Practice Tip of the Week | Early and Often: Navigating the NICU as a New Nurse

By Jada Jacquez, BSN, RN 
 

When I first began working in the Neonatal Intensive Care Unit (NICU), I quickly realized that nursing school had provided me with a strong foundation, but there was still so much to learn. The NICU is a highly specialized environment where nurses care for some of the most fragile patients in healthcare. Premature infants and newborns with complex medical conditions often require advanced respiratory support, specialized medications, nutritional management, and continuous monitoring. As a new nurse, I often found myself encountering situations that were unfamiliar or more complex than anything I had experienced during clinical rotations. Looking back on those early experiences, the most valuable practice tip I can offer to other nurses is simple: ask questions early and often.  

At the beginning of my NICU career, I sometimes hesitated to ask questions because I did not want to appear unprepared or inexperienced. Like many new nurses, I wanted to demonstrate competence and independence. However, I soon learned that nursing is not about knowing everything; it is about recognizing when you need additional information and seeking guidance to ensure safe patient care. In a critical care setting, assumptions can lead to mistakes, while asking questions can prevent errors and improve outcomes. The nurses and healthcare providers I worked alongside consistently encouraged open communication and reminded me that everyone, regardless of experience level, continues learning throughout their career.  

One experience in particular reinforced the importance of asking questions. I was caring for a premature infant who required respiratory support and frequent adjustments to the treatment plan throughout the shift. The infant’s oxygen requirements and respiratory status changed several times, leading the healthcare team to modify respiratory settings and closely monitor the baby’s response. While I understood the basic concepts behind respiratory support, I wanted to better understand the clinical reasoning behind each adjustment. Rather than simply carrying out the orders, I took the opportunity to ask the respiratory therapist and provider to explain their decision-making process. They walked me through the infant’s assessment findings, laboratory results, and the goals of each intervention. By the end of the shift, I had gained a much deeper understanding of neonatal respiratory management than I would have if I had remained silent. More importantly, I felt more confident in my ability to recognize changes in patient status and anticipate future interventions.  

Asking questions does more than expand clinical knowledge but also strengthens teamwork and communication. NICU care relies heavily on collaboration among nurses, physicians, respiratory therapists, pharmacists, dietitians, and other healthcare professionals. Each member of the team brings specialized expertise that contributes to patient care. When nurses ask questions and engage in discussions, they create opportunities for shared learning and improved collaboration. Open communication fosters a culture of safety where team members feel comfortable speaking up, sharing concerns, and seeking clarification when needed. This environment ultimately benefits both patients and families.  

Another reason asking questions is so important is that healthcare is constantly evolving. New evidence, technologies, medications, and treatment approaches continue to emerge. Even experienced nurses encounter unfamiliar situations and must seek additional information. Recognizing that learning is a lifelong process helps remove the stigma that some new nurses feel about asking for help. In reality, the nurses who ask thoughtful questions are often the ones most committed to providing safe, evidence-based care.  

Reflecting on my experiences in the NICU, I now view asking questions as one of the strongest indicators of professional growth. It demonstrates curiosity, accountability, and a commitment to patient safety. Every question asked is an opportunity to learn something new and improve future practice. For nurses entering the NICU or any critical care environment, my advice is to never be afraid to seek clarification or guidance. Whether the question involves a medication, procedure, assessment finding, or treatment plan, speaking up can make a meaningful difference in patient outcomes and personal development. Confidence does not come from pretending to know everything but from being willing to learn. By asking questions early and often, nurses can build knowledge, strengthen relationships with their healthcare team, and provide the highest quality care possible to their patients and families.  

REFERENCES

American Association of Critical-Care Nurses. (2023). AACN scope and standards for acute and critical care nursing practice. AACN.  

National Association of Neonatal Nurses. (2022). Neonatal nursing: Scope and standards of practice (3rd ed.). HealthCom Media.