Nice Nurses

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Nice Nurses

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November 26, 2012
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November 26, 2012
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Mean doctors and nice nurses: It’s time to change our brand
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In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery. She hadn’t lost weight and clearly was feeling discouraged about practically everything. She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.
As her anesthesiologist, I came to evaluate her prior to surgery. In fairly short order, I got her a tissue and a warm blanket, listened to her tale of woe, and finished my pre-anesthetic examination. Nothing special. At the end, she said, “You’re so nice. Were you a nurse before you were a doctor?”
No, I told her, I wasn’t. Never a nurse; always a doctor. She looked surprised.
And that little narrative may help to explain why we (physicians as a group) are having so much trouble with public relations, and with the onslaught and success of mid-level caregivers who want to practice medicine without a license. Their PR is better than ours because their PR task is easier: patients already think mid-level health care personnel, especially nurses, are basically nicer and more sympathetic than we are.
Just look at the recent coverage of Hurricane Sandy. News reporters on radio, TV, print, and online repeatedly and justly praised the heroic efforts that nurses made during the evacuation of patients from dark, flooded hospitals, and showed photos and video clips of nurses hand-ventilating premature infants. But not once did I hear a mention of the attending physicians and residents who were no doubt working right alongside the nurses, let alone the respiratory therapists, orderlies, and all the other personnel. Nurses got all the credit in the public’s view.
Anesthesiologists and nurse anesthetists represent perhaps the most visible part of the physician/mid-level conflict, but other physicians are at risk as well. The American Academy of Family Physicians (AAFP) has recently made public its opinion that nurse practitioners shouldn’t run medical homes, but the Affordable Care Act supports independent practice for nurse practitioners–including admitting privileges to hospitals–just as it supports independent practice for nurse anesthetists.
The latest unbelievable turn of events is Medicare’s decision in favor of nurse anesthetists practicing interventional pain medicine without physician supervision. Just so we’re clear, this means that a nurse anesthetist with no special qualification other than Medicare’s blessing can bill Medicare for performing invasive pain management procedures that physicians ordinarily train to do with four years of medical school, at least four years of residency, and a fellowship. These are procedures so risky that my hospital wouldn’t consider me qualified to do them despite my MD degree and anesthesiology residency, because I haven’t taken advanced training in interventional pain management.
What are we going to do to turn around this public perception that doctors are curt, mean, and unsympathetic? And that nurses are always better, kinder, and maybe even smarter? And can do everything doctors can do, just as well?
Some physicians believe that patients’ opinion of physicians can only be changed one encounter at a time. I hope this patient thinks better of physicians after meeting me, though the next encounter she has with a physician who hasn’t quite enough time and patience could certainly reverse her attitude.
Maybe, however, we need to take a cue from Madison Avenue and market ourselves better. The image and the brand are everything today. And many Americans, while they pay lip service to valuing education, hate to acknowledge that some people know more than others because they have studied harder and longer. Physicians are perceived as elitist; nurses as nurturing. The stereotypical TV physician is still an old white guy who’s probably a Republican, while nurses come from all ethnic groups and their unions support Democrats. Let’s face it: in this dichotomy, nurses are “cooler” and certainly easier to like.
So we need to change the brand. We don’t need to pretend that “Gray’s Anatomy” has done us any favors. Although the young doctors on that TV show certainly are a diverse group, their behavior isn’t what most of us would view as professional. But somehow, physicians need to demonstrate these truths to the public:
We are becoming as diverse as many other professions in America today, by gender, ethnicity, or any other measure.
The standard Wednesday afternoon off for the doctor to play golf ended sometime in the 1950s.
We do care about our patients. Often we wish we had more time to listen, but other patients need our time too.
We worked hard to gain the extensive education we have, and we take pride in using it to care for our patients.
Until Americans become convinced of these facts about their physicians, and like us just as much as they like nurses, we have more work to do.
Karen S. Sibert is an Associate Professor of Anesthesiology, Cedars-Sinai Medical Center. She blogs at A Penned Point .

