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Level 4 NICU suggestions


I currently work in a level 3 NICU and am in my first semester of a neonatal nurse practitioner doctorate program. I am getting fairly frustrated in my current unit because we do not have a lot of critical kids on a regular basis. We might have 1 or 2 intubated babies at a time (or none at all), and we have had times where our sickest kid is just a stable kid on CPAP. We use the oscillator ventilator maybe about every 4 months and see the basic surgical patients periodically. Also, when we do get a sick kid, we have to make sure that people who haven't had a sick kid in a while get their turn, so even if we have a sick kid, I may not have the opportunity to care for him/her. I don't mean for this to sound whiny because I obviously understand that everyone needs a chance to care for our sicker patients, but it just gets a little frustrating when it has been months since I have had an intubated patient. I love taking care of the feeder-growers too, but I would like a little variety.

I'm concerned that I am not getting good experience to prepare me to be an NNP, so I'm starting to look into relocating. I would really like to work in a level 4 NICU because I would like to see more surgical patients, especially cardiac surgeries. Both NICUs I have worked in have sent cardiac patients out of state for treatment and surgery. I currently live in the midwest and would ideally like to stay in that area, but I'm also willing to consider moving elsewhere if the perfect opportunity arose. Does anyone have any suggestions of level 4 NICUs that are good places to work at? I'm especially interested in the role of NNPs in those units. Do the NNPs only care for feeder-growers or can they care for post-surgical and other sick patients too? Do NNPs go on transports?

I'm trying to find somewhere that I want to build a career. I still have 3.5 years of school, so I would start off somewhere as a nurse, and hopefully move into a practitioner position if one is available. Any suggestions of level 4 NICUs (or level 3's with higher acuity or surgical patients) would be greatly appreciated. Thanks!

The Children's Hospital at Vanderbilt University Medical Center (Nashville, TN) has a Level IV NICU that utilizes NNPs on all types of cases, as well as on transports. It's a tertiary referral center, so there are lots of surgical cases, as well as many preemies both born at the accompanying adult medical center, and transported in from around the mid-south region.

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

I'd look into any university hospital or children's hospital. Our NNPs don't do transport, we ( the nurses) go with our fellows. Our NNPs take all the kids in the unit and the step down kids.

babyNP., APRN

Specializes in NICU. Has 12 years experience.

Like others have said, academic centers are generally Level IV NICUs and there are generally at least one in every major city. I would pick a few places in the country that you're interested in living and go to their websites. My experience has been that children's hospitals are always looking for NICU nurses, particularly experienced ones, generally short-staffed.

For my part, residents are not in our Level IV unit and PAs are not even allowed to be hired in the hospital (which is a shame IMO but another topic for another time). They purposely placed us so that we wouldn't take care of only feeder/growers (we have a separate Level II in which we occasionally rotate) and take care of the sick babies, particularly CDH and ECMO babies. We have a transport team of RNs/RTs that go out and there is an algorithm for when NNPs go out- generally cardiacs, micropreemies, and otherwise very ill babies.

Keep in mind that a lot of neonatology is just feeder/growers and what you get at a Level IV is not like most of the neo world so what you are getting is most of the norm for neo. What I take care of as a NNP is probably top 5% in regards to the sickness of babies. But you're right- it's better to start out with the sickest and have that skill set so that you can be a successful NNP most anywhere.


Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

I agree with the others... try looking for the major academic center in your area. I work as an NNP in a large RPC Level IV+ECMO+open heart NICU, and we are constantly overloaded with acuity haha. On my average shift, I have a few preop cardiac, a postop open heart, maybe an ECMO, and a smattering of convalescing preemies.

I am not sure anyone else is seeing this where they work, but we have seen a dramatic decrease in extremely preterm infants, where we used to get 23-26 weekers all the time...now most preemies are in the 28-33 range. I credit this to our OB colleagues doing great things to keep babies in, such as vaginal progesterone. By not having the really extreme pretermers, we avoid a lot of the sequel, which decreases overall daily acuity, which is a good thing! I will say we have seen more and more IUGR kids, which is probably related to keeping micros in longer until the placenta gives out.