Level II or Level IV??

  1. Hi everyone,

    I am in need of some advice. I am a new grad applying for positions at local hospitals in NICU.

    I may have an offer from a level II AND a level IV NICU. The more acute hospital is in a bad part of town and a longer commute but pays more and would give me more exposure to sicker patients. The level II hospital is much newer, less pay, and the babies are not as ill. In fact, they do not do any surgeries in house.

    Do you guys think starting out at a level II or a level IV would be better? Would my education suffer if I went for the level II? My heart says go for the less acute place, but my brain is scared I may be shying away from a great learning opportunity...HELP!

    Any and all opinions would be greatly appreciated!!!

    THANKS
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  2. 10 Comments

  3. by   suzanne4
    You have to weigh your options........which shift would you be working, same at either facility? A level IV as a new grad will be extremely stressful to you, it would depend on what types of kids that they would assign to you.........usually not those with the highest acuity.

    My suggestion would be to do a day at each facility, actually shadowing a staff nurse and see how you like it. You don't really see much when you only go on a tour for an hour or so. One will probably appeal more to you....
  4. by   mac23
    Think about your personal interests also when making your decision. Some people get very bored with feed and grow type babies and some people don't like the stress of a really sick baby. I personally enjoy them both. I started at a level 3 as a new grad and it was too much for me. Also have to mention that I was EXTREMELY shy and unsure of myself as a new grad and that and critical babies didn't mix. After about 6 months I went to a level 2 and loved every second of it but then felt like I could handle the sicker ones and wanted the challenge of taking care of them after I gained some confidence and had better mentors. For me, it was the best thing I could do. Unfortunatley I didn't know that until I was into it. The first hospital I was at was not a teaching hospital and hadn't had a new nurse(new grad) in probably 10 years. So that could have been part of the problem with that job. But I learned a lot and got a good foundation doing level 2; those babies can go from good to bad too. Also level 2's vary with the acuity of the baby.
    Now I've gone on to do NNP. Looking back I would have never thought I could do it. Just remember that nothing has to be forever. If you decide on one and hate it you can make a change. Think about your personality, what challenges you and weigh each option. LOTS of nurses are brand spanking new in a level 3 and do fine. Good luck. Let us know what you decide.
    As the previous poster said I also think if you can shadow or talk to the nurses from each place it can be helpful in making your decision.



    Quote from wahoowa
    Hi everyone,

    I am in need of some advice. I am a new grad applying for positions at local hospitals in NICU.

    I may have an offer from a level II AND a level IV NICU. The more acute hospital is in a bad part of town and a longer commute but pays more and would give me more exposure to sicker patients. The level II hospital is much newer, less pay, and the babies are not as ill. In fact, they do not do any surgeries in house.

    Do you guys think starting out at a level II or a level IV would be better? Would my education suffer if I went for the level II? My heart says go for the less acute place, but my brain is scared I may be shying away from a great learning opportunity...HELP!

    Any and all opinions would be greatly appreciated!!!

    THANKS
  5. by   wahoowa
    Well, one reason the level II position is appealing to me is that I will have the opportunity to attend high-risk deliveries and run down to the ER when they get a neonate. The level IV hospital does not have on-site births (it is a pediatric specialty hospital). I believe I will have similar shifts at both places, a 36 hour a week/12-hour/day-night rotation.

    I am scared that after a while, I may get bored at the level II hospital but like you said, it would not be forever and I would get to see a variety of babies there from really stable to not so stable.
  6. by   KRVRN
    Well, what about starting at the level II, and if you get bored or you want an added challenge you can always switch to the level IV hospital? I'd bet money that they'd absolutely be willing to hire an already-trained NICU nurse, even if it means putting you through more training to teach you the higher level stuff.

    If you start at the level II and then find that the stable babies that are starting to get sick and go downhill are the ones that really interest you and the plain ol' feeder growers are somewhat boring to you, then you know that you might like a change. And a level IV facility will still have a handful of feeder growers too, so you will always get a mix.

