in the emotions of an emergency situation and blindly follow a process, but you have to be strong and speak up to help your team and your patients. Mistakes can mean the difference between life and death in the NICU, so we all have to play our part to make sure we’re keeping our patients safe. 10. You will face many ethical dilemmas along the way. During your career as a NICU nurse, you’ll have moments where you disagree with how your medical team is handling a particular situation. If you feel strongly about how to handle the situation and everyone else seems to have made a different decision, it can become ethically and morally stressful. One of the hardest ethical dilemmas I’ve faced is knowing how much or how little information to share with a patient and their family. For example: Do you continue care for a patient whose outcomes are poor just because a family wants you to? Do you continue life-saving care on a patient because your facility’s legal team tells you to do so? Do you choose to provide hope to a patient’s parents, even if the outcomes don’t look promising? Are you aware of certain complications of a particular procedure that the family isn’t aware of? These scenarios are the types of ethical issues that I find most challenging as a nurse. In these situations, it can be helpful to bounce your ideas and viewpoints off of others in your team’s chain of command. This could be your unit’s charge nurse, manager, CNS, or even the director of nursing. Hospitals also staff ethical committees to help in these challenging situations, so don’t be afraid to collaborate with them if you’re feeling particularly stressed or concerned. 11. You are the coordinator of the party When you’re new, you may have serious imposter syndrome. However, you have to remember — many family members think of you as the boss! I like to think of myself as the host of the patient’s party. As the nurse, you’re the direct link between the patient and their family members, MDs, NNPs, surgeons, consultants, RTs, therapists, social workers, and radiologists. while they are under your care. It’s important to remember that you are your patient’s best advocate and that it’s your job to ensure that your patient is given all medical information, education and treatment options so that they can have the autonomy to make the decision that’s best for them. Obviously, this looks different depending on your specialty/unit, but the idea is the same. You are the one who is coordinating the other members of your team to keep all of the balls in the air. It’s vital that you give correct and timely information to the patient’s “team” to ensure they receive the quality care they deserve. Okay, this sounds like a lot to handle. What’s the real tea? Chances are, you’ll form a love-hate relationship with your nursing career. You’ll have hard days that leave you in tears on your commute home, but you’ll also have the days where you leave work feeling proud of yourself for helping to save a life. On your hardest days, don’t forget the good days that have shaped you into the strong nurse, colleague, and community member you are today. The talent and expertise that you bring to the table is needed in nursing today more than ever before. Join Our Nursing Support Network Looking for support from others in the NICU community? Join FREE NICU FORUM a free forum full of new and experienced nurses looking to grow and learn from each other! You can find answers to your toughest questions and help provide support and guidance to others looking for help! We’re all in this together :) Leave any questions you have about starting your new nursing career in the comments below! XO 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

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 a 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 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 .