Delivery hospital vs. Children's Hospital NICU

[marmaduke]

Hi,

I am a senior nursing student in Atlanta and am picking my preferences for my role transition 170-hour internship with a nurse preceptor this summer. I selected NICU as my top choice because I am interested in working in a NICU after I graduate in August.

The clinical coordinator told me that there are 2 spots available for students in a Level III Children's Hospital NICU (very good children's hospitals, one is Surgical, one is Med-Surg with ECMO) and also 2 spots in a Level III delivery hospital. I have previously had clinical in a delivery hospital NICU and shadowed in a Children's Hospital NICU, each for one day, and found them both interesting. I am not sure which one to pick. Would an experience in a surgical NICU make me more marketable for other pediatric/ICU positions (in case I can't find a NICU job), or look better for all NICUs because it's higher acuity? However, the delivery NICU would also allow me to see deliveries (which I enjoyed in my maternity rotation). I spoke to my professor who worked in a delivery hospital NICU about this decision, and she recommended the delivery NICU, because she said you get to see what normal is, and what "healthy" preterm babies are, and can recognize then when a baby is getting sick. But she also said that if I might be interested in going into the PICU, then the Children's Hospital NICU might be a good option.

I really keep going back and forth on this, and have to make a decision by the end of this week. Any input from NICU nurses about what would make me more marketable/would give me a better experience?

Thanks!!

[babyNP., APRN]

I am in NNP school and initially struggled a bit during my clinical rotation with the delivery room piece in that I've only worked at a children's hospital NICU with no deliveries. However, as time went on in my clinical rotation, I realized that the nurses did not have the breadth of knowledge that I had. Working at a children's hospital NICU means that you are usually working at a teaching facility where rounds is time for learning and you will learn a lot and develop excellent critical thinking skills. You will develop critical thinking skills at any NICU, of course, but it's a different experience in a Level IV NICU.

I'm still not up to speed on everything deliveries, but now seeing both sides of the pieces, I'm more grateful to have my nursing experience with very sick infants with multiple problems. It has made school a lot easier and helps "put things together." You will also see more ICU action in a children's hospital as far as managing ventilators, oscillators, pressors, nitric, ECMO, etc etc and that will help you if you wanted to go into PICU or peds CICU or even adult ICU.

The best of both worlds is to work at a Level IV that does deliveries, but these are few and far between.

I guess my question would be for you is: what are your ultimate goals? You should make a decision based on that, for sure. And in all honesty, I don't think you can make a "wrong" decision here. Working in any NICU is better than not working in one.

[zeus&lincoln]

I work in a level 3 NICU that is a children's hospital that is attached to a regular hospital so we do get deliveries... lots and lots of deliveries!! I personally love stabilizing and assessing the neonate immediately after birth. So, I would ordinarily recommend working in a NICU with deliveries. However, I can't imagine as a student that my hospital would let you handle a lot of the assessment/stabilization of the neonate from a delivery. You'd most likely be working with "stable" vents, osc, jets and drips. All of those are amazing learning opportunities as these kids can go from stable to sick as snot in no time flat.

However, my thinking of why they wouldn't allow you to help with deliveries is because first of all you would not have completed NRP and if you have, you haven't had the experience to back up your knowledge of NRP and secondly it is extremely chaotic even with experienced nurses, RRTs, neos ad NNPs all trying to do their part to stabilize the kiddo. So while stabilizing a 33 weeker may leave time for teaching and explanation of what the medical staff is doing, stabilizing a 24 weeker that has to be intubated, surfed, assessed, medicated, etc. will not leave time for any of that.

In my hospital we do everything inducing surgical patients but ECMO although we are getting ECMO within the next year. I agree with the PP, any NICU experience is better than none at all. Also, even if they don't allow you to do too much, just the experience alone will be well worth t. I do caution you to make sure you really want NICU because most of the skills are not transferable to other units. I couldn't imagine working in any other unit but I do know some people hate it in NICU

[rnkaytee]

I've worked both and my first instinct was to tell you to go for the Children's (non-delivery) hospital. I do LOVE deliveries and the initial stabilization but I think you'll see more/do more for the same above reasons.