Do you enjoy surgical babies?

llg, PhD, RN · Feb 5, 2004

I am an old NICU nurse who now does mostly administration and education -- just to tell you where I am coming from.

I think you have posed a very interesting question -- one that more people should think about as they choose a job. As with many questions posted on this bulletin board, there is no right answer. Eventually, you will simply have to make a choice based on what seems right for you at the present and then live with whatever consequence of that choice arise. That's all any of us can do.

Personally, I usually preferred the "cute little premies" over most of the surgical kids. However, those surgical kids often pose unusal, challenging problems that require more varied and sophisticated nursing skilld than do the typical premies -- and I am glad that I have had those experiences.

With a population of only premies (with some sepsis, meconium aspiration, and asphyxia thrown in), you tend to see the same problems over and over again. You settle into a routine with your care and that may make your transition to a staff nurse position a little easier. The children's hospital -- with its surgical cases and probably a lot of other interesting types of babies (genetic defects, rare metabolic syndromes, etc.) would offer a wider variety of experiences and the opportunity to grow further as a nurse.

If you choose to work in the less varied (and probably less sophistacated nursery), you MAY have an easier time of it at first. But if you stay there forever, your professional growth may be limited. When you go to NICU nursing conferences, read journals, etc. you will see things and think, "Gee, there is a whole lot to my speicialty that I have no experience with." You may start to feel that your hospital is a little less respected by the other NICU nurses you meet whose hospitals handle all types of babies. Will you be OK with that? If you are, then perhaps staying where you are might be the right thing for you.

In fact, I have often thought that if I ever go back to bedside nursing, a nice little NICU or even a Level II nursery without all the sub-specialty kids and political hassles of a big university teaching hospital (or children's hospital) might be my preference. I have "been there, done that" in the big sub-specialty NICU's -- and I am glad I did. Had I never worked in those places and worked with those more unusal sub-specialty kids and really gone "big time" into my profession, I would have regretted it. I would have always wondered about what I had missed and regretted not having done it all. But that's me: that's the kind of person I am. That's part of the reason I have my PhD. It's OK if you are not that kind of person and are different from me.

I would recommend looking closely at the two units, their emotional climates, their cultures, their orientation programs, their on-going educational opportunities -- and then choose the one that feels right in your gut. Give it a year or so and then re-evaluate your choice. If you have been a good employee (for whatever hospital you choose) you will be in a good position to switch if you decide you would like to try the other.

Good luck. Let us know what you decide.

llg

dawngloves, BSN, RN · Feb 5, 2004

Personally, I have avoided working at hospitals that do surgeries.

Just not into the GI thing that most of these preemies have or end up with. Wasn't real crazy about adult surgical pts either unless they were cardiac.

Jolie, BSN · Feb 5, 2004

Love 'em! For most of the reasons llg stated, especially the variety of skills their care requires.

You pose an interesting question that I never thought of as a new grad. Good luck to you in your job search!

iceNICUnurse · Feb 6, 2004

I really like the surgical kids. I just love to see them getting better in just a few days. It always amazes me how soon they recover and go home.

It is also a challange to recive the baby from OR and stabilise it, and I like that.

So for me, I would miss them if we didnt have them.

NICU Newbie · Feb 6, 2004

My head is swimming... ...I don't know what I want to do. I applied at the children's hospital. I figured that if they don't want to hire me, this won't be an issue. If they DO, I will have to do some soul searching. I am a little worried that in such a large unit, the teamwork will be lacking, or that I won't be treated as well. I don't wnat to end up in a job where I am wondering "what if" all the time. I also don't want to feel inadequate.

llg, PhD, RN · Feb 6, 2004

I'll be going out of town for the next week. So, I won't be able to follow any action on this thread for a while.

But remember, NICU newbie, whatever you decide ... It doesn't have to be forever. Once you have given the job a chance, you will be free to change your mind ... and that's OK.

