Start at a Level III or Level II?

  1. 1
    Hi everyone, I just graduated from nursing school back in May and am looking for my first RN job. NICU is the reason I went to nursing school, since I spent time in one myself after being born premature and heard so much from my parents about the NICU nurses growing up.

    I had my senior practicum at a level III NICU, but unfortunately they do not hire new grads. There are a few job openings in level II NICUs, but none in level III at the moment. Would it be wise to start at a level II and then move up to a level III in a year or two (assuming I'd even get the job)? I would think a level II would provide a good base of knowledge. Or if level III is ultimitely where I'd like to be, should I wait on a level III job?

    Also, if it matters, I would love at some point to do NICU flight nursing, not sure if a level II NICU would set me back with that.

    Thank you so much for any advice you can provide!
    twinkletoes53 likes this.
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  3. 6 Comments so far...

  4. 5
    A level 2 is better than med/surg or long months unemployed.
  5. 5
    Quote from UCAFblue
    Hi everyone, I just graduated from nursing school back in May and am looking for my first RN job. NICU is the reason I went to nursing school, since I spent time in one myself after being born premature and heard so much from my parents about the NICU nurses growing up.

    I had my senior practicum at a level III NICU, but unfortunately they do not hire new grads. There are a few job openings in level II NICUs, but none in level III at the moment. Would it be wise to start at a level II and then move up to a level III in a year or two (assuming I'd even get the job)? I would think a level II would provide a good base of knowledge. Or if level III is ultimately where I'd like to be, should I wait on a level III job?

    Also, if it matters, I would love at some point to do NICU flight nursing, not sure if a level II NICU would set me back with that.

    Thank you so much for any advice you can provide!
    I would definitely start working at a Level II NICU. You will get the basics of what neonatal nursing entails. You need a good background and experience working with infants who are less ill, so that you know what is "normal" behavior, vital signs, and activity patterns in a neonate who is stable, vs. going right in and starting to care for critical infants.
    Caring for critical infants is intense, labor-heavy, and can be exhausting. You are caring for sicker infants, and will not have time to study why certain procedures are done, drips started, care restricted in particular ways, or why certain medications are given. It is doing one task after another, quickly, while monitoring the infant's vital signs and how he is reacting to what is being done to him. Observing changes in his overall state, some of which may be small and seemingly insignificant, takes practice. You will get that practice and experience working in a Level II NICU. You will learn to care not just for your baby, but to offer support and guidance to his family as well.
    Remember, too, that babies in Level II NICUs may suddenly become sicker. As you gain experience and knowledge, it will help you to detect changes in a baby's condition earlier, so you can see how an infant reacts when he is first decompensating or getting sicker, & can act appropriately. You will learn why certain things are done to a neonate, vs. only learning a list of tasks associated with care.
    It would help you a lot to have an understanding of pathophysiology, anatomy & normal behaviors associated with a particular gestational age. You will learn time management skills, multi-tasking, and delegation. These are all skills that you will take with you throughout your career.
    You will need experience in a Level III NICU before applying for NICU flight training. Different hospitals have different requirements. In our hospital you needed a minimum of 2 years Level III nursing before applying to be a flight nurse.
    Good luck in your nursing career!
    notsosupernurse, newrnltc, UCAFblue, and 2 others like this.
  6. 3
    This should not even be a question :-P

    good luck
  7. 1
    Quote from twinkletoes53
    I would definitely start working at a Level II NICU. You will get the basics of what neonatal nursing entails. You need a good background and experience working with infants who are less ill, so that you know what is "normal" behavior, vital signs, and activity patterns in a neonate who is stable, vs. going right in and starting to care for critical infants.
    Caring for critical infants is intense, labor-heavy, and can be exhausting. You are caring for sicker infants, and will not have time to study why certain procedures are done, drips started, care restricted in particular ways, or why certain medications are given. It is doing one task after another, quickly, while monitoring the infant's vital signs and how he is reacting to what is being done to him. Observing changes in his overall state, some of which may be small and seemingly insignificant, takes practice. You will get that practice and experience working in a Level II NICU. You will learn to care not just for your baby, but to offer support and guidance to his family as well.
    Remember, too, that babies in Level II NICUs may suddenly become sicker. As you gain experience and knowledge, it will help you to detect changes in a baby's condition earlier, so you can see how an infant reacts when he is first decompensating or getting sicker, & can act appropriately. You will learn why certain things are done to a neonate, vs. only learning a list of tasks associated with care.
    It would help you a lot to have an understanding of pathophysiology, anatomy & normal behaviors associated with a particular gestational age. You will learn time management skills, multi-tasking, and delegation. These are all skills that you will take with you throughout your career.
    You will need experience in a Level III NICU before applying for NICU flight training. Different hospitals have different requirements. In our hospital you needed a minimum of 2 years Level III nursing before applying to be a flight nurse.
    Good luck in your nursing career!
    Wow, thanks for such a detailed answer!! You make some very valid points and it definitely sounds like a level II would provide great experience. I went ahead and applied to the job, so hopefully I can at least get an interview.

    And libran1984 and Boratz, RN you are both completely right!! A level II would certainly be a thousand times better than med/surg or unemployment. I'm not sure why I had any doubts about applying for it. Thank you all for pointing me in the right direction.
    twinkletoes53 likes this.
  8. 4
    Quote from Bortaz, RN
    A level 2 is better than med/surg or long months unemployed.
    Some things are worth emphasizing; this is one of them.
    fashionistaRN, newrnltc, UCAFblue, and 1 other like this.
  9. 1
    I had a similar dilemma in my ED choice. Start med-surg or hold out for a good ED job? It took 3 years of moving up the ED food chain but I ultimately landed at the pinnacle. Take what you can get at this point
    UCAFblue likes this.


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