level II vs. level III neonatal units

Most large hospitals have a real difference between level 2 and NICU babies and the NICU babies are not held by nurses unless it's necessary because we try to let them rest between feeds and assessments. We handle them for assessments, but if they are in an isolette (not incubators:)) we have to just do it through the portholes. There is a lot more holding in our level 2 because those babies are often learning to bottle feed.

Smaller hospitals often have one NICU which is a level 2 plus (or advanced level 2) and have a mix of sick and less sick babies, so you'd get a mix of babies who are handled often and those who aren't. Even the advanced level 2s have to transfer out their sickest babies to hospitals that have a level 3.

From my experience, this is what I can share with you...

At a 650 bed hospital which was also a Regional Perinatal Center (a large hospital capable of taking care of very sick undelivered Moms and all ages of babies... Smaller hospitals in the outlying counties would call us to go transport the sick Mom or baby to our hospital) we had all three types of nurseries...

Level I: This was the nursery area on the Mother-Baby Unit. It's like a Normal Well Baby Nursery. A few babies would be kept there if they were fine but needed to finish up a few days of IV antibiotics or phototherapy or wait for a foster parent to be assigned to them. These babies were either term or grown-up preemies. This is the best place to work if you want to spend some time holding babies. Mind you, there's not really much time because there are lots of babies as well as Moms needing your attention, but at least you can cuddle them while feeding them when their Mom wants them fed in the nursery.

Level II and Level III: Our NICU (Neonatal Intensive Care Unit) cared for preemies from 23-24 weeks gestation up to post-term babies. One side of our NICU housed the very sick preemies who were on all types of ventillators and supplemental oxygen, needed surgery, lots of IV fluids and medications, being fed through tubes, etc. This was considered the Level III side. On the other, Level II, side were the babies who had graduated on up to being more stable. We call them growers & feeders. Generally their health is much better. They are progressing from tube feedings to learning how to eat with a bottle, some are still requiring nasal cannula oxygen, some are on phototherapy, etc. The babies that were learning to bottle feed or were staying because they had other medical issues (like apneas and bradys, etc.) were held and cuddled during their feedings, but not for too long because we had more work to do and because the babies need their rest to grow. These babies still need close assessments because they can crash on you in a New York second due to NEC and other such complications of prematurity.

Some of the surrounding county's smaller hospitals had Level II nurseries. They took care of well babies and had the ability to take care of certain growers & feeders. They could do everything a Level I nursery does as well as take care of stable older preemies usually older than 33-34 weeks gestation. It was decided on a case by case situation and the ability and comfort of the hospital's staff also helped make such decisions. Often a baby would be born at a hospital with a Level II nursery but be too ill (either from prematurity or from other term baby complications) and they'd call us to come get it. We'd take care of it at our Level III nursery and as soon as the baby was stable enough to transport, and the Level II nursery felt they could continue caring for the baby in their nursery until it was ready to go home, we'd then transport the baby back to the Level II nursery hospital. The level II nurseries were usually 50 miles away or more from our hospital. Since it was so difficult for the parents to drive all the way ot our Level III unit, it was best to try to get the baby back nearer his eventual home so the parents and the baby could continue bonding and the parents could learn all they needed to know for taking their little one home with them.

I've worked in the nursery of a Mother-Baby Unit and in the NICU I've described for you, but I've never worked in a nursery that was classified as a Level II nursery per se.

If you want to hang out with healthy, fun babies then I'd suggest looking for a Level I -aka- Well Baby Nursery or Mother-Baby Unit. I worked on a Mother-Baby Unit for almost 7 years before I decided I was ready for a challenge and transferred to the NICU.

Good luck with whatever path your career takes you to!! Hope my post was of some little bit of help to you.

:)

Wow! I'm going to ditto what Tiki said. Great, descriptive post! You've described my hospital to a "T". :)

In our hospital, we've got three nurseries and do not really have a Mother/Baby system due to lack of interest from the parents (our hospital demographic generally prefers to send the babies to the nursery and keep them there until discharge, or they will keep the babies for a few hours in-room then send them back).

IMO, the Well-Baby nsy is probably the place where you will get the most time to cuddle or hold the babies, though, as someone else mentioned, they need their rest. Working a true Mother/Baby unit, you'd not only be taking care of the babies in-room for the most part, but you'd also be nursing their moms who are recovering during the PP period. Our WB nsy gets VERY busy, so with 6-8 babies per nurse, there is a lot of work to get done, though they do have down time (especially at night) during which the nurses can hold some of the babies.

Our Level II and III nurseries are exactly as Tiki described. In our Level II, we have AMPLE opportunity to hold the babies, not only during feedings but also because some of them (particularly those who have stepped down from Level III and were on vents for extended periods of time) are extremely fussy and hard to soothe. Also, those step-down babies need to be taught about non-medical touch (about 90% of their time in a Level III is medically-related, invasive types of touch), so we do make a special effort to massage, cuddle, soothe, and talk to these infants. I LOVE working in the Level II nursery for that reason. Most of the major medical hurdles have been jumped, so it's all about increasing health and preparing for discharge.

