Day shift ICU to night shift NICU? Please Help!

Lullabynurse, BSN, EMT-I · Jul 1, 2019

Hi,

I don't have much advice to give pertaining to day or night shift, but 2 things I can touch on:

1. I can relate to the anxiety and I just wanted to acknowledge that. I'm glad that you are persevering through the pain.

2. I precepted at a level 4 NICU. You need to know many skills and go through a lot of training. You also have to like babies, of course lol. Depending on how much experience you have, you may not be qualified since they often want a few years of experience. I'm not trying to discourage, just a few things you may think about. I didn't love the NICU because of how critical most of the babies were. I work in a children's hospital where the babies come after the NICU, and I really like it there.

adventure_rn, MSN, NP · Jul 2, 2019

This is a tough one. From the points in your post, I think NICU seems like it would be a very good fit.

I've done NICU (both Level III and Level IV) and pediatric cardiac ICU (which from my understanding mimics an adult ICU environment more closely). In my experience, NICU is far more predictable than typical ICU settings. It's a highly 'routine' specialty; you can plan your shift, and you can usually stick to the plan fairly closely. It's a great setting for people who are detail-oriented and organized, which you state that you are. Even the 'sickest' intubated kids are generally stable (or 'stably-unstable'). Outside of the delivery room, codes are exceedingly rare. This is in contrast to my cardiac PICU job, where every day I wonder if I'm going to be participating a code, and even the 'most stable' kid on the unit has the capacity to arrest. All that to say, I think you'd find the NICU to be far more routine and predictable than adult ICU, while still offering the detail-oriented ICU piece of knowing your patients really well.

That said, it's tough to know if nights will be a deal-breaker for you. I do think that you might have an easier time now that you've got some experience under your belt. Your first year as a nurse is tough, and adjusting to nights and 12-hour shifts on top of that can be brutal. The other tricky thing is that in NICU it can take much longer to go to day shift; NICUs have fairly low turnover, so it can be tough to build enough seniority to get to days. For instance, the last two NICUs where I worked had 2 and 3 year day shift wait lists. That may not be true in all NICUs, but it seems to be a bigger problem than in other units with higher turnover.

Here's my thought: you switched to days at your current job, and you're still unhappy. There isn't anything that would suggest you'll become any happier over time by staying in your current job. In contrast, I think you could be much happier in the NICU. Being in a setting that's a better fit might make working nights more tolerable, and it might be worth the sacrifice. In addition, working in the NICU might be worth the longer wait to go to day shift.

Here's something I'd also add which you may not have considered. First, I found the NICU to be a much more uplifting setting than peds cardiac ICU (and probably adult ICU). If you're in a Level III NICU (or even most Level IVs), deaths will be fairly uncommon; honestly, most deaths happen in the delivery room, and they never make it to the unit. In general, the kids tend to get better and go home; you get to watch their progression from start to finish, from delivery until discharge. The nature of disease progression in prematurity is that kids start out at their sickest, then get bigger and stronger until they leave. The is the exact opposite of most ICU settings; in adult ICUs (and PICUs), nobody leaves in a better state than they started in, which can be pretty traumatic to witness day in and day out.

In addition, I felt tremendously appreciated as a NICU nurse, far more so than I do in PICU (and probably more so than most adult ICU nurses). Families are so overwhelmed when their babies are admitted to the NICU, and they are extremely grateful when you can help them feel included in their child's care and put their mind at ease. Some of my NICU graduates' parents still send me cards and pictures on their kids' birthdays telling me how grateful they were for my nursing care. One thing I've found frustrating about my PICU job is that it is significantly harder (physically, mentally and emotionally) but I feel much less appreciated by the patients and their parents; I haven't been an adult ICU nurse, but I'd imagine it's a similar experience. As I said before, NICU kids tend to get better from their baseline; therefore, their families tend to be very appreciative. In contrast, most adult ICU and PICU patients are getting sicker or worse from their baseline; families are upset at watching the patient decline, and sometimes they take it out on the front-line staff.

We can't make the decision for you, but here's my two cents: if you were already feeling burnout in the ICU, then adding the stress of night shift on top of that could send you over the edge. But nights might feel more tolerable if you're in a job that you really enjoy.

Coffee Nurse, BSN, RN · Jul 13, 2019

Bear in mind that not every state has the level IV designation; in some places, level III is as high as it goes. It would behoove OP to do some digging and find out what the local unit is like. There's a flipside to the coin of everything adventure_rn mentioned -- while the majority of NICU patients improve from their baseline, it can be even more heartbreaking when a baby doing well takes a sudden turn for the worse. Similarly, while the majority of parents are very grateful and eager to be shown how to be involved in their baby's care, the ones who ignore education and insist that "I know my child best" (despite being brand new parents), or who are determined to "do everything" when it means thrashing a poor child who has no hope for a meaningful quality of life, are especially frustrating and difficult to deal with.

vintage_RN, BSN, RN · Jul 27, 2019

Not sure what level you work in @adventure_rn...I’m in a level 3 in Canada (tertiary centre, highest level with all the sickest babies of the region)...and we have a lot of codes, we’ve had at least one every shift this set alone! Lots of very sick babies. A baby died yesterday. Babies that get NEC, perf and need a bedside OR....this happens often in my unit. It’s pretty much always crazy. But I do agree that not every baby is critical like in an adult ICU, we do have lots of feeder growers. I would advise the OP to find out what level the NICU is so they can know what kind of acuity they’ll be dealing with.