Level III to Level IV

[krenee]

So I've now had experience in level II, and almost two years in level III. Just got hired in a level IV. When I went from II to III I had a rough transition - basically felt like I knew nothing and even the kids I thought I was capable to take care of, I sucked at. So I'm nervous . . . my question is, how hard of a transition should I expect? I know micropreemies now, but not surgical, nitric, or cooling. And I'm basically expecting more sick babies since this is the hospital they get shipped to from all around.

[NicuGal, MSN, RN]

Your level 3 nursery didn't have those types of kids? I find that odd as most level 3's do all that, the only thing we don't do is ecmo. Make sure to tellyour Preceptor what you need to focus on. An experienced NICU nurse only gets 4-5 weeks orientation in our unit. How long are you getting?

[krenee]

No, we don't do surgery or cooling, we ship them out. I'll get 8 weeks I'm told.

[HyperSaurus, RN, BSN]

We do nitric, but no surgicals or cooling either. I think that puts us at level IIIa or IIIb

[abritto1]

I currently work in a level III and we have surgery, micros, nitric and cooling. The only thing we don't have is ECMO. My advice to you would make sure you tell your preceptor what you're comfortable with and what you're not that way you can really focus on what you need to learn. Also, if at the end of your 8 weeks you're still not comfortable with caring for these types of patients, tell your preceptor. I precept new grads and new employees and if I feel they arn't ready to be on their own or they tell me they arn't comfortable with their skills on a certain type of patient we just extend their orientation. It usually isn't a big deal. Hope this helps!

[JRich]

I can understand your fear. I am currently a level II NICU nurse and I am switching to a level IV. I too am so nervous about this transition. I am very excited to learn everything I can.

[jennylee321]

Once you get a feel for the unit, write yourself a list of diagnoses/skills you would like to experience while still on orientation and share it with your educator/preceptor. That way hopefully you don't get stuck with assignments that you can already handle no problem while on orientation and aren't shocked when you come off and get your first cooling kid/surgical baby.

[bmsrn]

I work in a level III NICU. The only thing we don't do is ECMO. I'm guessing that the only thing that makes somewhere a level 4. I don't think your transition is going to be hard, since you have already had critical babies. You should pretty much know everything already. If you can take care of a critical intubated 1:1 patient, then you should be able to take care of a cooling baby or a post op baby.

[littlepeopleRNICU]

I think it really depends on your state and what the levels are recognized as there. In SC, a level III is recognized as the highest. The hospital I work at does everything aside from cardiac surgeries. We do ECMO, cooling, all other surgeries, etc. The only thing we DON'T keep is cardiac kids. Can you ask to shadow for a couple of shifts to see what the differences will be?

[Mindylane]

I am a new grad in a level IV NICU. If I can do it, you can do it! LOL! We see everything, though, and you'll learn a TON on the floor. I've only been there for a month, but if I can help you with any questions, please feel free to message me :)