Our Level III does get infants that can be held, but for the most part, these babies are SICK and that, coupled with the fact that a nursery can get extremely noisy with the alarms and staff and whatnot, means that they need as much rest as possible. However, if you read about kangaroo care at all, you'll find that sometimes babies actually do sleep better when they're being held (due to the comfort, warmth, movement of your breathing chest, and heartbeat). We get some babies in Level III who are in Isolation rooms and get virtually no contact other than from the nurse who is assigned to them that day, and who may have 1-2 other infants to care for. I like to make a particular effort to hold them and interact with them in a soothing, non-stimulating way whenever I can. Some of the nurses don't like doing Isolation, but I just love it, especially when the babies are on minor O2 or on room air and can be "handled." Our Level III also gets babies who have certain genetic disorders (Down's Syndrome, etc.) who don't require O2 but may have heart problems (or babies who experience things like SVT's) who can be cuddled and held. So I wouldn't say that in a Level III you never get to hold babies; I certainly do as much as possible, because I feel that comforting touch is essential for the well-being of these children.

For me, I also enjoy our Level III (we get floated between the two nurseries depending on need or request) because even the vented babies need tender care. I was scared of the Level III at first because I was intimidated by the status of these tiny babies, and the machines they were dependant on, but after a while, I came to look forward to the nights when I would be assigned a particularly ill or difficult baby, because I knew that SOMETHING I did would be important, whether it was just cooing to the baby or gently stroking a limb or cheek, or performing oral care, or whatever. You'd be surprised how those ELBW's can react to a little TLC.

In this area, you have a few actual Level III's, then a whole lot of Level II's (in the smaller, private hospitals, they will often call their Level II's NICU's, though in fact most of their babies are feeder-grower's, along with a few stable vents), and every hospital has either a Well-Baby nursery or a Mother-Baby system in place. You just have to explore the opportunities at each and every hospital until you find one that's a perfect match for you.

Wherever you go, I wish you the best of luck. Come by the NICU forum sometime- they have some wonderful nurses who frequent that forum who I owe a debt of gratitude to.

Let us know what you decide!

Sincerely,

Kristi

Great descriptions above.

Where I work, we have a Level 2 nursery. There is no such thing as level one nursery there. If the baby is well, he/she stays in the LDRP room with mom/dad 24/7. the only time our nursery is "used", per se, is if we have a baby who is on antibiotics, phototherapy, feeder/grower status, etc. Conditions like these do not necessitate NICU-level care, yet a nurse has to be assigned to monitor the status/care of a newborn more intensely. That is the concept at most smaller hospitals in the area where I live. Well babies don't require a "nursery"; they stay with mom.

Thanks for all the information. I still have a ways before I graduate, but so far I think I would like working with babies. Just another question if you don't mind. What do the abbreviations NEC, SVT, and ELBW stand for?

NEC is Necrotizing Enterocolitis. This is an inflammation (possibly caused by infection, though this anecdotal and not defined by research so far) of the bowel tissue that can cause necrosis (death) of the tissue and require serious surgical intervention, including removing parts or much of the bowel and may include an ostomy- have you learned about ostomies yet?

SVT is Supraventricular Tachycardia. It is a very rapid heart rate (in our babies, whose regular heart rate is anywhere from 100-160 or so, you'll see this sudden rocketing heart rate to 250 bpm or more) that originates above the ventricles (in other words, above the lower heart chambers).

ELBW is Extremely Low Birthweight; these are the preemies that are born, for example, at 23 weeks and may weigh 500 grams or less. There is a range, but I'd have to look it up to make sure I was telling you correctly, thus the singular example. :)

Sorry, I should have defined them or written them out. I'm one of THOSE people now, I guess! Didn't mean to confuse you, it's just that once you start working with the abbreviations life becomes so much simpler. And easier to pronounce. And type.

I don't mind. I understand it is easier. I am just very early in my education. I have worked as a volunteer (CICU, ICU, intermediate care, OR, and the lab to get my phlebotomy certificate) and a CNA (at a long term care facility) , but right now I am going to be finishing my prereqs next semester (Chemistry, Sociology, and Health). The health class is so I can get an Associate in Health Sciences before nursing school. I am hoping to begin nursing school in January. Thanks again for being so helpful.

Your avatar is wonderuful, I have always admired it, PRMENRS

Thanks prmenrs, I was wondering about that. I figured that it would probably be good for most babies to be held, but also thought that some of the babies might be too fragile.

What I love, prmenrs, is your quote "Never trust a 35 weeker" I always smile when I see it, because my youngest was a 35 weeker, and she's still the troublesome one! LOL