Leaving the NICU - where to go?

[kate1114]

I have 10 years of NICU experience at some fine facilities, and I love working with the infants and families. The problem is, for the past 2 years I have been stuck in a smaller town with a decent sized NICU with extremely poor practices.

I have tried to use education to help introduce things like developmental care and noise reduction. This has not been received well.

Typical problems:

-people talking extremely loudly near infants, shouting to be heard down the corridor

-playing radios fairly loudly, sometimes the radios are placed next to a baby's open crib (or worse, radiant warmer with an unstable infant).

-slamming doors

-ignoring alarms

-not checking emergency equipment (I have found intubated infants without bags/masks)

We have very poor outcomes. I came from a unit that had fairly good outcomes for infants 23-26 weeks. Here, infants of that gestation are assumed to not live, or to live only with severe head bleeds. In 2 years, I have only seen a handfull of infants less that 27 weeks escape without at least a grade 3.

I have tried to do a noise protocol to introduce a quiet time, and that was encouraged until I had done all my research and then presented my proposal. At that time, I was told that it wasn't an issue for day shift, but that maybe those of us on nights needed extra education. My manager thinks that anything I do is "just fine" as long as I do all the work for it. That's perfectly fine, but I get absolutely no back up.

I love NICU, but the next opportunity for me to work is 120 miles away in a metropolitan area with lots of choices. I know some people do this sort of commute, but with the price of gas and a very high mileage vehicle, it tends to be a pipe dream. This hospital also has a PICU, but has a huge turnover, and most people tend to leave because of concern for their license. The adult units, however, seem to have a better reputation overall.

Please let me know what would be a decent area to switch to. I enjoy working with families and critically ill patients. I prefer neuro issues over cardiac and would prefer to avoid cardiac if at all possible since I don't have as well of a grasp on that area. I love working at a fast pace, and I love making a difference. I really hate leaving this place without changing it for the better, but it would take an entire culture change to make that happen. I have made some strong strides in education for individual nurses, but so much more needs to happen, and I'm so incredibly frustrated that I dread going to work every night.

Thanks!

Kate

[prmenrs, RN]

I'm assuming you cannot move closer to the "metropolitan area" or to another city w/a better NICU? That is really a shame because it sounds like you're a terrific NICU nurse. I also don't know what level of education you've achieved. Would you be willing to go for a Masters and/or an NNP??

I think you are @ a crossroads. Now would THE time for you to sit down and figure out what you want out of what is potentially an awesome career. Obviously, it's not going to happen @ your current unit.

If you have to stay in the community and facility you are currently located, then you probably will have to move to adult critical care. Can you take a class or spend some time in the adult units--try it on, so to speak?

In any case, I wish you well.

[EricJRN, MSN, RN]

My question would be, 'If the NICU at your hospital has such poor outcomes and practices, is this issue of apathy a hospital-wide problem?' If it is, you might just end up back in the same boat in your new department. Is there an agency in your area that does pedi home health?

[kate1114]

Thanks for the responses.

I have an MSN, and coursework towards my doctorate. I have an interest in teaching eventually. My MSN is in nursing management, which I got for 2 reasons - to open up career possibilities and to eventually teach. While I was in the big city, I did get to teach some clinicals and I loved it.

I have seriously considered NNP in the past, but that would also require a metro area, as our town's unit doesn't use them. OTOH, if I did the NNP route, then I would be making more money and could probably get some 24 shifts, which would make the commute possible.

We moved several states away for my husband to go to school, and he is still in school. It is possible to make a move within a year, but I absolutely love our community. We don't have the traffic, smog, or crime of the bigger areas and our crime is much much less. Plus I love our house and neighborhood. That's how I wind up in this position

There are 3 hospitals in town. Mine, a private hospital (which has about a 10 bed NICU and which has the same reputation), and a larger hospital which has a better reputation. I have no desire to stay at my small hospital, and would prefer to work at the larger one, which does have adult ICU positions. There is home health in the area, but no openings right now. And Eric, you were right on about the hospital apathy. The adult ICU here is horrible and the nurses are the most burned out that I've ever seen.

I have thought about the neuro ICU, as I have heard good things about it (supportive coworkers, good educator, etc.) so that might be my next move.

So if I move to adults, all of a sudden my teaching possibilities open up (I've had issues before with the fact that I only have NICU/PICU experience). But I absolutely love working with the preemies and I have a strong clinical level of comfort here. Maybe I could find a PRN job once a month at the big city so the commute wouldn't be so bad?

Thanks for the advice. Prmenrs, you hit the nail on the head. I am at a crossroads, just a little too frustrated to see all the options Thanks!

[DDRN4me]

Is there a nursing agency nearby that does private duty nursing??? you would be a godsend to a child at home on a vent!!!