NICU Nurse Needs Advice

[southeRNsally]

Hi all,

I moved to IL 2 years ago and began my career as the charge nurse on a pediatric psychiatric unit. My only credential for a job: that I worked with children. But, I found myself missing the medical aspect of the profession. So, a year after I was hired in, I switched jobs to a small Level 2B SCN (special care nursery) working days (at a very small catholic community hospital).

This job was all I had ever dreamed of (I worked in the infant room of a daycare with both special needs and well infants ranging from 5wks-12months while in nursing school).

Working as an RN, I love caring for the well infants, the mildly ill infants, and have really grown to love caring for the acutely ill infants. I became certified in NRP (neonatal resuscitation), S.T.A.B.L.E. (certification for transfer to a Level 3 NICU for critically ill infants), and as a CLC (certified lactation counselor). Lately I have found that I long to get into the ambulance with the infants and continue caring for them.

At my current facility, we resuscitate (if needed) the infants and continue to stabilize them until the transferring facility arrives. This includes: phototherapy, NG/OG insertion, resuscitation, intubation, UAC/UVC lines, starting periph IVs (kind of rare and I am not as skilled as I'd like to be in this), drawing/interpreting labs, inerpreting ABGs/CBGs and responding accordingly (with HCO3 etc), hypoglycemia tx, thermoregulation, premature infant care, RDS care, care of infants w seizures. But if the infant needs any sort of surgery, care from a specialist, or oxygen for more than 6 hours, he/she has to be transferred.

My question: As I have only been here a year, do you recommend I stay and gain more experience or try for a position with a level 3 NICU?? (I haven't even thought about it until now as I have my ADN ..BUT FINALLY graduate with my BSN May 3rd. (WOOT!) )

My concern: My current facility only employs 2 SCN nurses a day and there have been many days that I have been alone with ZERO support with a critically ill infant that I have to transfer. And, in regards to support and patient safety, I don't feel it... especially when I'm the only SCN nurse on staff. What if I can't get a stick? Guess we'll put in a UA/UV line. I also am frequently floated to the Mother/Baby unit and get a pt assignment of 5 couplets. Did I mention that I hate taking care of adults??! Recently they've been staffing the SCN nurses in MB.

I'm just not sure what to do at this point. Stay and gain more experience or start looking at level 3s since I grauduate with my BSN in May??

Thanks for reading and thanks in advance for the advice :)

(Side note: I'm 25 if it makes any difference)

[Fall.out.nerd]

You could also try a level 2C NICU because they will have higher acuity babies (vents, CPAP for short term) gain that experience then do your level 3. I'm just starting the level 3 course and I'm super blessed that I have experience so I understand more what's being said

[Jory, MSN, APRN, CNM]

I started working straight out of school in a Level III unit, so it can be done.

However, I can tell you that maintaining those infants in a Level III is a major difference from simply stabilizing and transferring.

So if your question is can you make the transition? Absolutely. You have already seen enough to where it's just a learning curve. The only reason that you may want to go to a Level II NICU with a higher acuity as the poster above suggested, is to see if you would really like it or not.

However, I do find it a bit shocking that they are having the nurses interpret the blood gas results and making decisions regarding what to do next. We NEVER do that in my facility. All blood gas results have to be run by a NNP, Resident or the Neonatologist...no matter how small the setting change. Obviously, the only changes we make is changes to the FiO2....nothing else. To administer any drugs (HCO3) is dangerous to be given under a protocol.