At my nursing school pinning ceremony, the professor informed my graduating class that we would all become leaders. She gave her famous “oh the places you will go” speech as we all listened, and excitedly dreamed of our futures. In that moment, I don’t truly think I thought I would become a leader, innovator, or change maker in such a diverse and large field. Little did I know she was correct I would become a leader. Nurses are all leaders in a variety of ways.

A Typical Day as a NICU Manager

My day normally begins with a very lengthy to-do list. I enter the unit or my office and the organized chaos begins. My day is filled with meetings, completing tasks such as scheduling for 180 staff, managing time and attendance for 180 staff, rounding on patients, families, and staff—and much, much more. Often at the end of the day I look back at the to-do list, and I have accomplished none of the tasks that were high priority for the day.

Being flexible and adapting to the needs of the unit is a quality one must possess to become a nursing leader. Prioritizing tasks is helpful, but understanding that often priorities change depending on the needs of patients, families, and staff is how leading a large NICU is accomplished. Like the life of a preemie, the life of a NICU manager has many ups and downs.

Currently, as an organization we are working to obtain Magnet designation. Empowering nurses to be leaders, innovators, and change makers is very challenging. Recently when speaking with a physician, he compared NICU nurses to mother lions, and this comparison is fairly accurate. NICU nurses are advocates and the voice for the tiniest patients each and every day. NICU nurses are protective and territorial when caring for these tiny patients. They nurture them from 400-500 grams (and sometimes less) to discharge three to six months later. NICU nurses not only provide care for these tiny patients, but they also care for their parents/caregivers and are emotionally attached to these tiny humans and their families.

Convincing a NICU nurse to change a process or method that they have been using is often met with lots of resistance. Could this be generational, cultural, or learned? Possibly, but part of my job as a manager is working with the diverse, multidisciplinary team to provide quality, evidence-based care for all patients in the NICU. Finding a way to change the culture or resistance to improve practices is one of the hardest aspects of my job, and can be physically and emotionally just as draining as being a bedside nurse. I have found that listening to staff and families and asking for their input while providing the “why” behind change has become one of the greatest tools I have as a leader. Asking or empowering staff to take part in problem solving has also become a very useful skill that I am learning and getting better at each day. Becoming a NICU manager does not make a NICU nurse’s personality change. We simply protect different territories and advocate in different ways than before.

Being a NICU manager is a fine balancing act that I am still working to perfect. My inbox is always full, and just when I think I have it empty another problem, issue, or task is waiting. The NICU is a 24/7 operation that never stops, and rarely slows. Although I find it difficult to step away from the NICU at times or put down my electronic device that my email is constantly updating on, I have recently discovered that this pause makes me a better and more focused leader.

As a leader and in life I attempt to live each day, knowing not what tomorrow brings, but being optimistic that what I am doing today will impact positive change, and lead to innovations and improvements for future NICU patients and families. It is often said that it takes a village to rear children. It also takes a village to manage a NICU.

Jill Krause, MSN, RN

Jill Krause, MSN, RN, has 15 years of experience caring for NICU patients and families. She is currently the NICU/CTCU/MTCU patient care manager at the University of Chicago Medicine Comer Children’s Hospital in Chicago, Illinois.

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