Parts 1 + 2 Combined!
3-to-1 Assignment
0700: Arrive on the unit & participate in morning huddle.
0730-0800: Get report on all 3 patients.
Room 1: Former 28 week preemie, now a 38-week feeder/grower, has some meds & on a 3L HFNC requiring 21% oxygen.
Room 2: Hyperbili term baby who came from home, has a peripheral IV for fluids + nutrition & an NG tube used intermittently when he doesn’t finish his bottles. Has some labs, stable on room air.
Room 3: NAS baby withdrawing from IUDE, requiring methadone Q3H & frequent consoling.
0800-0830: Scrubbing in & removing all jewelry per my NICU’s policy. Next I assess the safety of the bedsides (i.e. check suction, bag & mask inflation, & visualize emergency drug sheets). I sanitize each bedspace + everything that I plan on touching throughout the day. Wiping down high-touch areas (cribs, IV pumps, stethoscopes, bedside tables, charting area, work phone, etc.) is so important to prevent infections.
Next, I double check orders, assess lines, drains, & airways & organize my day. NICU babies eat every 3 hours at my facility (9, 12, 3, 6 AM/PM), meaning I wake up & assess each baby 4 times during my shift. Cares for each baby should take NO LONGER than 30 mins or else you will fall behind!
0830-0900: Start rounding on my patients & introducing myself to any families present at the bedside. I start with the baby who’s already awake, crying, & hungry (example: Room 1). I collect vitals, perform my nursing head-to-toe assessment, complete my ADLs (diaper change, oral hygiene, eye care, measure abdominal girth, etc.), & feed the infant. I administer morning meds & ensure all cares are complete before I exit the room & move on to my 2nd baby.
0900-0930: I complete all of the above tasks for the baby in Room 2. I touch, look, & compare the IV site, flush the line, & check the dressing. I draw labs such as serum bili or glucose (as needed), check NG tube placement, patency, & aspirate residual, then put him to sleep before moving on to my final baby.
0930-1000: Administer morning dose of methadone to the baby in Room 3 in addition to all of the prior care tasks (See previous post). This baby may take longer to console & might need to be held/comforted for quite some time after all of my cares are complete.
1000: Charting begins on all of my patients. This includes documenting ALL. THE. THINGS. that I did in the morning such as my assessments, vitals, education, provider notifications, etc.
1100-1130: My first (& sometimes only) lunch break.
1130: Round 2 starts!
Assessments, vitals, feeds, diapers, medications, labs. Then charting everything on round 2!
1330-1430: Catch up on any charting or any missed tasks from the morning/early afternoon.
1430: Round 3 starts!
1600: Pharmacy delivers TPN + lipids to the NICU around this time. If any of my babies have a PICC line with caps + tubing due to be changed, this is when I would perform that task. If any of my babies are on IV fluids or require respiratory support, I check their capillary blood sugar and/or blood gases.
1630: I take my second (& final) break.
1700: Update my report sheets & organize the information needed for my hand-off report at the end of the shift.
1730: Round 4!
1900: Give report on all of my patients to nightshift!
1930: Byeeee!
This would be considered a smooth day. Most of my shifts include all of the above PLUS dealing with unexpected situations that arise such as responding to critical labs, changes in patient status, talking with MDs, providing education to parents, admitting + discharging patients, starting new IVs, processing new orders, transporting patients down to radiology, comforting inconsolable babies, hunting down volunteer cuddlers, teaching + educating a nursing student or new orientee on everything & anything, etc.
Hopefully this helps to give you a glimpse into a typical day in the life of a NICU nurse!
Let me know in the comments if you want a rundown for a sample 1-to-1 assignment!
