NICU RN: Job Description, Requirements and Duties

JOB SUMMARY
Nurses care for people who are sick, injured, convalescent or disabled. Under general supervision, they
deliver care to patients utilizing the nursing process of assessment, planning, intervention,
implementation, and evaluation, in accordance with established philosophy. Nurses collaborate with other
professional disciplines to ensure effective patient care delivery and achievement of desired patient
outcomes. Nurses effectively interact with patient and significant others, while maintaining the standard of
professional nursing.

Nursing infants is very different from nursing adults. Infants cannot communicate verbally when in pain,
their bodies respond differently to medications and treatments and they must be protected from potential
dangers. In addition, the neonatal nurse must educate and support the infant’s parents, who may be
stressed or frightened. A neonatal nurse should have excellent interpersonal skills, with the ability to
establish rapport and provide compassion and empathy to parents. She must also understand and be
vigilant to prevent harm from risks that specifically affect newborns, such as temperature changes or
excess oxygen.

The neonatal period is the first 28 days of an infant’s life. Each institution establishes practice skills for
neonatal nurses, but most expect the nurse to be able perform math calculations -- an infant often needs
a fraction of the dose of medication an adult would require. Other basic skills are management of
intravenous lines, cardiopulmonary resuscitation and the use of specialized equipment such as ventilators
and incubators. A neonatal nurse must be technically proficient with skills such as starting intravenous
lines or using feeding tubes on very tiny infants. Neonatal nurses work in nurseries that provide different
levels of care to babies who range in condition from healthy newborns to premature babies or babies who
have serious birth defects, severe illnesses or other life-threatening problems. Neonatal Intensive Care
Unit (NICU) Nurses care for newborn babies who are delivered pre-term (neonates) or at-term newborn
who experience complications at the time of birth. Nurses who work in the neonatal intensive care unit,
more often called the NICU, care for sick and premature infants, whose medical status can deteriorate in
an instant. The NICU provides intensive around-the-clock care, including both medical needs and basic
daily care activities. Neonatal intensive care unit (NICU) registered nurses (RNs) take care of newborns
that are sick or premature. They work within a team of other healthcare professionals to provide the
necessary medical care to infants. Neonatal intensive care unit registered nurses provide critical care to
premature and sick newborns. In addition to providing around-the-clock care to these patients, NICU RNs
offer support to the parents. This parental support can range from emotional encouragement to advising
parents on how to take care of an infant when they return home. NICU RNs work as a team member with
other nurse practitioners and physicians. Their prime responsibility is to ensure that a newborn's critical
care treatment is secure. Working in the NICU involves much more than holding and feeding babies.
NICU nurses function as critical care nurses, whose small charges might have multiple intravenous lines
and medications as well as ventilators to keep them alive. In the NICU, dealing with parents can also be a
major part of your job description and challenge.

DUTIES AND RESPONSIBILITIES

Providing direct and individualized nursing care to patients based on the application of scientific nursing
principles.

Providing complete care for babies. Caring for newborns transitioning to extra uterine life. Attending
deliveries, weighing, measuring infants, bathing them and monitoring their health. Monitors vital signs and
initiates corrective action whenever the patient displays adverse symptomatology.

Starting and maintaining IV lines, managing ventilators, assessing vital signs and drawing blood.

Providing health teaching to new parents about newborn care and breastfeeding. Instructing and
educating patient’s family.
Providing Respiratory Care
Providing respiratory support if the baby is on a ventilator, making sure the tube is properly placed, that
the baby's oxygen saturation remains above a certain level and that blood gasses show good oxygen
exchange are all crucial for survival. While respiratory therapists adjust settings on vents, making sure the
tubing is patent, taping the tube in place and checking it each shift. If the baby is on continuous positive
air pressure, or CPAP, keeping the prongs in place and assessing oxygenation levels. For a baby on
nasal cannula oxygen, adjusting the settings, checking the prongs for placement and assessing the
effectiveness of the treatment. Many babies need frequent chest PT or suctioning to keep the lungs clear
of secretions.

Provides Nutritional assessment & Specialized Feedings

Some babies in the NICU take bottle feeding, but many get their feedings via naso-gastric, or NG tubes.
Some get all their nutrition via IV. Babies in the NICU often bottle feed very slowly; NG feedings run
slowly through a tube that goes into the stomach through the nose or, sometimes, the mouth. Intravenous
feedings must run at precise amounts. Setting up IV pumps and maintaining feeding rates. Because
premature or sick infants are at risk for necrotizing enterocolitis, a potentially deadly gastrointesinal
infection, measuring abdominal girth and checking for blood in the stool.

