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... but I need some advice. And many of you are seasoned NICU nurses and may have some insight. 

I have been a nurse for about a year and half, doing pediatric home care. During this time, I have been finishing up my BSN and am currently doing my senior practicum in a Level IV NICU. The NICU has always been "the dream" and I have been really enjoying my clinical experience from a nursing care perspective. Now that I am almost done, I have been applying to NICU jobs and have two offers on the table. 

  1. One offer is from the Children's hospital where I am currently doing clinical. Like I said before, it is a large Level IV, and I have become familiar with unit. However, I am nervous about handling that acuity on my own one day and also dealing with the toxic, highly stressed culture of the unit. 
  2. The other offer is an 8-bed Level II within a birth center of another metro hospital. I have heard great things about the nursing culture of this hospital and there is an opportunity to cross train within the birth center. 

I am worried that if I take the Level II position I will regret not stepping up to the challenge of the Level IV. But I am also worried if I take the Level IV I will be constantly stressed and that the toxic vibes on the unit with mentally take a tole.

Any advice? 

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Specializes in NICU.

Depends on your goals and aspirations. If your goal is being able to care for high acuity patients, then Level IV is your path. Even if you do not see yourself staying at that facility, the 2-3 yrs of experience at a large Level IV NICU will put on the short list of openings in other Level III/IV NICUs as compared to 2-3 yrs experience at a very small Level II.

The Level II cares for low acuity newborns that are unable to stay in the newborn nursery. In my opinion, it is very mundane and I personally would get bored very quickly (I love my micro preemies), but you need to decide for yourself.

I started my nursing career as a new grad in a very large (103 bed) Level IV NICU. It took 18 months to begin to feel confident in my role.

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Specializes in NICU, and Transport.

If you want high acuity do the level 4. They aren't, hopefully, going to put you with the super high risk babies right away. It can be hard to move from a level 2 to a 4.

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Specializes in NICU.

I know this thread is old. But I just taught I’d share my experience! I started as a new grad in a level 2 NICU… I’ve been here since November 2021…. I just finished orientation and while I absolutely love it hear, I’m hurting to get my hands on some high acuity micro preemies… we are a 16 bed unit at a delivering hospital but any really sick babies get transferred out and we only have and get transferred in feeder growers.., today we only have 1 baby and 3 nurses, I discharged my baby at 1051 this morning and have been sitting here since then… it’s 1719 as I write this… the cares on a feeder grower is the same for every baby unless they have some type of line, and for me, it did not need to be 14 weeks of orientation to be doing the same thing over and over again, everyday and every week… especially on the same baby that’s been here since 12/13! 
 

all that to say, in April I’m leaving to go to a level 4 NICU. It’s a large 70 bed unit that has seen no less the 60 babies at once… and I’m very excited to get my hands on them! I wish it could’ve been where I started my career but being at a level did give me a great opportunity to see and touch healthier babies to see what’s normal vs what’s abnormal… but now I’m ready to go up to sicker babies 

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Specializes in NICU.
On 2/13/2022 at 5:23 PM, Voiceofbeauty said:

I started as a new grad in a level 2 NICU… I’ve been here since November 2021…. I just finished orientation and while I absolutely love it hear, I’m hurting to get my hands on some high acuity micro preemies… we are a 16 bed unit at a delivering hospital but any really sick babies get transferred out and we only have and get transferred in feeder growers

I have been precepting a Capstone student for the last month. I keep telling her how fortunate she is. Each week she has taken care of some of our sickest patients. She has taken care of a myelomeningocele, gastroschisis, and a HIE in the last month. We hire most of our Capstone students at my Level IV NICU. Her interview for a new grad position is tomorrow.

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Specializes in NICU.
On 2/15/2022 at 2:05 PM, NICU Guy said:

I have been precepting a Capstone student for the last month. I keep telling her how fortunate she is. Each week she has taken care of some of our sickest patients. She has taken care of a myelomeningocele, gastroschisis, and a HIE in the last month. We hire most of our Capstone students at my Level IV NICU. Her interview for a new grad position is tomorrow.

She’s very lucky! I wasn’t able to get a capstone because of Covid…. NO NICU would touch me without capstone or nurse extern experience…. I went to a level 2 that trained me for feeder growers for 3 months, applied to a level 4 NICU you and children’s National and they called/ interviewed/ hired me all within a week! 

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