Best NICU for a new grad?

[chickapin]

Hi there. I'm graduating with my BSN in December and I've really been leaning towards the NICU for quite a while, though I'm also starting to get curious about PICU. Anyway, I'm lucky in that I live in a metropolitan area with several different hospitals with level II and level III NICU's.

I applied almost 2 months ago to the NICU at the free-standing children's hospital in my area (the internship program said to apply after Aug. 1st) and have yet to hear back from them, despite their constant advertising of their internship programs and open houses for new grads. I also applied to a large non-profit hospital system and was contacted the following day. I've since had a phone interview and the managers of 2 different NICUs are supposed to be contacting me within a few days. I was also given the number to call the recruiter at another hospital a little further away to talk with her about their programs, and there's also another hospital I haven't applied to yet, but possibly will in the future.

So the NICU that hasn't called me yet is a 60+ bed level III in a teaching hospital. The other level III I've applied to has 10 beds (and is only a couple of years old), and the other NICU is a level II, not sure how many beds. And the one's I've not applied to yet are both level III.

So, originally I was really desiring to work at the big level III at the children's hospital with internship programs. But I've since heard some not so great things about the hospital from current employees. The pay is the lowest in the area and they have poor nurse retention.

The other hospitals I've applied to are in a great system that allows transfers throughout the system. They pay the highest in the area and are Magnet hospitals with high retention.

So! Basically, I'm just wondering if I were to get hired at one of the smaller NICUs, would I be able to get a lot of experience there? I'm not sure how many beds the level II has, but I'm pretty sure it's more than 10. I want a place where I get a lot of experience, but also a hospital I can be happy with. Is 10 beds really small for a level III NICU? What are the benefits/drawbacks for starting at a level III v. level II?

I'll be doing my preceptorship in a month in the 60+ bed NICU so I know I'll have a better idea of things then, but right now I don't think that hospital is my first choice anymore. Ok, any insight on this would be great! Thanks!

[MA Nurse]

I have some experience with what you're asking about. I was in a level 3 NICU for 16 years that was about 40 beds. I transferred to a level 3 NICU that has a max of 22 beds. I left my old job because I wanted a more flexible schedule. After about a year at my new job, I'm finding the unit to be very slow. We've only been getting half of our usual census!

If there's one vent in the unit the RT's and nurses get excited to see a busy baby!

I highly DO NOT recommend starting in a small NICU. If your goal is to see a lot of different babies with different problems, you will not get that experience in a small unit. You will also run the risk of getting cancelled for your shift if they are over-staffed...that's if your hospital cancels nurses (some don't). So you might be out of work! Some new grads don't realize that is a possibility, esp. when you have low seniority.

I would go for the bigger teaching hospitals, even if staffing is an issue...most hospitals have that problem anyway. You will learn a lot more and not get bored like I am.

Or, if PICU interests you, i would look into that too.

Hope I've helped.

[RainDreamer, BSN, RN]

10 beds does seem awfully small, and I just wonder if they even hire new grads into the NICU, and if they do I can't imagine they have a need to hire that many. So that's one thing to keep in mind there.

I did my preceptorship in a little level II NICU, then got my first job working in a well-baby nursery for 5-6 months, then moved onto a big level III NICU.

Starting at a level II wouldn't be too bad, but only if you end up staying for a short time. I think it would be hard to start at a level II, work there for a year or more and then move onto a level III, as you'd almost be like a new grad again. Whereas if you start in a level III and get experience, then you'll be able to work at pretty much ANY kind of NICU, you'll be more expendable.

Whether you chose level II or level III though, I agree with the above poster in that you definitely do NOT want to start as a new grad in a small NICU. Go for the large NICUs, whether it be level II (but again, don't stay in the level II for too long), or a level III.

Good luck to you!

[chickapin]

Thanks...yeah you're pretty much telling me what I was thinking. Sigh...well I'm going to call the recruiter at one of the other hospitals I've not applied to yet. Everything I've heard says they won't hire new grads into the units, but it can't hurt to ask. At least the recruiter for a different hospital in the system said she had never heard that, and she was the one to give me the name and number for that recruiter, so I'll see what she says. I'm not writing off the hospital w/ the 60+ bed NICU yet, but I do really wish I could get a good position in one of the other hospitals.

[RNDreamer]

I'm confused, and curious...which has the sicker babies? level 2 or 3, and why not stay in level 2...from your post, my understanding is that level 3 has the sickest babies (in comparison to levels 1 and 2) and the reason not to stay in L2 would be because of the lack in variety of sick babies....am I right? Please explain, I'm not a nurse yet. Thanks!

Starting at a level II wouldn't be too bad, but only if you end up staying for a short time. I think it would be hard to start at a level II, work there for a year or more and then move onto a level III, as you'd almost be like a new grad again. Whereas if you start in a level III and get experience, then you'll be able to work at pretty much ANY kind of NICU, you'll be more expendable.

[RainDreamer, BSN, RN]

I'm confused, and curious...which has the sicker babies? level 2 or 3, and why not stay in level 2...from your post, my understanding is that level 3 has the sickest babies (in comparison to levels 1 and 2) and the reason not to stay in L2 would be because of the lack in variety of sick babies....am I right? Please explain, I'm not a nurse yet. Thanks!

You're right, level III has the sicker babies.

I'm just saying, and this is just solely my opinion and what would have worked for me, that it would be fine to start in a level II to get some basic experience, but not to stay for too long. If you get comfortable in a level II, stay there for a few years, then move onto a level III, you'd have to pretty much start as a new grad and go through the whole orientation again.

Whereas, if you start in a level III, you see a lot more stuff. You see sicker babies, more variety of diagnoses, acquire more skills, etc. Once you get all that level III experience, then you could easily go work in any level II.

Does that make sense?

Don't get me wrong, I love the level II kids, and I could definitely see myself going and working in a level II NICU someday, as the level III stresses me out at times. But for me, I feel like I need to get a few more years in a level III before I do that.

I hope I'm making some sense, or at least someone knows what the heck I'm talking about lol.

[RNDreamer]

AHHH! I understand. This is something that I definitely need to look into and think about when job searching. Thank you for taking the time to answer my questions.

You're right, level III has the sicker babies.

I'm just saying, and this is just solely my opinion and what would have worked for me, that it would be fine to start in a level II to get some basic experience, but not to stay for too long. If you get comfortable in a level II, stay there for a few years, then move onto a level III, you'd have to pretty much start as a new grad and go through the whole orientation again.

Whereas, if you start in a level III, you see a lot more stuff. You see sicker babies, more variety of diagnoses, acquire more skills, etc. Once you get all that level III experience, then you could easily go work in any level II.

Does that make sense?

Don't get me wrong, I love the level II kids, and I could definitely see myself going and working in a level II NICU someday, as the level III stresses me out at times. But for me, I feel like I need to get a few more years in a level III before I do that.

I hope I'm making some sense, or at least someone knows what the heck I'm talking about lol.

[elizabells, BSN, RN]

I went straight from school into a 60+ bed level III, and I wouldn't have it any other way - but that's just because of the kinds of babies I like to take care of. I'm much, much happier with ECMO or an oscillator than trying to teach a pokey preemie how to eat. Some people love the interaction with families that chronic kids give them. So I'd say try to get into a level III so you can find your niche. If it turns out you love the feeders and preemies and not so much the really acute kids, you can go to a level II.