Is this the best decision?

UTVOL3 · Oct 6, 2008

I always tell new grads to jump right in to NICU if that's what they're interested in. Don't be scared off by the small size. It is a completely different skill set and having worked elsewhere usually has no bearing on how someone does in NI.

Personally I couldn't take Peds or well baby but that is just me. For example, would you like to practice starting iv's as a new nurse on a 3 year old that takes three people including his mom to hold him down? Or a 2 lb infant you can restrain with a baby blanket? JMO

If you can handle NICU you will be able to work anywhere, but, cutting it in Peds and newborn does not neccessarily mean you will like or succeed in NI.

Good luck though, you will know soon enough if you make the right decision! If you don't like where you end up, transfer when you are able.

ilstu99 · Oct 6, 2008

"Normal" is relative. A normal term baby doesn't look anything like a "normal" 28-weeker. Some of the skills you will use will cross over, but much of it is exceptionally different: the terminology, the procedures, the population, the assessments, the equipment, etc. Peds doesn't give you much help with NICU readiness, unless your facility has a special designation for babies and is very busy. All of our very ill babies who have been sent home are readmitted to the PICU, not the regular peds floor.

Don't get me wrong - all experience is good, even when it's bad. But don't choose to move from unit to unit in an effort to gain experience for your "ultimate goal." New grads around here are told that it takes 3 years, MINIMUM, to claim "proficiency" within their department.

I went to the NICU as a new grad, and I don't think I'd do it differently.

Sun*shine · Oct 7, 2008

this is a really helpful topic. I'm an adult nurse just qualified. i've accepted an adult nurse job but my passion is in neonatal nursing, and i've just been offered an interview in a regional neonatal unit. i was thinking it might be best going to a setting i'm familiar and confident in to consolidate my skills and get my feet on the ground before going onto neonatal. it's so scary when i think i've no experience in neonatal and just don't have a clue about it, even though i'm desperate to learn it all and get stuck in. it's interesting to think that actually i'll likely be as scared and muddled after 6 months experience elsewhere! :nurse:

Jolie, BSN · Oct 7, 2008

minnie,

While pediatric and well baby experience may be somewhat helpful in the NICU, adult experience generally is not.

It is necessary for adult nurses to "unlearn" so much, that they tend to have a harder time adapting to the NICU than nurses who come in with no experience at all.

TiffyRN, BSN, PhD · Oct 8, 2008

It is necessary for adult nurses to "unlearn" so much, that they tend to have a harder time adapting to the NICU than nurses who come in with no experience at all.

I would like to respectfully point out that this is not universally true. Though it is the common belief, I have not found it to hold out in actual practice.

I had a whole long post written on this, but this is not the topic of the thread, so I digress. . .

Jolie, BSN · Oct 8, 2008

I would like to respectfully point out that this is not universally true. Though it is the common belief, I have not found it to hold out in actual practice.
I had a whole long post written on this, but this is not the topic of the thread, so I digress. . .

Of course it is not universally true. But in my 11 years in the NICU, I have seen a much higher attrition rate of "adult" nurses than those who came in as new grads or who came with other maternal-child experience.

I would never discourage an experienced adult nurse from trying to make the change to the NICU. But when one is starting out knowing that the NICU is their desire, I don't see any benefit in taking a detour to adult care, only potential pitfalls.

Sun*shine · Oct 8, 2008

You both make really valid points here. After giving it lots of thought I can't help but think being a new graduate would maybe help me more at this current time than a few months experience in the adult setting. Of course if I had much more experience than this in adult nursing then I'd say it'd make a big difference, I'd have picked up lots of drugs knowledge and leadership skills etc which are invaluable and also applicable to all healthcare settings.

I spoke to the ward manager regarding this and she told me that it was really up to me, but that neither option would put me at a disadvantage. One of the beautiful things about this job is that the units really do appritiate and respect a vast range of clinical experience in their staff.

I think the main thing I'd gain from going into an adult setting is confidence. I'm not only new to nursing but totally new to neonatal settings. The thought is terrifying!!! But if i'm honest it's the only thing putting me off.

