Level IV NICU RN looking to transition to level II/II less acute NICU

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Hi Everyone!

I've been an RN for almost 7 moths and currently work in a large level IV NICU in Philadelphia. I've been learning a lot, have been challenged, and am really making the most out of my current experience. I am very well supported, have great resources, and work with a wonderful team of RNs. I will say, however, that although I love the patient population (neonates), I don't love the immensely critical nature of my patients every single day. I've quickly realized that I am not an adrenaline junkie, and would much prefer working with stable babies/feeder and growers. I find myself with an immense amount of anxiety going into work each shift, and it's really starting to affect my personal life.

I'm not running out of the door of my current institution--rather, I'd like to start getting a feel for what else is out there so I can make a move once I hit my one year mark. Can you all suggest less acute level II/III NICUs for me to consider? NICUs whose patients are primarily working on feeds, growing, on cannulas and CPAP, etc. I don't care to have the majority of my patients intubated/trached, on pressors, clinging on to life. I am not tied down to a particular state and can move anywhere (I'm ready for a change obviously!) I'd love to be in a fairly large city as well! Thanks in advance!

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Specializes in NICU.

The vast majority of NICUs are exactly as you describe. Most NICUs have a few kids on a ventilator and the rest feeding/growing. While the Level IV NICUs are larger, there generally are only 1-2 of them in each city, depending on the size of the city. I would try to stick it out at your job for at least 1 year because you'll be more marketable plus it would be nice for your employer to get some return on investment on all the training that they provided you. Remember, during the 3-5 month orientation that most Level IV NICU new grads get, the hospital is paying your salary to you with benefits without getting anything out of it. Training a new grad (when you take into consideration the educator lecturing, preceptor pay etc etc) costs tens of thousands of dollars, probably at least $30,000 if not more.

That being said, if you truly want to move out of there, once you have a year experience in such a high level NICU, you probably won't have much trouble getting a job elsewhere and there are community NICUs as you describe in every metropolitan area in the US. You should figure out more where do you want to live and then start researching the local hospital systems and look at postings. If you feel confident about where you want to live, it's a nice bonus to get the RN license in that state before you interview with the hospital (i.e. it wouldn't be a bad idea to get the license now) because it would show them that you're serious. PA has some hoops to jump through in order to get your license verified to other states anyway, which can take awhile.

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I agree with babyNP; almost all NICUs fit the parameters you describe. Super-high acuity NICUs like your current unit are quite uncommon, and there are even some 'Level IV' units that rarely have critically unstable babies.

The one thing I'd add to babyNP's post is that you might be bored to tears in a Level II. In a Level III you'd get a bunch of feeder-growers with some high flow/cpap/piccs thrown in, the occasional stable vent/uac, and a truly critical kid once in a blue moon. In a Level II, you get a bunch of feeder-growers/NAS/bili-babies with occasional high flow/IVs, and CPAP once in a blue moon. When kids do crump in a facility that only has a Level II nursery, it's very stressful because most of the nurses have limited experience with high-acuity interventions. It seems like most nurses enjoy starting in a Level II, then work up to a Level III; the only nurses I've seen back off from a Level III/IV to a Level II are older nurses easing into retirement age.

Burnout in Level IV units is fairly common, especially among new grads. As babyNP said, with a year of Level IV experience, you can work pretty much anywhere. If you can tough it out for two years, you'd be well-qualified to travel nurse with a Level IV background. That would allow you to try out some different units and cities to see what you like.

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Thank you for your input!

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I've worked level IV and am currently in a Level III. It's the perfect place. We get the occasional vent, body cooling, or critical 24-28 weeker, but honestly most of our kids are CPAP, NCPAP, BCPAP, High Flow PIV or UAC then feeder growers or NAS infants. It's a great mix. The suggestions above are the best way to go about it. Most states have 1 or 2 Level IVs and the rest are IIIs or IIs. Pick a state and just start looking. I love where I'm at though I sometimes miss a gastro kid or having surgery kids, but for the most part, this is a perfect level for me right now!

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I work in a 143 bed NICU that is divided in to L3-4 and then L2. I work L2 and love it. We each have 4 babies and share a tech. It can get extremely busy but the acuity is Less and I get to hold and feed my little ones. We have private rooms for 36 babies. I've worked L3 and am now enjoying this. Good luck.

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I work in a 143 bed NICU

That is the largest NICU I have ever heard of. Wow. Imagine how many nurses there are. Do you mind me asking where?

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OP, I actually had the same experience of realizing I didn't want the super-sick babies, but I realized it less than halfway through orientation and transferred into the progressive/step-down nursery which takes mostly NICU grads who need to learn to eat and grow. We still get a pretty varied patient population as we get ex-preemies on nasal cannula or high flow, neuro babies, kids who we send for g-tube surgery and then get back from NICU after recovery, lots of NAS kids, plus all the feeder-growers who don't need level IV care. Eventually I'd like to move up in the level of care but not at this NICU, which frequently has several kids on oscillators and head cooling, plus plenty of vent/NAVA/bubble CPAP. Too much adrenaline for me! Stick it out for at least a year and then look for a level III almost anywhere you want to go and you will probably find something more to your liking. I precepted in a level III in nursing school which took up to 28 weekers and was mostly feeder-growers, and absolutely loved it! I'll probably eventually look for something more like that. Best of luck!

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Specializes in NICU.

My NICU is divided into a level IV with a level II around the corner. All nurses work in both...so one day you may be in level IV with the sickest vented 24 weeker ever, and the next day you're in level II with 3 term/chronic ex preemie feeder growers....although most people hate working level II and its usually the newer hires stuck in there...everyone always makes a big stink and complains whenever they're assigned to level II.

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