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RegisteredNursing.org Staff Writers | Updated/Verified: May 6, 2022
Neonatal Intensive Care Unit (NICU) nursing is a field sub-specialty where nurses work with newborn infants who have a variety of medical ailments, such as premature congenital disabilities, cardiac malformations, dangerous infections, and other morphological or functional problems. Medical literature defines the first month of life as the neonatal period. NICU nursing typically encompasses care for infants with complications proximately after birth; however, that isn't to say that it excludes care for infants experiencing chronic long-term problems following their birth. NICU nurses will typically care for infants from the time of their birth until they're discharged from the hospital.
To become a neonatal intensive care nurse, you first must be a registered nurse (RN) with either an Associate's Degree in Nursing (ADN) or a Bachelor's of Science in Nursing (BSN) . Hospitals hiring for neonatal intensive care appointments will give priority to RNs who have obtained their BSN over those with only an ADN. Although certification is not always required for RNs to work in NICU settings, many NICU nurses must meet the requirement of having a minimum number of years of clinical experience in institutional contexts.
After obtaining an ADN or BSN, individuals are then eligible to sit for the National Council Licensure Exam (NCLEX-RN). Upon taking and passing the NCLEX-RN examination , individuals are subsequently able to apply for their registered nursing license.
The National Certification Corporation (NCC) requires the following credentials for individuals to be eligible to take the RNC-NIC examination specific to neonatal intensive care nursing:
Read more for further clarification on neonatal nurse certifications .
A day in the life of a NICU nurse is unpredictable, and can be both overwhelming and rewarding. At the start of the shift, you walk through secure doors to a locked unit. You’re required to first stop at the sink area to scrub your hands and arms from fingertips to elbows for a full minute with antiseptic, antimicrobial soap as if you are about to perform surgery. 
Most NICU assignments consist of one to three patients, depending on the acuity of the baby. You may have three “feeder growers” or one very ill baby on life support. Some days, you may find you are the admission nurse and start your day attending a very premature delivery. 
The NICU has a strict schedule for feedings and checking vital signs while minimizing the number of disruptions. NICU days are typically divided into three or four-hour periods, depending on “hands-on” care for the baby. Babies that are eating by mouth usually eat every three to four hours, whereas sicker babies or very premature infants receive less hands-on care to reduce overstimulation. All babies are continuously monitored in the NICU, and each baby is placed on a cardiorespiratory monitor to measure their heart rate and respiration. Other babies may require constant pulse ox monitoring, invasive blood pressure monitoring, and temperature or CO2 readings. 
Since more focused care is needed for acutely ill newborns, NICU nurses typically have a lower nurse-to-patient ratio than floor nurses. The number of babies a NICU nurse is responsible for can vary depending on state regulations as well as the facility. For example, mandatory nurse-to-patient ratio laws determine the maximum number of patients a nurse may care for at a given time. In California, for example, nurses in the neonatal care unit may only care for a maximum of two babies.
However, some facilities implement their staffing ratios based on acuity systems. NICUs classify patient acuity by “levels” usually 1-4. For example, neonates with more care needs (level 3 or 4) may be the only patient assigned to a NICU nurse. Intubated or post-op babies may even have two nurses assigned, depending on the case. Babies with less acute needs (i.e. “feeders and growers”) may be one of two or three patients per nurse.
Being that intensive care requires more attention and bedside care, nurses should be aware of their state’s ratio laws as well as their facility’s ratio standards. Asking for help and speaking up for unsafe assignments is essential in an intensive care area, especially with vulnerable newborns.
It takes a special type of person to face the day-to-day challenges of working in a NICU. One of the most significant challenges, especially in the higher-level NICUs, is caring for babies who are struggling to survive. Sometimes, even when the most cutting-edge technology is employed, babies may not survive. Nurses and NPs establish a relationship with not only the baby but the parents and family. When a baby dies, the grief and loss felt by nurses can be significant. Nurses must be able to provide comfort to families and seek comfort from their support systems as well.
Caring for critically-ill infants is also emotionally draining. The challenge of caregiver stress and burnout is also significant. Nurses may feel depressed, anxious, or irritable at home. Being able to identify caregiver burnout and finding healthy outlets for stress is crucial for the mental well-being of NICU nurses.
Alarm fatigue is another challenge. Nurses and NPs work long hours. NICUs have multiple alarms sounding to guide caregiver interventions. While the alarms are set up to keep patients safe, sometimes alarm fatigue places patients at risk. Over time, caregivers can become desensitized to sounding alarms, risking them to be overlooked, ignored, or missed. Many times, repetitive alarms lose the urgency to caregivers who hear them for hours at a time. Luckily, many facilities employ strategies to reduce alarm fatigue among caregivers.
NICU nurses will find employment in both privately owned as well as public hospitals. Once in a while, although infrequently, NICU nurses can be found working in home-health service settings or even as a part of medical emergency teams. Here is a list of the most common locations you will find NICU nurses:
Neonatal intensive care nurses typically take on the following duties:
The following describes the distinct levels of neonatal care and the kind of work involved at each level:
According to Payscale , RNs that work in the Neonatal Intensive Care Unit (NICU) make an average annual salary of $60,375, while Neonatal Nurse Practitioners make an average annual salary of $93,122. Individuals should be aware that salaries of NICU nurses and nurse practitioners can vary extensively depending on a wide variety of factors.
The demand for RNs is robust. The Bureau of Labor Statistics cites that RNs holding at least a Bachelor's of Science in Nursing (BSN) are more inclined to have better job prospects than those with an Associate's Degree in Nursing (ADN). Between 2012-2022, job growth for RNs in general is expected to grow by 19%.
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