How Can I Preserve the High Acuity Thrills of NICU Nursing While Finding Better Work-Life Balance?

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Hi! I've been a NICU nurse for 3/4 years and am looking for some career advice. I love my job in the level 3 NICU. Moreover, I love the high acuity. But honesty, the high acuity is not everyday. Sometimes it can feel a lot like babysitting which is totally draining.

My other issue with my job is of course the hours. To be full time in Ontario, you have to work a split days/nights schedule. More specifically 2 day shifts, 2 night shifts and then having 5 days off. I've been casual for while now, picking up mostly day shifts full time, which works! until it doesn't...there is not always shift certainty and not having vacations/ sick days sucks.

Not to mention that missing out of premium rates. It's really not a perfect solution. When I reflect back on if the the DDNN schedule was 'that bad' I think it was actually OK, but I was exhausted all the time on my days off. So, was it really OK? I'm starting to think my time at the bedside is running out and ill eventually need a full time days positions somewhere. I'm worried I'll miss what keeps me at the bedside- the high acuity.

Sometimes I really do love the chaos of it. The real critical thinking portion fills my cup. I love using clinical skills- starting IV, mixing meds, using my hands and my brain. Any ideas what a good next move could be? What nursing position out there lets me do the things I love, while having better work/life balance? Any thoughts? words of advice?

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Specializes in Tele, ICU, Staff Development.

Oh, my goodness. You're perfectly capturing the dilemma of the nurse at the bedside who is at a crossroads job-wise. That's completely normal after a few years.

It's commendable that you've identified the aspects you love about your current position and your challenges. Look at potential next steps to balance your desire for high-acuity work with improved work-life balance.

Rotating Schedule

First, I can't say anything without addressing the DDNN schedule. Two days on, two nights on, and five days off is brutal. They hook you in with the five days off, but they're either recovery days or dreading-going-back-to-work days. Your first day off is either sleeping or sleepwalking. The worst thing for your body and being is rotating day to night. It's a schedule that plays havoc with your circadian rhythms.

I look back at pictures of myself when I was working a similar schedule. I thought I was fine, but the photos show me tired and washed out. I was terrified of making a mistake when on the night shift. It was also when I once came home from the grocery store and put the eggs away in the freezer—shame on managers who work their nurses on a permanent rotating schedule. There's no reason for it.

Being casual and not having benefits is not a long-term solution, as it leaves you at the mercy of the facility's needs and without any control.

High-acuity addiction

Working in high-acuity settings with excitement and chaos can be both fulfilling and addictive. The challenge of saving lives through critical thinking and emotionally bonding with new parents can be highly rewarding. However, there are also periods of clock-watching tedium and boredom when things are slow (the s-word). Despite these ups and downs, walking away from such a fulfilling job can be challenging.

Options

  • Advance your education. Consider pursuing further education or certifications that could open up new opportunities. For example, you might consider becoming a neonatal nurse practitioner (NNP), which would allow you to remain in the NICU setting but take on a more autonomous role with increased responsibilities and likely more regular hours.
  • Transfer to a different unit. While you enjoy the high acuity of the NICU, there may be other units within the hospital or even in different healthcare settings that offer similarly challenging work but with more predictable hours. For instance, critical care units or emergency departments could provide the adrenaline rush and clinical challenges you seek while offering more scheduling flexibility.
  • Explore home health or case management. These roles still involve critical thinking and clinical skills but often offer more regular hours and the ability to work independently. Home health nurses, for example, usually manage complex cases and must make quick decisions in challenging situations.
  • Consider telemedicine or remote nursing. With advancements in technology, there's a growing need for nurses in telemedicine or remote monitoring roles. While not the same as bedside nursing, these positions can still provide clinical assessment and intervention opportunities.

Do you like educating new nurses and families? If you enjoy teaching and mentoring, transitioning into a role where you train new nurses or provide education within your specialty could be fulfilling. This would allow you to stay connected to bedside care and have more regular hours. You still get to use your clinical expertise.

Have you considered a career in nursing management? As a manager, you can positively influence patient care on your unit and establish high standards.

 If you're not quite ready to leave bedside care entirely, consider exploring part-time or per diem positions that offer more flexibility in scheduling. This could allow you to maintain your skills and connection to high-acuity care while also having more time for yourself.

Remember, there's no one-size-fits-all answer, and it may take some time and exploration to find the right balance for you. Don't hesitate to reach out to mentors and colleagues for guidance as you navigate this transition.

Your dedication to providing excellent care while prioritizing your well-being is admirable, and I'm confident you'll find a path that aligns with both.

Very best wishes,

Nurse Beth

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