    And no, your education won't suffer!
    Last edit by KRVRN on Mar 19, '05 : Reason: typo
  7. by   jml
    As a NICU Nurse with 22 years experience ( 20 which were in a level 4 lung rescue center with ecmo ), I would HIGHLY recommend you obtain your training in the level 4, and get a few good years of xperience there.........later on you can switch jobs to a lower level if you wish. You would make yourself MUCH more marketable and sought after with a higher level of experience,therefore having greater options for future choices of jobs...........................After 20 years in the level 4 I relocated, worked as a perdiem in both a level 2 and level 3.I quit the level 2, as it was just too boring, very close to nbn work...........still work in the level 3, and even there I see new Grads. orienting........after being on staff for 1-2 years they have not seen the things you would see in a level 4..................4-6 months training in level 4 is probably worth 5 yrs. in a lower level unit, as you will see almost EVERYTHING possible in nicu..............the assessment skills you accrue are definately your most valuable assets, and this is the place to get them !!!!!!!!!!!!!!!!!!!!.
  8. by   Jolie
    Quote from jml
    As a NICU Nurse with 22 years experience ( 20 which were in a level 4 lung rescue center with ecmo ), I would HIGHLY recommend you obtain your training in the level 4, and get a few good years of xperience there.........later on you can switch jobs to a lower level if you wish. You would make yourself MUCH more marketable and sought after with a higher level of experience,therefore having greater options for future choices of jobs...........................After 20 years in the level 4 I relocated, worked as a perdiem in both a level 2 and level 3.I quit the level 2, as it was just too boring, very close to nbn work...........still work in the level 3, and even there I see new Grads. orienting........after being on staff for 1-2 years they have not seen the things you would see in a level 4..................4-6 months training in level 4 is probably worth 5 yrs. in a lower level unit, as you will see almost EVERYTHING possible in nicu..............the assessment skills you accrue are definately your most valuable assets, and this is the place to get them !!!!!!!!!!!!!!!!!!!!.
    I agree with jml. The learning experience in a Level IV unit just can't be duplicated. Spend 2 years there, and you will absolutely be able to handle anything and everything you will see anywhere else, and you will never be frightened or intimidated by sick babies, because it will all be "old hat" to you.

    I too love attending deliveries, and did miss that aspect of NICU nursing when I worked in a Children's Hospital. Perhaps once you are comfortable in your position, you could pick up a few shifts per diem in a community hospital where you would have the opportunity to do delivery room care.

    Best of luck to you whatever you choose.
  9. by   jml
    i forgot to mention earlier that even in some level 3-4 units, the rn may attend high risk deliveries, along with residents, fellows, and respiratory therapists to assist in evaluating and treating the infant in the d.r..(..i.e., assisting with intubation/ surfactant administration.)............
  10. by   LilPeanut
    My totally unprofessional opinion is to go with the latter advice and go to the lvl IV NICU. Those will be the best habits to pick up in your nursing. When you're brand new, it's a good time to learn the ropes of a new situation, it will be just as stressful learning in a lvl II NICU. And this way you'll be sure not to pick up any "bad" habits that you can get away with in a lower level nursery because the babies aren't as sick.
  11. by   mac23
    Just curious, what "bad" habits would you get away with in a lower level nursery? I know you know a higher level nursery does not mean all or most of the babies there are on death's bed. Level 2 type babies will be mixed in. She can learn good organizational skills and good assessment skills at a level 2. With all NICU babies, no matter which level they are considered, good assessment skills are essential. Sorry if I misunderstood what you are trying to say but I came from a level 2 (although the level 2 and the level 3
    +ecmo were in the same area it had 2 different staffs) as my story above explained and it did not hurt me one bit when I got to the more critical babies. NICU babies can go from stable level 2's to critical level 3's in a matter of minutes.


    Quote from LilPeanut
    My totally unprofessional opinion is to go with the latter advice and go to the lvl IV NICU. Those will be the best habits to pick up in your nursing. When you're brand new, it's a good time to learn the ropes of a new situation, it will be just as stressful learning in a lvl II NICU. And this way you'll be sure not to pick up any "bad" habits that you can get away with in a lower level nursery because the babies aren't as sick.
  12. by   LilPeanut
    That's why I put bad in quotes. They're not really bad, but just a different method of doing things. I'm just usually of the mind of doing the harder thing first and then if that doesn't work, take a step back, I find it harder to go from a more "relaxed" environment to a higher stress.

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