Of course I've not even taken the interview yet :nuke: but even just getting this far is so exciting!

Jolie, BSN · Oct 8, 2008

minnie,

I hope I'm not being over-bearing, and I really don't want to push your decision, just trying to share my experiences with new NICU nurses of all backgrounds.

I understand your desire to gain some self confidence and experience prior to going to the NICU. You mention leadership, which is an important quality in a NICU nurse (need to be able to advocate for your patients, more so than in other settings), and I agree that practicing in a setting that will enhance your leadership abilities is a good idea. Med-surg is an ideal setting to learn critical thinking, prioritization, time management, hospital politics, etc. If that is what you are seeking to gain, I encourage you to do so.

You also mention clinical skills and knowledge of drugs. Those are 2 areas where the care of adults differs so much from the care of neonates that I truly believe that having adult experience (and an adult mindset) can be detrimental to a new NICU nurse. Many former adult nurses have such difficulty "letting go" of the adult ways of performing clinical tasks such as managing IVs and calculating drug dosages, that they struggle in the NICU. So if your reason for wanting med-surg experience is to help you master tasks such as starting IVs, inserting ng tubes and managing ventilator patients, I would encourage you to reconsider.

I hope that clarifies my thinking.

Good luck to you. You are a conscientious and thoughtful person, and will do well regardless what you choose.

Sun*shine · Oct 8, 2008

Thank you for all your advice. What you said makes a lot of sense.

It's really useful to hear what kind of experience I might gain and not gain from an adult setting. My reason for going into surgical first was to practice skills like IV's, drain care and medications etc. This is what I'm least confident in. I thought that adult experience would help me get the skills I'd need for neonatal. It's helpful to know that the clinical side is very different in neonatal and I can now appreciate what you mean by unlearning certain skills.

Leadership and time management are all vital skills too, but not one that overly worry me. Not having a lot of experience in these doesn't scare me or leave me feeling vulnerable like my lacking of clinical skills does. I'm sure leadership and management are skills I'll be able to develop over time, often subliminally, by trial and error and following good example. Where as running an iv and working out medication doses are a high risk skills that needs perfecting quickly, no room for error. yikes.

Everyone keeps saying to follow my gut feeling and go into what I most want to do, but I've been pondering and over-analysing it for some time now! You've helped me see things a lot more clearly.

Even if I don't get it I know that the adult experience is really valuable still. I think either choice will have a good outcome because I know one day Ill end up in nicu somehow, even if I'm not able to step into it right away. So thanks again! Can't wait for my interview.

TiffyRN, BSN, PhD · Oct 8, 2008

when one is starting out knowing that the NICU is their desire, I don't see any benefit in taking a detour to adult care.

Couldn't agree more there Jolie. And to the OP, if your desire is to sharpen specific

skills, getting med-surg experience has almost no value. I see the only benefits to previous adult experience as time-management skills, critical thinking skills, knowledge of hospital routines. These things are not going to be well developed until you have at least 2 years experience anywhere. The specific skills you mentioned: IV's, meds and drains are worlds apart. I used to be the IV queen until I went to NICU, no more. I used to struggle to get an NG tube down, not anymore.

I wish the OP the best of luck on your interview. I personally love being in NICU, wish I had gone there as a new graduate!

narcissus · Oct 9, 2008

Hello all,

This has been a real informational thread. Thanks to you all who have replied. I have taken into consideration what everyone has said and today I interviewed for peds as the nicu didn't have any positions open. One thing that the manager told me was that when census is low we could float to either nicu or newborn nursery. I would get a chance to see the best of both worlds. I wouldn't float until I came off orientation and everything but it's nice to know that I would get a chance to see some of everything. Either way like one of the posters said experience would not hinder me either way so I'm happy with I got for right now. Once a position opens up in the nicu I'll apply. We only have to be in the dept. for at least 6 months before we can transfer. I certainly don't mind that! :yeah: