Help! ICU day shift to NICU night?

[Bjones94]

Hi everyone!

I am a new grad nurse that went straight into ICU starting last September. I started out on night shift and had a very hard time. I went onto the unit on my own during peak season and was very overwhelmed with being a new nurse combined with not adjusting to nights. Things started to slow down and I still was hating ICU, applying and interviewing to other jobs outside of the hospital and by chance a day shift position opened up and I took it. Now about 3 months into day shift I am a happier person, but I still don’t like ICU. I do not love adrenaline rushes or crashing patients. Walking into something very different every shift freaks me out. One day I have to psych patients that don’t need to be in ICU, the next I have two patients on the verge of coding and I can’t get ahold of a doctor.

I like routine. I can work well with critical patients as I consider myself being very detail oriented and organized. I like to know what I’m doing and focus on doing it well. I get a lot of anxiety before work. Sometimes sick to my stomach. I have called in sick due to anxiety. And now on day shift I get floated to med surg at least once a week. Also increasing my anxiety due to never knowing where I will be or what I’m doing.

A position has has opened up in NICU which seems fitting for my personality. Critical patients I can pay close attention to, but hone in on a smaller skill set. I see myself happy in NICU. But my few months on night shift were so tough I am not sure what’s the right thing for me.

Physical health on days, or mental health on nights where I can see myself happy?

ANY input would be so appreciated!

[Elizabeth777, BSN, RN]

Dude, NICU is not a place where you go for less anxiety. It's an intensive care unit and the skill set is not smaller, just the patients are. Why do you see yourself being happy there vs a traditional ICU? It's a fantastic place to work, but people either love it or hate it.

Yes, I have nights where I go in and have three feeder-growers, but there are shifts that I don't leave the room because I have a critical kid on HFOV and multiple gtts. Families are often there 24/7 when a baby is critical and they bring their own stressors. Plus, your skill set is not the same as what you have now. You would essentially be starting as a new grad. Think very hard about this before you decide to leap into a new scenario.

[Bjones94]

My apologies if it came across that I think NICU would be less acute or less stressful. For me personally it’s about finding joy in our work, which I believe may lift some of my stressors and anxieties.

I have found I don’t enjoy working with adults. Where I work I take care of a lot of older people whose kids refuse to change the code status and I am left pounding on a 90 year olds chest breaking their ribs. I don’t find joy and satisfaction in seeing end stage diseases every day. I don’t get excited about what surprise I’m going to walk into in the ICU. I get anxiety about what I don’t want to run in to that day. I dread the easy non critical patient that is cursing at me all day. I will take drips and vents over that any day. I am not afraid of acuity. I am afraid of wasting all of my hard work in nursing school on a unit where I am unhappy.

I just want to enjoy my job, and be happy to do it, even when it’s hard. I’m not looking for smooth sailing. I am more than willing to start from scratch if it means finding a place where I will be happy.

I only meant honing in on a smaller skill set because where I work the NICU is very small, and any very acute babies needing surgery, ecmo, cooling, etc are flown out.

I feel like my post maybe could use some re wording as I did not mean to make it seem like I am running to NICU to be lazy or for easier patients.

[Elizabeth777, BSN, RN]

Ahh, all right I understand. If you think that it would make you happy, then I suppose you'd have to try it. The issue I'm seeing, though, is that you've only been at your current job for less than a year. You'd have to come up with a good reason for why you're leaving in an interview.

[Bjones94]

Having someone I cared about die in an ICU setting in a very traumatic way took the interest out of it for me. I was interested in adult icu due to the complexity of all the different disease processes. My pain I feel for these people and their families takes away the interest in the physiology and dulls the fulfillment aspect of the job that many nurses come to work for.

And im not so sure that’s appropriate to say in an interview.

Also the night shift for many years in NICU aspect is a little daunting. But if it’s lifts this weight off my chest, it could be worth it.

[kp2016]

I’m a little concerned for you that you didn’t cope well with nightsift and the NICU job is also nights. I think you should look for an option C. Your current job isn’t a good fit for you but that doesn’t mean you should apply for another one that will likely also be a bad fit due to the schedule. Try and hang in there a little longer until you can find something on days. In terms of what to say at your interview the things you have said here are a great start.

[Bjones94]

10 hours ago, kp2016 said:

I’m a little concerned for you that you didn’t cope well with nightsift and the NICU job is also nights. I think you should look for an option C. Your current job isn’t a good fit for you but that doesn’t mean you should apply for another one that will likely also be a bad fit due to the schedule. Try and hang in there a little longer until you can find something on days. In terms of what to say at your interview the things you have said here are a great start.

I am so thankful for your input! Your option C is probably my best option. I just have to be patient and find it.

[PeakRN]

I would see if you can shadow in the NICU before you discount it.

The NICU is very different from other care areas, and in many ways is much less stressful.

There are plenty of kids who will be crashing or will have poor outcomes (especially those with diseases incompatible with life), however there isn't the same level of intervention as in the adult ICU. Most NICU babies are too small (at least the onse who would need it) for things like CRRT or ECMO. You certainly won't have a patient emergently getting a balloon pump or impella, you won't be cracking open a chest, and you wont be mass transfusing.

There certainly are some critical interventions, predominantly respirator related, but it isn't like an adult ICU or PICU train wreck.

The NICU is very detail oriented, to the point that it drives a lot of the PICU and adult ICU nurses a bit crazy. There are protocols on feeding, on managing antibiotics based on low long a line has been in, about being a bit insane about an oxygen above 94%, and a bunch else. The put away a lot of their kids in a box for two and a half hours at a time and put a blanket over it. They obsess about how many grams a kid has gain or lost every day. Not raising the legs on some of the kids when you change diapers (and barely moving them at all).

All of that level of detail is so that we can try to have good outcomes. All of that detail can prevent head bleeds, prevent ROP, produce good neuro outcomes, prevent or catch NEC early enough that it doesn't kill the kid...

The pace is definitely slower than the adult ICU, but mostly because that is how you actually produce good outcomes for those kids.

[Bjones94]

On 7/3/2019 at 4:39 PM, PeakRN said:

I would see if you can shadow in the NICU before you discount it.

The NICU is very different from other care areas, and in many ways is much less stressful.

There are plenty of kids who will be crashing or will have poor outcomes (especially those with diseases incompatible with life), however there isn't the same level of intervention as in the adult ICU. Most NICU babies are too small (at least the onse who would need it) for things like CRRT or ECMO. You certainly won't have a patient emergently getting a balloon pump or impella, you won't be cracking open a chest, and you wont be mass transfusing.

There certainly are some critical interventions, predominantly respirator related, but it isn't like an adult ICU or PICU train wreck.

The NICU is very detail oriented, to the point that it drives a lot of the PICU and adult ICU nurses a bit crazy. There are protocols on feeding, on managing antibiotics based on low long a line has been in, about being a bit insane about an oxygen above 94%, and a bunch else. The put away a lot of their kids in a box for two and a half hours at a time and put a blanket over it. They obsess about how many grams a kid has gain or lost every day. Not raising the legs on some of the kids when you change diapers (and barely moving them at all).

All of that level of detail is so that we can try to have good outcomes. All of that detail can prevent head bleeds, prevent ROP, produce good neuro outcomes, prevent or catch NEC early enough that it doesn't kill the kid...

The pace is definitely slower than the adult ICU, but mostly because that is how you actually produce good outcomes for those kids.

I appreciate your comment! You have given me a lot to think about, as well as communicated what I was feeling/thinking in regards to adult ICU and NICU.