Large v. Small NICU

EricJRN, MSN, RN · Jul 3, 2006

I work in a combined Level II/III NICU with a capacity of ~40 babies. While our unit seems big to me, we're tiny compared to a couple of the other hospitals in the city who have over 100 beds. I like where I work.

Many larger hospitals have separate units for Level II and Level III babies. I consider that to be mostly a disadvantage. If I worked all Level III (or all Level II) all the time, I might burn out a lot faster.

As it stands at my hospital, when a nurse has a terribly stressful Level III assignment one shift, there's a good chance that the nurse will be able to 'relax' the next shift with a Level II feeder/grower assignment. I also like the fact that we have continuity with the patients and familes, following them from admission to stabilization to discharge.

Jolie, BSN · Jul 3, 2006

Eric makes a geat point. I have always preferred units where I am able to follow "my" babies from admission to discharge, whether that be a matter of days, weeks or even several months. There is a great satisfaction in being able to do that!

As far as beginning a NICU career, I suggest you apply to a large, teaching and referral center. These units typically hire many new grads, have very well-planned orientation programs, and have sufficient numbers of staff to incorporate newbies while supporting and mentoring them. They also have an endless "supply" of challenging babies which will enable you to gain tremendous experience in caring for vent patients, surgical babies, working with IVs, PICC lines, art lines, etc. In a nutshell, you will be able to hone the skills necessary to deal with practically any baby with any condition.

Small NICUs in community hospitals are a great place to work AFTER you've gained these skills, but they are not a good place to learn them. The patient population generally includes larger, less sick babies, with the occasional critically ill newborn thrown into the mix. Such units may go for months without a vent baby, then suddenly have 2 or 3 at once. The nurses in these units must have solid skills in place to be able to rise to the challenge when it presents.

For example, I started in a 45 bed level III NICU. Every day, my preceptor was able to choose from a number of tiny preemies, full-term surgical or cardiac kids in order to ensure that I gained experience in caring for patients with these disease processes, and handling the equipment necessary in their care. 5 years later, I switched to a small level II nursery in a community hospital. I had a 6 week orientation, during which time, there was never a vent baby in the unit. Had I started there as an inexperienced nurse, I would have had a hard time gaining that expertise.

Good luck to you!

LaNICUnurse · Jul 6, 2006

Eric makes a geat point. I have always preferred units where I am able to follow "my" babies from admission to discharge, whether that be a matter of days, weeks or even several months. There is a great satisfaction in being able to do that!
As far as beginning a NICU career, I suggest you apply to a large, teaching and referral center. These units typically hire many new grads, have very well-planned orientation programs, and have sufficient numbers of staff to incorporate newbies while supporting and mentoring them. They also have an endless "supply" of challenging babies which will enable you to gain tremendous experience in caring for vent patients, surgical babies, working with IVs, PICC lines, art lines, etc. In a nutshell, you will be able to hone the skills necessary to deal with practically any baby with any condition.
For example, I started in a 45 bed level III NICU. Every day, my preceptor was able to choose from a number of tiny preemies, full-term surgical or cardiac kids in order to ensure that I gained experience in caring for patients with these disease processes, and handling the equipment necessary in their care. 5 years later, I switched to a small level II nursery in a community hospital. I had a 6 week orientation, during which time, there was never a vent baby in the unit. Had I started there as an inexperienced nurse, I would have had a hard time gaining that expertise.
Good luck to you!

Yep, larger teaching hospital to learn then smaller to stay. Also, staffing is usually more of a problem at a larger hospital. So, you can choose your hours, and work more as you feel able.

I went from a teaching hospital to a community hosp, the units are about the same size, but the staff attitudes and atmosphere is better at the community hospital.

Also, being able to follow babies from beginning to end is rewarding.

1/4lberrnc · Jul 6, 2006

I totally agree that if you can start in a larger level 3 unit you can get some great experiences under your belt and then move onto a smaller unit if you wish. After working in both types (larger first) I do prefer the smaller units the pace is better and I feel I get to spend more time with my patients and their families. But I am grateful for the experiences that I have had from the larger units.

NICU-RN · Jul 9, 2006

I really appreciate all your responses. I am not having good experiences at the smaller NICU. They do not keep vented patients very long because they dont have in house Neos. They mostly have babies that had trouble transitioning and feeder-growers. They do not keep chronic babies either. I want to wait and give them a try, I have 3 years PICU experience , so I have experienced ICU, but I know NICU is different. I just want to give them a chance but at the same time go get the experience of a larger NICU. If you cant tell, I am just confused!!!