Level 3...not good enough?

Burnvegas · Mar 31, 2017

In the UK, I've known people that have become an nnp who worked in a level 3 centre, even one that had predominantly worked in a level 1. So it is possible here at least.

**NICU Guy, BSN, RN** · Mar 31, 2017

Working in a Level IV is no guarantee that you will get the sicker babies. I have worked 2 yrs in a Level IV and rarely get the sicker babies. A certain group of nurses seem to always get the sicker babies. Management calls it "Continuity of Care", we call it preferential treatment.

KKEGS, MSN, RN · Mar 31, 2017

I worked for nearly 3 years in a Level III and didn't get my first truly sick baby (24 w, pressor and insulin drips) until I'd been there over 2 years. We opened up a Small Baby Unit and I volunteered to work in that new unit and THAT was when I got the really sick babies but I burnt out on that after only 5 months. Now I work as a FT school nurse and only pick up in the NICU PRN and get the big feeder/growers. :)

llg, PhD, RN · Mar 31, 2017

It's a culture thing -- and NICUs vary in their cultures. Some unit push the new folks into the sicker babies too soon: others make them wait 2 years before entrusting them with the care of the sickest babies. Figure out the culture of your unit. Who are the gate-keepers into the sicker assignments. Cultivate positve relationships with those people and be sure they view as really competent and ready to advance to the sicker kids. They won't give you those assignments until they trust you can handle it and feel comfortable giving you those assignments. So, help them feel comfortable with doing that.

jennylee321 · Apr 1, 2017

Have you discussed with your charge nurse or manager that your ready to take on some sicker assignments ?

RNtoNNP, BSN, DNP, APRN · Apr 1, 2017

I work in a level III NICU that sounds pretty similar to yours, and I'm also in my first year of a 4-year NNP program. I've had about 3.5 years of NICU experience and I know I was worried about not feeling prepared for school too (sometimes I still don't feel completely prepared!). But, I also still have 3 more years to soak up every learning opportunity that I can. I would love to work in a level IV NICU after I graduate, so I am planning on seeking out clinical opportunities in larger NICUs that can give me more experiences that my own NICU can't. At work I try to seek out new experiences as well and and learn about the sicker kids on the unit from the nurses around me. If you have a light assignment, offer to help another nurse do cares on an intubated baby or offer to help with a procedure. Most NNP programs are going to be several years long, so you will have time to continue to learn new things and to have more opportunities to care for the sicker babies. And, as others have said, talk to your charge nurse if it's been a while since you've had a sick kid and ask if there is anything you can do to get those sicker kids in the future. I think level III experience is enough for NNP school if you make the most of all of your learning opportunities, whether that's in the classroom, at work, or at clinicals. There are a couple people in my NNP program that work at level II NICUs and they are doing just fine. Don't count NNP out just because you don't work in a level IV.

babyNP., APRN · Apr 2, 2017

Ironically I had a similar experience and then when I went to school, they started giving me all of their sick sick babies. I did get to learn a lot and I'm grateful for the experience, but it would have been nice to have some cushy days again as a break from school and to unload my head, lol.

Keep in mind that the vast majority of NICU is not very sick babies (unless you're at an academic center). I think it's a great idea to work while in school so that you can start to see how things work on the other side and start thinking of how you would manage your assignment as if you were the provider and asking questions on rounds and the like. A lot of things clicked for me while in school that way.

Level IV is the best for experience, no doubt there. But you can see if you can get a Level IV experience in school and that would help balance out your experience. I would continue to try to seek out learning opportunities and ask questions. Maybe even listen in on rounds if you can on the sick babies just to start learning the provider's thought process.

You can always start taking theory classes for graduate school like patho just to start things out while you try to gain more experience, if you like.

Keep us posted on how it's going!

vintage_RN, BSN, RN · Apr 4, 2017

I keep getting confused, because here in Canada (or Ontario at least), level III is our highest level with the sickest babies. I work in a level III right now with IMC and level II pods mixed in...new staff always start in these pods before being trained in the critical care pods. Many people have been waiting over a year to be trained in the critical care pods....

jennylee321 · Apr 4, 2017

In the US by level 4, they usually mean: surgical babies, cardiac and Ecmo

ThePrincessBride, MSN, RN, NP · Apr 4, 2017

Hey everyone, thanks for the responses.

Working in a Level IV is no guarantee that you will get the sicker babies. I have worked 2 yrs in a Level IV and rarely get the sicker babies. A certain group of nurses seem to always get the sicker babies. Management calls it "Continuity of Care", we call it preferential treatment.

That is true. Whenever there is a sick baby, usually he/she goes to the more senior nurses. The problem is, once these experienced nurses start retiring, we, the newer nurses, will be left to take care of these babies without much hands-on work experience.

Have you discussed with your charge nurse or manager that your ready to take on some sicker assignments ?

We are allowed to ask for higher acuity nurses, but it doesn't mean we will get it. When I do ask for higher acuity, I usually get bubblers and VERY rarely an oscillator/conventional vent.

I feel as though I can't be a good NNP without a TON of experience with sick, sick babies and that I need to have experience with every kind of baby there is before I start giving orders.

Most NNP programs are going to be several years long, so you will have time to continue to learn new things and to have more opportunities to care for the sicker babies. And, as others have said, talk to your charge nurse if it's been a while since you've had a sick kid and ask if there is anything you can do to get those sicker kids in the future. I think level III experience is enough for NNP school if you make the most of all of your learning opportunities, whether that's in the classroom, at work, or at clinicals. There are a couple people in my NNP program that work at level II NICUs and they are doing just fine. Don't count NNP out just because you don't work in a level IV.

Yeah, the NNP schools I am looking at are two years full-time, three years part-time. I plan on going part-time and will have, by graduation, five years of NICU experience.

I am surprised that they will allow people to enter NNP school without Level II experience. Nearly every NNP school I have looked at requires at least two years of full-time level III NICU experience.

ThePrincessBride, MSN, RN, NP · Apr 4, 2017

Keep in mind that the vast majority of NICU is not very sick babies (unless you're at an academic center). I think it's a great idea to work while in school so that you can start to see how things work on the other side and start thinking of how you would manage your assignment as if you were the provider and asking questions on rounds and the like. A lot of things clicked for me while in school that way.
Level IV is the best for experience, no doubt there. But you can see if you can get a Level IV experience in school and that would help balance out your experience. I would continue to try to seek out learning opportunities and ask questions. Maybe even listen in on rounds if you can on the sick babies just to start learning the provider's thought process.
You can always start taking theory classes for graduate school like patho just to start things out while you try to gain more experience, if you like.
Keep us posted on how it's going!

Yeah, that is true. Most of the babies that come to my unit aren't really sick, which is a good thing. We ship all the babies who require surgical/more intense intervention to the Level IV NICUs. I am just wondering, if I can't get level IV experience and I decide to go through NNP school, will I be stuck managing Level III, II and Special Care Nurseries as an NNP?