Med-Surg to NICU or Intermediate Nursery

[applesRN]

Hi everyone,

I have been a mostly med-surg float nurse for 11 years, I recently finished my BSN, and have had a lot of life changes in the last year. I never thought I would have difficult finding a RN job somewhere I wanted, but with this economy eveeryone who has a good job is holding on to dear life for it. I have applied and interviewed for an office position. I have also put in apps at the local cath lab and CVRU. I have always wanted to work in the NICU, but life has gotten in the way. Now my life is stable enough to pursue the dream, and I have an interview coming up next week (an hour away). I have wanted to work in my local (and current) hospital's NICU (level 2) but there are no openings. It is one of those great places that you have to wait until someone retires to get into it- especially with no experience (I have a few months of Peds experience).

My interview is at a respected 60 bed level 3 NICU and its Intermediate Care unit. Realizing that the majority of my experience is with adults, which do you feel I'd be better to start in? Of course, it may not be up to me... Both will be 7p-7a. (I am somewhat concerned about doing nights, but I feel my body has naturally gone to a later bedtime and later rising lately. The hour drive also concerns me, but I feel that I can do it for now- this hospital used to have a commuter program incentive but doesn't anymore). Both my current hospital and potential hospital have Magnet status. I don't know what the patient to nurse ratio is in either. Some of these things I'll just have to cover in the interview. I am nervous, even though this is what I want... I fear it not being what I think it will be, or messing up some how- it is scary to take on babies without recent experience. I have a lot of what-if scenarios running through my mind. What if I don't like it, what if I can't take that long drive, what if a position opens soon at the local NICU... (say, for instance, if a position opens up locally- how soon is too soon to leave the other hospital, recognizing that they will put a lot of effort and money into hiring and orienting any new person)?

A little more about me- I love technical aspects of nursing and seek out extra education on my own often. I will hopefully start a FNP program (online in the fall) and would like to get into neonatal before then (who knows, I may decide to be a NNP or CNS instead). I know new grads are often hired because they have a clean slate- and I don't know how my adult experience will affect my NN nursing. I have adult cardiac experience and enjoy that. I have been NRP certified in the past (let it lapse), current PALS, ACLS. Do you think I'd like feeder/growers or more intensive nursery better?

[NICURN29]

I think it's hard to say that you would like better, as I don't know you. I work in a NICU that has the intensive care nursery and the intermediate care nursery in the same unit, so we work with both populations. I happen to prefer taking care of the smaller, sicker babies, but that it probably not true for everyone. Is there room for movement between the two areas, or are the nursing staffs pretty well segregated? Do the nurses float between the two? I would probably apply for the job in the intensive care nursery over the intermediate care nursery, but that is just me. Others might have different opinions.

As for the commute, I commute about 40 minutes for my job, and I work three days per week (I am in a day weekend program), and I don't mind the commute. My commuting times are different from the rush hour times in my area, so traffic is very rarely a problem, and I actually enjoy the time in the car in the morning on my way to work as a way to ease into my day and listen to the radio and get my thoughts together. I don't like the drive home because I just want to be home at the end of the day, but what can you do?

You will find that the patient to nurse ration will vary according to unit. Most often, in our unit, a NICU assignment has a 2:1 patient to nurse ratio, while an intermediate assignment has a 3 or 4:1 patient to nurse ratio. If a baby is very unstable or very small, we sometimes have them as a 1:1, and very occasionally (basically just when we are beginning therapeutic hypothermia and only if staffing permits it), we may have a 1:2 patient to nurse ration. Some hospitals have 5:1 patient to nurse ratios for intermediate care, I believe, but we don't do that here.

Good luck...both sound like such great opportunities! I am sure you whichever one you choose will be a great experience and a great place to be!