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This is one of the toughest—but most rewarding—jobs in a hospital

It takes guts to work in a neonatal intensive care unit, but sending home healthy babies is the best perk you could ask for.

This is one of the toughest—but most rewarding—jobs in a hospital

Lots of hospital jobs will put you through the emotional wringer, but maybe none so much as those in the NICU. Neonatal intensive care units (NICUs) provide round-the-clock care for babies who are born premature or with severe health problems. These special-care nurseries came to be in the 1960s as technology became sophisticated enough to effectively treat premature babies.

According to the March of Dimes, a preterm birth is any baby born at less than 37 weeks gestation, and the United States has a preterm birth rate of 9.6%. According to the Journal of Perinatology, 1% of even full-term infants need care in the neonatal intensive care unit.

Suffice it to say, it’s an intense place to work. As a NICU employee, you’ll be dealing not only with patients, but also with worried families who are desperate to be informed every step of the way. Though much of the work can be taxing emotionally, the NICU is also a unit full of love, support and positive outcomes.

This is what you might experience day-to-day if you were to work in a NICU.

Exacting checklists

Premature babies need routines, so routines dominate much of the hands-on work in the NICU. And, like most other realms of health care, everything is documented.

“The NICU is very task-oriented,” says Dawn Sirek, a nurse who works at Kosair Children's Hospital in Louisville, Kentucky. “You get a report from the off-going shift about what the baby has been doing in the last 24 hours; conditions can change rapidly. You then follow a very strict round-the-clock schedule for hands-on touch times, medicines and feedings.”

Varying schedules

Caregivers in the NICU may work 12-hour shifts that change weekly. Mary Chan is a registered nurse who works in the NICU at Lenox Hill Hospital in New York City. She generally works 8 a.m. to 8:30 p.m. three or four days a week, depending on her shift.

Staffing levels may change depending on how many babies are in the NICU, so someone who works as a unit coordinator may need to make staffing decisions throughout the day, says Amanda O’Brien, unit coordinator/charge RN at the NICU of the University of Kansas Hospital.

She makes staffing assignments as well, and can also attend high-risk deliveries or help staff with patient needs or questions.

Few patients, but intense involvement

Most NICUs mandate that nurses have no more than three babies to care for, Sirek says, while more critical babies may have their own dedicated nurse. “With a ventilator baby, you stay by the bedside all the time,” she says. “For some babies, it’s just a waiting game—you try to take care of them without touching them too much, as best you can, and let them sleep and grow.”

We should note that this is where the work pays off. Working in the NICU is rewarding in that neonatology has come so far, Sirek says. “Lots of our babies do very well. When I started nursing, it was unheard of that a 24 to 25-week-old baby would live, and now it’s routine.”

Lots of collaboration

In her work in a NICU at a teaching hospital, O’Brien says the neonatologist does a lot of teaching during rounds each day and always asks for the nurses’ input and that they attend rounds.

“You are definitely considered a vital member of the team,” she says. “You have to be very familiar with the hospital’s policies and procedures because you have residents writing orders when it might be their second day in the NICU, so you have to know what the orders should be instead of just doing whatever they order.”

Intimate connections with families

People who work in the NICU help support parents and teach them how to bond with their new and fragile babies, Sirek says. In some cases, the nurses become almost like family members.

And this is the hard part. Not every baby makes it, even after months of intensive care.

It takes a special person to work in NICU, Sirek says, and burnout is common; she is currently taking a break from working the NICU. “But I will always be a NICU nurse,” she says. “It will always be in my heart.”

See all available NICU jobs.

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