Advice for Peds RN applying to NICU

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Specializes in Pediatrics.

Hello! I am seeking advice from some nurses ?

I am a pediatric RN thinking about applying to 2 different NICUs. I believe one is level 3 and one is level 4. I have been in pediatrics since I became a nurse 5 years ago. The first 2 years I worked on a general surgical/neuro/ortho floor at a children's hospital. For the last 3 years I've been working at a busy pediatrician's office. When I worked in the children's hospital we frequently got pulled to the NICU, and I loved it more than my own floor. I enjoyed the patients more and I also enjoyed the more structured environment. I felt like the NICU had more order and the regular children's floor was more chaotic. I highly considered switching to the NICU after 2 years of being there, but I was tired of night shift and that's why I left for a more regular, day time job. I felt like I have literally thought about the NICU daily since I left the hospital LOL. But these are my concerns... 

I worked in the NICU quite a bit, but since I floated I always took care of feeder growers. Sometimes they would have a few lines such as fluids or TPN & lipids, maybe CPAP, bili beds, but usually not too critical. I'm worried that the reason I enjoyed it so much is because I basically only took care of feeder growers. I have no clue if I would like the more critical patients or not. I also am unsure if I would be able to mentally handle a baby who passed away on my time clock. I think I would blame myself even if I knew it had nothing to do with me. I really miss a lot of the skills from the hospital, such as mickey buttons, tube feedings, jp drains, stringing fluids, etc. The only skill I don't really miss is starting IV's but I think thats mainly because it was always on toddlers who fought back. 

I unfortunately can lack confidence in myself sometimes and I tend to worry easily, so I know I'm my own worst enemy. But I desire to be the best nurse I can be and I'm a hard worker. I'm very detail oriented. I want to find somewhere that I will want to work for years and years. I am not one to hop around. 

With all that being said (sorry so long!!), any advice or thoughts? Thank you guys!

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Specializes in Pediatric CVICU, General Peds.

Hi! Any update on this?? I'm honestly in the same boat.

I've always wanted to do NICU since nursing school, but found myself in Peds CVICU for 2 years, then I got so burnt out I switched to outpatient peds, but still think about NICU daily! Wondering what I can do to strengthen my application or help make the switch?

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Specializes in NICU.
On 5/17/2021 at 10:43 AM, oklapedsRN said:

I tend to worry easily, so I know I'm my own worst enemy. But I desire to be the best nurse I can be and I'm a hard worker. I'm very detail oriented. I want to find somewhere that I will want to work for years and years.

These are main qualities of a good NICU nurse. NICU nurses tend to be OCD when it comes to their patients.

A baby passing away is not a frequent occurrence and is usually a result of congenital defect or prematurity (22-23 week gestation). I have only had 1 baby die under my care in the last 6 yrs (Excellent nursing care or pure luck of the assignment?).

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Specializes in Pediatrics.

Hello! Yes, I do have an update! I accepted a position in one of the NICUs in the city I live in! I am very excited about it and so thankful I decided to apply. I had no issue with having my last 3 years of experience being in a pediatrician's office. During my interview I just told them the truth - which was that I truly desired to work in the NICU and I thought about it on a daily basis since I left the children's hospital. And pretty much everything I said in my original post was discussed during the interview in some manner. I think being genuine and honest is the best route!

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Specializes in NICU.
1 hour ago, oklapedsRN said:

which was that I truly desired to work in the NICU

That is only the most important qualities that they are looking for. One of the first questions they ask you in an interview is "Why do you want to work in the NICU?"

1 hour ago, oklapedsRN said:

I accepted a position in one of the NICUs in the city I live in!

Welcome to the land of the little people. 

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Congrats to the OP on your new job!

On 6/22/2021 at 5:32 PM, tinyheartRN said:

I've always wanted to do NICU since nursing school, but found myself in Peds CVICU for 2 years, then I got so burnt out I switched to outpatient peds, but still think about NICU daily! Wondering what I can do to strengthen my application or help make the switch?

I've done NICU with a stint in the PCICU in the middle, so I can speak to that. Honestly, you probably don't have to do anything to strengthen your application--if NICUs in your area are hiring, just apply. Cardiac kids make a lot of NICU nurses very nervous, so they'd probably be happy to have you. I'm sure your assessment skills and comfort with codes are on point. The biggest roadblock is simply if the local NICUs aren't hiring (sometimes hiring slows down in the late Summer since they've just loaded up on new grads).

I think NICU can be a much better 'lifestyle specialty' than PCICU. You get a handful of super-sick kids, but the average acuity tends to be lower (in my experience). For every tiny half-pound, vented, critically-ill baby, you've got several stable, room-air feeder-growers just learning to eat. It's a good mix of stable and unstable kids, vs. cards with a bunch of codes, open chests, ECMO/VADs, super-sick hearts, etc.

Also, in NICU kids tend to start out sick and then get healthier and stronger; in heart failure, a lot of kids start out healthy and then get sicker and sicker until they get a new heart or die (or both). NICU tends to be a bit more uplifting in that sense. The majority of NICU nurses are lifers, whereas PCICU has pretty high burnout and turnover.

Just a note--NICU manages their kids in a vastly different way from PICU/PCICU/peds. Regular peds/PICU loves fluid resuscitation, cards love acid-base and electrolyte correction, and NICU loves caffeine. PCICU is very reactionary, whereas NICU is very laissez faire. If your baby's K+ is 2.9, they'll fix it in tomorrow's TPN (vs. PRN IV K+ supps). If your baby bradys to the 30s, we give them 15 seconds to self-resolve, then tap their foot (vs. starting chest compressions). We tolerate CO2s in the mid-50s and don't give bicarb unless our pH is sustained in the high 6s. We tolerate crits in the high 20s if the baby isn't symptomatic. NICU is notoriously very stingy with sedation vs. PICU.

I think that the transition is definitely doable, but be prepared to feel like a new grad again. Depending on where you work, it can also take a while to get onto day shift (since the turnover is so low).

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