Providing Medications
Most babies are sick enough to be in the NICU are on multiple medications, which must be given at
precise times. Blood transfusions are also common treatments in the NICU. Running blood at a precise
rate via a pump and verify the blood type, in addition to watching for signs of a transfusion reaction.
Starting IVs -- a challenging skill on these tiny infants -- and drawing blood. Assessing IV sites for skin
breakdown or other skin damage is also done frequently, since newborns, particularly premature
newborns, have very delicate skin. Preparing, administering and recording prescribed medications.
Reporting adverse reactions to medications or treatments

Providing Psychological Support

Both the baby in the NICU and the family need psychological support. Fostering quiet times necessary for
infant growth and development. As well as healing in sick newborns by dimming lights or covering the
isolette to reduce stimulation, if possible. Unlike well babies, sick infants need less stimulation, not more.
Stimulation causes stress, which uses up energy needed for healing.

Communication
As with any nursing position, keeping the oncoming shift, physicians and other professionals apprised of
any changes in the baby's condition. Writing concise and accurate notes and giving a comprehensive
report help keep everyone in the loop so that care can be customized and changed as needed. Consults
and coordinates with health care team members to assess, plan, implement and evaluate patient care
plans. Recording all care information concisely, accurately and completely, in a timely manner, in the
appropriate format and on the appropriate forms

Promoting a friendly and supportive atmosphere for parents and relatives in which they can learn to care
for their babies.

Clinical Responsibilities

1.1 Using evidence-based practice and a holistic approach to individualised nursing care,
assess plan, implement and evaluate care for babies within a defined clinical area.

1.2 To actively support and promote the involvement of parents/carers in the planning,
management and evaluation of care by working together in partnership.
1.3 To establish and maintain effective communications with parents and relatives, from
admission, ensuring they have sufficient confidence, assistance and support to enable
them to care for their baby in preparation for discharge.

1.4 To be an advocate for the neonate and to promote good liaisons and effective
communication with all members of the multi disciplinary team.

1.5 To adhere to and actively participate in the regular review of nursing practice, policies,
procedures and protocols.

1.6 To safely administer prescribed medications and to monitor their effects.

1.7 To ensure competency and safe maintenance of all medical devices within the sphere of
responsibility.

1.8 To actively promote Health Education in the Unit.

2. Professional Responsibilities

2.1 To maintain personal records of continuing professional development in order to meet

PREP requirements.

2.2 To promote a professional image at all times and to accountable for own clinical practice.

2.3 To ensure appropriate documentation of care is in accordance with NMC guidelines.

2.4 To act in accordance with the NMC Professional Code of Conduct for Nurse, Midwives
and Health Visitors.

2.5 To ensure confidentiality at all times, only relating confidential information obtained during
the course of employment to those acting in an official capacity.

3. General Duties

3.1 The duties and responsibilities of the post will be in accordance with policies and practice
of ………..Healthcare Trust, which the Trust may amend from time to time. It is the
nurse’s responsibility to remain up to date with these and other Trust policies and
procedures.

3.2 Particular note must be made to Health & Safety regulations, the reporting of fires, major
incidents and untoward clinical incidents.

3.3 To be aware of and act in line with the requirements of the Data Protection Act. This
includes obtaining, processing or using information held on computer in a fair and lawful
way, to hold date only for the specified registered purposes and to use and disclose data
to authorised persons or organisations as instructed.

3.4 To undertake such duties that may be required that are consistent with the
responsibilities of the grade and the needs of the service.

3.5 The …………….Trust is an equal opportunities employer. Staff are expected to take into
account equalities in all areas of work.
This job description is not an exhaustive document but is a reflection of the current position. Details and
emphasis may change in consultation with the post holder and in line with the needs of the service.

PERSON SPECIFICAITON

STAFF NURSE – NEONATAL UNIT

Factor Essential Desirable

Education/ Valid registration as an Neonatal/Paediatric nursing

Qualifications RN/RSCN/RM experience
Neonatal Course (405 or ENB 997/998
equivalent – local requirement)

Skills and Abilities Analytical skill Assertive

Excellent verbal and written
communication skills
Good interpersonal skills Knowledge and experience of
Ability to be reflective working with staff and patients of
Able to work within a multi-racial various different background/cultures
and cultural environment
Good organisational skills

Attributes Polite and pleasant manner Computer skills

Commitment to neonatal nursing Leadership skills

Enthusiastic/motivated

Team spirited

Sense of humour

Flexible and adaptable

Revised and updated by the London Neonatal Nurse Managers’ Group – May 2002.

Neonatal nurses certainly have their work cut out for them. Newborns today face some challenges --
addiction, HIV infection, premature birth. And it's not just medical care these infants need. They need care
and comfort to survive and thrive. Neonatal nurses give them the care and compassion they deserve.
"Some common health problems I see are drug-addicted babies, premature babies, HIV-positive babies
and babies born with respiratory distress. We work as a team with the doctors to help the babies," says
neonatal nurse Susan Early.
Hospital work requires nurses to be composed, caring and in control every second of their shift. Although
neonatal nurses witness the miracle of birth every day, they also view untimely infant deaths.
"My job is very stressful because I deal with life and the prevention of morbidity and mortality. I would say
my career is more rewarding than fun. When I'm not working as a nurse, I engage in my hobbies or other
activities that give me great pleasure," says Kathleen Baker, a neonatal nurse.

