Adult ICU RN interested in NICU

adventure_rn, MSN, NP · May 21, 2017

This question comes up pretty frequently on the NICU forum, so it may be helpful to look through the archives.

Everything you've said sounds about right. NICU has a steep learning curve, although your experience in the ICU should definitely be helpful. You'll probably feel like a new grad again, and that's ok (everybody does). You'll almost certainly complete a 'new to specialty' orientation that is very similar to new grad orientation, but perhaps slightly shorter since you have experience. It will probably be at least three to four months of orientation, although they may split it up into a low acuity portion and a high acuity portion. In that case, you may be on low acuity orientation for a couple of months, work independently with low acuity kids for a few months, then go back on high acuity orientation for a couple of months before you're totally finished. The purpose of split orientations is to allow you to get comfortable with 'normal-ish' newborn assessments and interventions before they give you the super sick kids.

The only thing I'd add is that unless you're working at a Level IV Children's Hospital with a separate 'intermediate care' step-down unit, Neonatal ICU is not always very 'intensive.' Unlike adult ICU, where most of your patients are truly critical care patients, many NICU kiddos are basically tiny, adorable, total care med-surg patients. You will have vents, drips, and art lines, but many of your patients will be stable, off respiratory support, just learning to eat and gain weight. I personally love the mix; if all of my kids were low acuity I'd get bored, and if they were all high acuity I'd get burnt out. However, if you thrive on true critical care nursing, you might be disappointed with the lower average acuity in the NICU.

Luckyyou, BSN, RN · May 21, 2017

The only thing I'd add is that unless you're working at a Level IV Children's Hospital with a separate 'intermediate care' step-down unit, Neonatal ICU is not always very 'intensive.' Unlike adult ICU, where most of your patients are truly critical care patients, many NICU kiddos are basically tiny, adorable, total care med-surg patients. You will have vents, drips, and art lines, but many of your patients will be stable, off respiratory support, just learning to eat and gain weight. I personally love the mix; if all of my kids were low acuity I'd get bored, and if they were all high acuity I'd get burnt out. However, if you thrive on true critical care nursing, you might be disappointed with the lower average acuity in the NICU.

I can't emphasize this enough. It's the reason I'm currently looking for options outside of the NICU. If you're looking for a true critical care environment, the NICU isn't it. Even my level 4 has a huge number of very low acuity patients.

guest769224 · May 21, 2017

However, if you thrive on true critical care nursing, you might be disappointed with the lower average acuity in the NICU.

I also agree with the above two posters about this.

Adult ICU experiences high acuity on a far more frequent basis than Level III and Level IV NICU's do.

I worked NICU for 2 years and did see very sick babies, but they are the exception. In NICU I hardly ever saw a shift where the nurse was so busy that they didn't have time to chart. In Adult ICU this happens fairly often.

However, NICU has so many other perks and charm to it that the trade off may be well worth it to you.

I will admit I miss the NICU a lot. There's a reason why NICU's have such low turnover rates.

ThePrincessBride, MSN, RN, NP · May 22, 2017

I work in a level 3 NICU and we can go weeks without a vent and months without drips. Our census usually consists of feeder-growers, kids on bubble/nasal cannula, NAS babies and the big kids acting up (low blood sugars, etc).

I wouldn't have a problem with it if I didn't want to become a NNP. I feel like the experience I'm getting isn't enough to prepare for advanced practice...it stinks.

vintage_RN, BSN, RN · May 24, 2017

My NICU has over 65 beds, I'd say at any given time less than 20 of those beds are critical care patients. I love critical care, but the reason I love NICU is like Guy in Babyland said...it's a nice mix as to not be totally overwhelmed OR bored all the time. Also, babies can turn on a dime - so although many of our patients may not be "truly" crtical care patients, our assessment and monitoring skills have to be stellar. Also it's nice to be in an ICU environment without necessarily having patients crashing all time time....eg. RTs at a moments notice, diagnostic tests and procedures generally being done right at the bedside (I work in a large level IV children's hospital) etc. My patients the majority of the time are preemies on CPAP, learning to eat and breathe...with some more critical ones thrown in there and some chronic ex-preemies thrown in there to. Keeps things exciting

essT · May 27, 2017

I made the transition from adult ICU to NICU about 2.5 years ago. Like someone already mentioned, there have been a number of similar threads on this topic, most of which I have responded to. If you have specific questions, feel free to PM me! In brief, moving from big people to little people was the best decision of my career -- difficult, but very worth it.

Penelope_Pitstop, BSN, RN · May 29, 2017

I've known a number of nurses to successfully make this transition and not one has looked back. They all went from a high acuity adult medical ICU (lots of post-cardiac arrest and severe septic shock) to a level III NICU that sounds much higher acuity-wise than the level IIIs mentioned here. Babies tend to be transferred to the local level IV only for very specific reasons - I want to say ECMO, therapeutic hypothermia and very specialized surgery. Lots of vented babies still.

kdkout, BSN, RN · Jun 3, 2017

I agree with all the above posts, although some NICUs are higher acuity than others, by far. Your other adjustment will be working very closely with stressed out parents. While I enjoy that the NICU is not full of constantly high acuity patients like when I did adult cardiac ICU years ago, I also find that working with

stressed out parents who "room in" 24/7 has it's own challenges. Every area of nursing has it's pros and cons. If the unit has good morale/a healthy culture, you'll be fine.

The other important factor as you age- your back will thank you for switching to 1-12 lb patients.

vintage_RN, BSN, RN · Jun 5, 2017

I agree with all the above posts, although some NICUs are higher acuity than others, by far. Your other adjustment will be working very closely with stressed out parents. While I enjoy that the NICU is not full of constantly high acuity patients like when I did adult cardiac ICU years ago, I also find that working with
stressed out parents who "room in" 24/7 has it's own challenges. Every area of nursing has it's pros and cons. If the unit has good morale/a healthy culture, you'll be fine.
The other important factor as you age- your back will thank you for switching to 1-12 lb patients.

I work in an older hospital, so our NICU is "pod style"....this means things get pretty crowded at times, there's next to no privacy and (sometimes thankfully)...no option for parents to "room in", although we do encourage them to be there as often as possible.

adventure_rn, MSN, NP · Jun 6, 2017

While I enjoy that the NICU is not full of constantly high acuity patients like when I did adult cardiac ICU years ago, I also find that working with
stressed out parents who "room in" 24/7 has it's own challenges.

Lol, I hear you, but I'll take stressed out parents who room in over stressed out grouchy adult frequent fliers who are mad about being NPO, or because you didn't have time to get them a glass of water :) Even though NICU parents can have their moments, most are genuinely appreciative that you're taking care of their little one.

MtGal · Jun 7, 2017

My first job out of nursing school was adult trauma ICU which I worked for 2 years and then I took a non hospital job working 3-4 days a month for the past 4 years when I started having kids so I could mostly stay home with them but also keep my license active. I decided to go back to the hospital but told myself I would hold out for a NICU position. I began applying for nicu jobs last October and finally got an interview and job offer last month. I start in a few weeks. I will let you know how it goes! :)