What's the Difference?

[Neo_Nurse]

Hi All,

I am a new grad and I am thrilled at the fact that I have been offered a position at a level II/III NICU. I don't have any prior experience in NICU but I do have 2 years expereince (clinical placement) in peads.

I always thought that I would start my NICU career in a large paediatric teaching hospital in my city but when I saw the posting for the position I was offered I figured why not give it a shot? Now I am wondering (if I am offered the position at the teaching hospital) which one should I take?

The first hospial has a labour and delivery unit on site and is known as the high-risk pregnancy hospital. They mostly manage premature babies who tend to stay in the hospital for long periods of time (165 days is not unusual). There is more of a chance to bond with parents and become really involved with the care of the infant. Since its an in-born NICU, there is also the opportunity to attend deliveries. I am very excited about this. The orientation is 8 weeks in class, then 5 shifts on level II and then 2 months in level III. The good thing about this job is that nurses get to work both levels.

The second position at the teaching hospital has its benefits as well. Its a teaching hospital so they are really supportive of new grads and they have an extensive orientation program (6 months). This NICU is a level III/IV that mostly deals with cardiac defects, congenetial anaomolies, genetic defects, and surgeries. The babies can be as premature as 22 weeks and they are flown in from all over the world. The average lenght of stay is 10-12 days and unlike the other unit, there is less of a chance to get close with the family. Overall, the babies on this unit are really, really critical which means lots of stress but great learning opportunities.

So based on this information and all of your expereince, which one is the better choice? Based on your experience is it better to have babies stay for a long time or a shorter period of time? Please let me know that you all think. Your opinions are important to me!

Thanks!!

[Sweeper933]

I don't think there is a true "better choice". It really all depends on what you're looking for. My unit is a level III. We handle all ages of premature babies, and we do basic pediatric surgeries (PDA ligation, GI surgeries, some basic neuro...) Anything above and beyond that we send to the Children's Hospital. I love the level of care that my unit has. I can go weeks with just taking care of one baby each shift - they're that sick and that critical that having that one baby is more than enough to handle. I can also go weeks where all I have each shift are 2-3 feeder growers and I get to hold and bottle feed babies all night long. It's nice to have the opportunity to take care of some easier babies after having such critical babies the night before. It's also nice to be able to watch your primary go from this tiny 23 weeker to a healthy 4 or 5 month old. I love being able to form the relationship w/ my primaries and their families.

[fergus51]

I'd go with the first hospital. Children's hospitals that do all the wierd stuff are a great place to learn and all that, but they don't give you as much of the general experience. If you want to move around to other units and other hospitals, you're better off getting a more "normal" nicu experience.

It's actually what I did when I went into NICU. I've since worked in a Children's hospital and it was enjoyable, but I definitely feel I made the right choice in starting out where I did. That place gave me the foundation to travel with that the Children's hospital wouldn't have.

[Neo_Nurse]

This might be a dumb question but what are you doing for 8-12 hours that could keep you busy with one patient? How ciritical is critical? Are you literally standing over the bed-side assessing the infant every 10 minutes? I've always wondered about this...

[Sweeper933]

Let's see...

Giving numerous blood products (PRBCs, platlets...), starting doPamine, doButamine, and an epi drip, giving 3 different antibiotics on time, making sure you have enough IV access for all of this, probably coding the baby at some point, keeping track of all of the different ventilator setting changes (regular vent, HFOV, starting nitric...), suctioning... Charting all of this. Believe me, it doesn't take much...

[elizabells, BSN, RN]

Suctioning every ten minutes so the baby doesn't drown, restarting IVs, dealing with different consulting services and six consecutive phone calls telling you to do contradictory things, dealing with the family, retaping ETTs, road trips to radiology because they don't feel like doing a portable in the middle of the night, dealing with your podmate's kid who crashed when she went on break and is nowhere to be found, changing the ECMO oxygenator because it ate all your kid's platelets and her pltct is now 24, q30 minute nebulizer treatments, REdoing your labs because the lab lost/dropped them, doing a million DextroStix because all the stress has made your kid's blood sugar 300, fighting with the pharmacy, going back and forth to the Pyxis because the docs won't start a freaking sedation drip, trying to find the 12-lead because Cardiology won't believe that your post-op is in SVT just because her HR is 225, trying to get a doc to hang out at your bedside because an RN is unable to tell when a kid with rhythmic four extremity jerking motions coupled with VS changes is seizing, running from storage room to storage room to get supplies because the NA called in sick, fighting with Central Supply because yes, you really DO need that many syringe/IV pumps ...

[SteveNNP, MSN, NP]

You receive a postop open heart post transposition of the great arteries from the OR, connect to monitors, monitor chest tube drainage, connect to ventilator, draw q30min-1hr ABG/Lactates/lytes, transfuse multiple units of FFP/PRBCs/cryoprecipitate/platelets, medicate the kid frequently to keep him paralyzed and sedated. You monitor his 2 right atrial lines, AV pacer wires, etc. You get several stat ekgs when he goes into SVT for the third time, after vagaling him, suctioning, placing ice to the face, and several rounds of adenosine. You hang a procainiamide drip after cardioverting him twice to break his rhythm. You monitor hourly foley output, continuously calculate total fluid intake, output, collaborate with neonatology, cardiology and genetics. The kid suddenly shoots out 50ccs of blood out of his CT, and goes into an arrythmia again, so you assist with reopening his chest at the bedside, while making sure peds surgery has everything they need. You spend precious minutes on the phone wrestling with pharmacy trying to get stat meds, equipment depot to get your 7th syringe pump, and trying to update the dazed family. You escape for 5 minutes to empty your distended bladder, and miss two important phone calls, as well as the cardiology fellow. You then attempt to clean up the bloody mess that is your patient's bed, as well as the piles of crap left behind by everyone else. You report off to the oncoming RN, as you silently pray that the kid doesn't arrest during report. Then you come back to work the next day and do it all again, because it's what you love to do.... make a difference.

[Neo_Nurse]

Wow... SteveRN21..what level is your NICU?

[wensday, MSN, RN, APN, NP]

what are you doing for 8-12 hours that could keep you busy with one patient

Sometimes you don't even have any idea what you did, just that the shift has gone by in what seems like 10 minutes but it's dark again outside and you didn't get a break all day. Oh and the nearest doctor is either in stunned or sulking in silence cos you told them what to do or is that just me....

[llg, PhD, RN]

I'd recommend the Level II/III hospital for the first NICU experience. It will give you a more comprehensive foundation of the neonatal patient. Then, if you want the "super-intensive" environment later, you can step up to that.

If you start with the super-intensive environment, it might work out just fine -- but it also might be a little too intensive and you might get burned out fast if you are not quite ready for that.