A Day in the Life: Nursery RN

Are you interested in caring for the tiniest patients in the hospital?  As a Nursery RN, that is exactly what I get to do every time I go to work.  In this post, I will give you an inside look into my unit and what a typical shift is like for me.  Read on to learn about the responsibilities of a Nursery RN, as well as which babies we care for.

Interested in being a NICU or nursery nurse?  Click through to find out what a typical shift is like when you are caring for the tiniest patients!

Nursery Profile

The nursery has 60 private rooms available, and usually it is one baby to a room.  The nursery is divided into four pods, and our unit practices “pod nursing”, meaning that nurses work on the same pod for the majority of their shifts.  Although the unit is technically a step-down unit from our hospital’s NICU, we like to call it a “graduate” unit because when babies come to us, they are closer in their journey to going home.  Because the patient acuity is not as high as it would be on the NICU, our nurse to patient ratio tends to be 1:3 or 1:4, depending upon the census.  In order to work on this unit, a nurse must be certified in neonatal resuscitation (NRP), which consists of a nine-module online course and a skills validation.  Because the nursery is highly specialized, nursing experience in other units is not necessary.  I am a new grad, and this is my first job as a RN!  Nursery RNs can float to NICU and Mother/Baby when the need arises.

Baby Profile

Most of the babies in the nursery are considered “feeders and growers”, meaning that they are working on learning how to eat and continuing to gain weight until they are ready to be discharged.  A baby in the nursery is usually over 1000g, starts off in an isolette until they can regulate their own temperature and be moved into an open crib, receives either breast milk or a formula with added calories, and eats either with a bottle or through nasogastric or orogastric tubes.  Most of our babies are pre-term babies, but some are drug withdrawal babies.  Some of our babies have a higher acuity than others and have diagnoses such as pulmonary hypertension or BPD.  Babies who are born with very critical illnesses, cardiac conditions, or who require surgery are taken immediately to the nearby children’s hospital.  The most common medications that we give are aminophylline (to prevent babies from dropping their heart rate too low and too frequently), multivitamins, and methadone for our withdrawal babies.

Shift Break Down

19:23 - It’s time to clock in and go get report!
20:00-21:45 - With a three baby assignment, usually one baby eats at 20:00, another at 20:30, and the last one at 21:00.  They eat every 3 hours.  This first round tends to be the longest because this is when I perform my shift assessment (assess fontanels, heart and lung sounds, pulses, bowel sounds, measure abdominal girth, temperature, B/P, change diaper, check tube placement and residual if feeding tube is present, and obtain a new weight).  It’s normal to be running a little behind schedule this first round!
21:45-23:00 - I’ll chart on all of my babies before second round, and I check each baby’s orders to see if any labs need to be drawn later and which meds I need to give.
23:00-00:00 - Second round begins!  This goes much faster than first round since my shift assessment has been completed.  My q 3 assessment consists of vitals (which are on baby’s monitor), obtaining a temperature, changing the diaper, and checking residual and tube placement if applicable.
00:00-01:00 - At this time, I like to go to my pod’s central monitor and write down any episodes of bradycardia and desaturations that my babies have had since the start of my shift.  I document these along with my assessments from second round.
01:00 - It’s lunch time!
01:30-02:00 - I’ll check the MARs again, print specimen labels if I need to draw any labs, and I also like to make sure that my rooms are appropriately stocked for day shift.  Doing this third round makes fourth round go a lot smoother!
02:00-03:30 - Third round begins!  I am completing my q3 assessments, drawing labs, and feeding the babies.
03:30-05:00 - I chart my third round assessments, and I go back to the central monitor to chart more bradys/desats.  I usually have about 30-40 min of downtime, and this is when I start feeling sleepy!
05:00-06:00 - Last round begins! My last q3 assessment and feeds!
06:00-07:23 - I finish up my charting and look over it to make sure I haven’t missed anything.  I check bradys/desats one last time, and organize my report sheets.
07:23 - Time to give report and clock out!

So there you have it, a brief glimpse into my shift as a nursery nurse.  Sometimes, extra things come up such as starting an IV, replacing an OG/NG tube, changing out baby’s bedding, and giving baby a bath.  Caring for babies is truly rewarding and I love my unit!  

Do you have more questions about caring for babies?  Would you like to be a Nursery or NICU nurse?  Comment below!