Good luck,

llg

Gompers, BSN, RN · Feb 7, 2004

For a first job, especially, I think it's more important to go where the atmosphere seems more supportive. You can always leave later if you want a different population, but that first year or two of nursing is so vital to your emotional transition into nursing. If it's not a nice place to work, you might burn out. Find out which unit has the lowest turnover rate, and if possible tour the unit and get a feel for the climate.

iceNICUnurse made a great point. I love recieving a baby post-op and feel that this is when my skills are really put to the test. For those who haven't worked in NICU - understand that neonates usually don't go to the recovery room. As soon as the surgery is over, you come to get the baby from the OR and all the post-op care is done in the NICU. Sometimes it's just a matter of monitoring a baby after a minor surgery who is already extubated and just slowly waking up from all the drugs. Other times, kids are in full-blown shock and it is just absolutely crazy. I once came onto my shift to pick up my primary baby from gut surgery - it took us three hours to get a blood pressure on him and when we did it was 14/9. FOURTEEN OVER NINE. But you know, I started out with a sheet-white shocky baby, and by the end of my shift (multiple transfusions, meds, drips, vent changes, etc. later) I left a pink, stable baby with a BP of 50/30. Yes, he was still critical, but in my 12 hours I actually saw the wonders of modern medicine at work and felt that I actually helped save a life.

One other thing - with a children's hospital you will lose out on going to high-risk deliveries and doing newborn recuscitations. So unless you can find a hospital that has both OB and peds surgery, you will have to balance this aspect of NICU nursing as well.

GOOD LUCK!!!!

fergus51 · Feb 7, 2004

I guess I am in the minority, but I really don't feel that surgical babies are all that exciting or anything. To me, it's the intensive care that is exciting and you get that on any sick baby, whether they are surgical or not. Seeing full blown shock is just as nuts on a non-surgical baby:)

NICU Newbie · Feb 7, 2004

Great points. The NICU where I am doing my practicum (some call it management) has a lot of experienced staff, and the few times I did a rotation at the children's hospital, I noticed they had a LOT of young staff. I also wonder if being at the smaller NICU is better for my new grad orientation--there will only be a couple of new nurses orienting, versus 10 or more at the children's hospital. I don't want to get lost in the stuffle.

Also, but the time I graduate, I will have spent 24 hours a week for 3 months at the hospital where I am now. I think my transition into the RN role would be easier--I will know the charting, the protocol, the staff, the docs. I would know exactly what I was getting into, versus it being a "starting from square one" situation.

UGH! But I am soooooo interested in all of the interesting cases that a surgical hospital provides, and if I decide in a few years I want to go the NNP route, I would be in a better place clinically. I also don't want to be in a job where I am kicking myself every day for not taking the risk of trying something different and very possibly more challenging.

Thanks to everyone for letting me use you as a sounding board. It is really helping me work through it all!

At least this is taking my mind off preparing for boards!

Jolie, BSN · Feb 7, 2004

Another point to consider: While the Children's hospital may afforf you the experience of caring for surgical babies, you will (most likely) trade off the option of attending deliveries and caring for babies in the immediate newborn period.

In my first job, I worked in a Level III unit in a major teaching/referral center. We had the best of all worlds: preemies, surgical babies, open hearts, and delivery room care. I then went to a Children's hospital, and enjoyed many aspects of the unit, but sorely missed having the opportunity of attending deliveries. There is just something about being present to witness the miracle of birth, then have the privilege of being the first person to assess and care for a newborn. Much like a detective, you are collecting clues and forming an impression as to the baby's health and well-being, then acting on that impression. I found that I missed that when all of our patients came transported to us with their problems largely sorted out.

Gompers, BSN, RN · Feb 7, 2004

NICU Newbie - I was also a student in the NICU where I work, doing 160 hours there with a preceptor before graduation. It definitely made my transition into working there easier, because it felt like I had already gone through orientation. There is so much stress once you start your first job, so really anything to make you more comfortable is a big help. Plus, you already know what the unit is like, and if the nurses there are happy or not. But your experience will also help you if you go to the children's hospital as well. GOOD LUCK!