Working with Neonatal Nurses – A Bird’s Eye View

By Sue Ludwig | 15 comments

By Sue Ludwig

Originally written for Donna Ranker on the occasion of her first retirement from the NICU

Neonatal nurses are a difficult group to describe. I have a bird’s eye view of them, working with them yet not being one of them.

I entered their world cautiously, knowing they would eat me for lunch if I so much as looked the wrong way. Forget that I had any knowledge or even a personality. I knew that first I must just exist in their world and do no harm for a very long time, and if that plan worked out, maybe I could start treating some patients. I respected their protectiveness. I couldn’t think of any group of patients in greater need of protection.

And slowly, they allowed me to be.

If you’ve never seen a NICU nurse work it’s quite amazing. They can bundle a baby as tight as any burrito in 3 seconds flat, especially if showing a new resident how to properly perform this task. Seemingly regardless of their age and/or eyesight they can start an I.V. in a vein that’s no wider than a thread or fishing line while blocking out all surrounding distractions.

And don’t kid yourself if you’re a friend of one of these nurses and you visit her with your new baby. You may think she’s just admiring his adorable face when really she’s trying to control her excitement about how good his scalp veins look in case he ever needs an I.V. in his noggin.

I’m telling you, they’re just not right.

They are meticulous about the state of the baby’s bedside and the baby himself, and are so anal that they typically revamp the entire area when they come on shift because the nurse before them wasn’t quite anal enough. This is all in the best interest of the baby of course, and for that nurse’s state of mind for the rest of the shift.

They have the ability to discern when a little 1-pound person just doesn’t seem like herself from a mile away. They will do everything in their power to convince the docs of this and will likely not let them leave for the day unless they get what they want for that baby.

NICU nurses have known forever that these babies feel pain, even though it was difficult to ‘prove’. They think about the babies on their days off, come in from home if they are dying. They provide a baby with lots of love one minute, and run to code another one the next.

They are expert at what they do.

Now that I’ve been working with them for well over a decade and they trust me not to do anything too stupid, I must say I understand them. This little world in the NICU is unique. It is at once a place of celebrating new life and the grasping for it. It has been noted to be a place of intense parental love or at times abandonment; parents sometimes lost in their own set of horrible circumstances. It is mostly happy. It is mostly positive. It can be devastating.

We tuck years of that pain into a place we pretend doesn’t exist in health care. We go home and kiss our children.

I can’t say enough about the dedication of this group of people. They make me laugh hysterically with the sarcasm and humor that comes with the territory. They stun me with the level of skill they take for granted and the patience with which they teach the unending line of new doctors, new nurses, and people like me.

It is an immense responsibility to dedicate your work to a place that never closes, which needs you for its smooth and competent running, where fragile babies living and dying can just be part of your day’s work. All of that for a six figure salary…………

Thank you to the NICU nurses, for your expertise, your example, and your friendship. May there be a place in heaven for you with a coffee pot, good Chinese food, and the perfect schedule!

15 comment to “Working with Neonatal Nurses – A Bird’s Eye View

  • suzanne leffler

    What an absolutely incredible accurate description! being a neonatal nurse for over 20 years i certainly agree with you 100% ! we don’t ever just walk away…we live,eat,sleep and yes …even dream neonatal nursing. OUR babies as we so fondly like to refer to them….are NEVER far from our thoughts and actions! i loved my job as a NICU nurse! <3 and I will be back at it because those babies are my heart and soul!

  • stephanie buganski

    Sue-what a wonderful story. I loved every word you wrote and oh so true. you are so observant and have such an insight into people. you truly capture the moments. I feel priviledged to have worked with you and learned from you.-take care-steph

  • Jane

    Wonderful story….. Can we reprint to use it for Neonatal nurses Day this month?

    • susan

      Hi Jane, Yes, you may reprint, however, we do ask that you keep all information and links in tact, if applicable and that you include an authors resource box, like the one below:

      Sue Ludwig, President and Founder of NANT is a practicing neonatal occupational therapist at University Hospital in Cincinnati. She is a sought after national speaker, consultant, writer and educator. Sue has published articles related to infant-driven feeding and developmental care in the NICU. She is also a published poet.

      Sue is a member of the American Occupational Therapy Association and an ex-officio member of the Education Provider Committee for the National Association of Neonatal Nurses.

      Sue lives in Ohio with her husband and two children.

  • Lisa

    I just came across this and love it! I am in nursing school now and a NICU nurse is what I want to be. I was in NICU for the first time last night on my clinical shift and I love watching how great the nurses are with the babies. It hits home to me because I had a preemie in NICU 16 years ago and that is what made me want to one day be a nurse. I want to be able to make sure all babies in the NICU feel love and comfort when their parents have to be away as I remember how hard it was to have to leave mine there but knew he was in good hands. I hope one day soon I too will join the world of being a NICU nurse!!

  • Sue Ludwig

    Lisa- this is great! Your experience will serve babies and families so well!

  • norma buhrts

    i love this article. i am a neonatal nurse in The Childrens Hospital in Southwest Florida. 25 years of experience. each day I work is more challenging than the previous one. We are a special breed of a nurse. only a NICU nurse knows. Norma Buhrts

  • Tammy Mahan

    I loved this the first time I read it and love it every time still. It is very accurate and always lets me laugh at our anal overprotectiveness! Thank you for seeing us as you do and thank you for teaching me so much and helping me become the NICU nurse I am today!

  • Sue


    Thanks for your comment. It means the world to me as do you (miss my UC family). Working with nurses has always been one of my favorite things about being an OT. I owe so much of what I know and do to great teachers like you.

  • Marie C. Taylor, RN

    Dear Sue,
    I just came upon this article and could not sum up being a NICU nurse and better. I’ve taken a brief hiatus to complete another degree and those babies are in my blood. I am looking forward to getting back in the NICU where I belong. Also, you have contributed to helping the NICU babies heal and thrive and taught us how to support those tiny lives.

  • Francesca

    Fantastic pieec of writing – i’ve been interested in the emotionality of NICU care since nursing in this unique world and your writing is wonderful to refer to… – brilliant. thanks for much…

  • Kim

    You nailed the NICU nurse in this article-you were right on! You are right about your initial fear-as a NICU nurse for 30 years-outsiders beware when monkeying around with our babies. I bet you were scared to enter the lions den. The only thing I would add to your article is waiting at the end with the coffee and Chinese food is lots of chocolate!

  • Susan A Cranmer RRT/NPS

    Sue, you nailed it. As a Respiratory Therapist, I have worked in two different NICUs. The faces may have changed but the nurses were the same. Highly skilled, fiercely protective and until they are certain you are good enough to take care of their babies, a bit scary. Once you have proven yourself, there’s not a better group to work with nor is there work that is more satisfying.

  • Sue Ludwig

    Kim- I agree- chocolate would be a great addition!

    And Susan- YES! They are an amazing group to work with. I love nothing more than fleeing moments of teamwork that maybe no one else ever sees, but that make our days more meaningful and the infants’ care incredible.

  • Sharon Nichols

    Thoroughly enjoyed this article!!! I too am an outsider with the NICU nurses. My back ground is Labor & Delivery, Mother/Baby, and Lactation. 🙂
    My question: Where are NICU nurses getting a six figure income??? No where in the south east. 🙁

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