Neonatal nurses work with needles, feeding pumps, incubators and ventilators. "We use thermometers,
stethoscopes, baby warmers...and cardiac monitors for special care babies," says Early.
This means neonatal nurses must keep current with the latest instruments, procedures and research
through continuing education and medical journals. As nurses take on increasing responsibilities
previously restricted to physicians, a strong educational background is a must.

"Neonatal intensive care is continually challenged with new technologies that may reduce mortality for the
most fragile and immature newborn," says Pat Johnson. Johnson is the operations manager for the
National Association of Neonatal Nurses.

The duties for a neonatal nurse may vary slightly at each hospital, but overall their care tasks are the
same. A neonatal nurse is one of the primary caregivers of a baby in the intensive care unit, and often
becomes the saving grace to worried parents who have plenty of questions and few answers about their
situation. Below are just a few of the tasks on a nurse's daily to-do list when caring for the smallest and
sickest of babies.

One of the main duties for a neonatal nurse is the general care of the infant. Babies,even tiny ones or
those with physical ailments, need regular changes, feedings and cuddles. At each care time, the nurse
will change the baby's diaper, take his temperature, and feed him breast milk or formula. If a baby is
receiving any medications, these may also be administered during these times.

If the parents of an infant are able to visit regularly, a neonatal nurse will teach them how to perform these
basic cares. With time, nurses will help parents to feel equipped in all aspects of meeting their little one's
needs and will continue to serve as a basic support system during the hospitalization.
Sometimes babies are too fragile or small to eat directly from breast or bottle. When this is the case, they
are fed either intravenously, or through a gavage tube, which is a small tube that goes from the nose or
mouth into the stomach. Nurses will carefully place the correct amount of formula or dietary
supplementation if a baby is not yet eating, into either of these methods of nutrition, and monitors the
baby for any positive or negative changes in the infant.

The duties for a neonatal nurse also include inserting and changing IVs, administering blood transfusions
when necessary, and drawing blood for various testing. Nurses are able to perform many other
procedures as well, and it fully depends upon each hospital's individual protocol, as well as the nurse's
experience level and staff rating.

Regardless of their other responsibilities, all neonatal nurses do a fair bit of charting on each of their
patients. This may be on a paper sheet, or more commonly every year, completed electronically via a
special hospital computer system. The details logged into the online chart allow doctors, other nurses,
and anyone else within the baby's medical care team to view a baby's updated health records.

Emotional Support
A neonatal nurse often gets to know the families of infants very well, especially if they happen to have a
primary baby they take care of. A primary nurse will care for the same infant for the duration of his
hospital stay, whenever he/she is on shift. This works well, as the nurses become very familiar with their
babies and can in turn provide them with the best care possible.

In building relationships with these families, they can often provide emotional support and comfort during
scary times. If a baby has to go through surgery or is exceptionally ill, nurses are great for reassuring the
parents and providing as concrete of answers as they are permitted to.
Neonatal nurses are often the unsung heroes to families and able to give the earliest of lives a fighting
chance. Their daily duties add up to countless miracles and a rewarding career at the same time.

Neonatal intensive care nurses provide treatment to seriously ill babies.

Neonatal intensive care nurses care for babies with special medical needs, such as those born
prematurely, with birth defects or with severe illnesses. They provide constant monitoring and specialized
care such as oxygen therapy, while also intervening in the case of an emergency. These nurses need
advanced training and an understanding of babies’ fragile bodies.

Duties
In addition to basic care such as changing diapers and bedding, neonatal intensive care nurses
administer medication and IV fluids and perform oxygen therapy. They also feed their patients, sometimes
inserting feeding tubes for babies too ill to be nursed. They monitor babies’ vital signs, including
temperature, pulse and heart rate. If an infant isn’t responding well to treatment or his condition worsens,
they alert the doctor on duty and administer emergency treatment as directed. Neonatal nurses also keep
detailed records of the care they provide and any change in the babies' condition, so nurses on the next
shift know what kind of care each patient needs.

Work Environment
While some neonatal nurses work at birthing centers or clinics, neonatal intensive care nurses work
almost exclusively in the neonatal intensive care units of full-service or children’s hospitals. Other facilities
don’t have the high-tech equipment needed to sustain infants with severe medical conditions. In addition,
while some nurses rotate between departments, those specializing in neonatal intensive care work only in
the NICU, because only nurses with their advanced training can provide the necessary care.

Challenges
Neonatal intensive care nurses spend much of their time on their feet. In addition, they must remain calm
under pressure and respond quickly in a crisis, because many of their young patients are so ill that their
condition could deteriorate at any second. NICU nurses may also encounter significant emotional stress,
especially when they lose a patient or when caring for infants whose conditions don’t improve. They also
need compassion, patience and people skills, particularly when interacting with distraught or worried
parents.