Neuro ICU to NICU

[iggyalligator]

Hello there,

This is my first post. I am currently working in a neuro icu, and have been working here since I was a pct (pct for 1 year then hired on as a new grad, have been working as an RN for about 18 months). I recently got an opportunity to interview for a nicu (neonatal) position. I am having a hard time deciding if it is the right choice for me. There have been so many cutbacks in my institution that makes me want to switch, and I have about an hour commute.

The nicu position is at the same hospital I currently work at. I never used to mind the drive, but working with short staffing and few good outcomes (hemiplegia, trach/peg, not many full recoveries due to the nature of neurological injuries) makes it hard to go to work some days. I love critical care, and I did a shadow in the nicu while in nursing school that really inspired me to become a critical care nurse. I love babies, but am nervous as I have little to no experience caring for them.

I am also nervous about switching from one extreme specialty to another. I am just now feeling like I have a good handle on anticipating patient issues and am worried things will be totally different in neonates vs adults. I also don't want to limit my options for future growth if I go to nicu (have considered going on for np or crna).

And then there is the drive. I have the option to interview for a prn cardiac Cath position that is a half hour closer (same system). I just don't want to switch departments and find the same problems (I know there will be some drama, that is the nature of the beast of working in a hospital), as well as being the new one on the unit with so much to learn.

Sorry for the long post. Any input you have will be very much appreciated!

[NICU Guy, BSN, RN]

The key to longevity and not getting burned-out in a job is finding a job that feeds your soul. Which job do you feel will be most rewarding/satisfying to you? Going to work where most of your patients will not have a good long term outcome can drain your energy. There are times when NICU patients will not have a good long term outcome, but as a whole most discharges have a good long term prognosis. There are many reasons that I will stay in NICU my entire career. Moving a 3 pound baby is far easier than a 300 pound adult and I would prefer to change an incontinent baby than an incontinent adult are just a couple obvious ones.

[iggyalligator]

Thank you for your thoughts. This is my biggest reason for wanting to go to nicu. As a nicu nurse i would have a huge impact on the long term quality of life for these little people, and seeing that be a positive, healthy outcome would be wonderful.

I have dealt with my share of death, but dealing with baby deaths I'm sure is unimaginably horrible and difficult. Knowing most of these babies will recover is a blessing.

Thanks for your response guy��

[adventure_rn, MSN, NP]

I second Guy in Babyland, the majority of NICU kids have very good outcomes (unlike the adult population in general). I've found it to be one of the most uplifting places in the hospital, because you get to be a part of little moments of joy (i.e. putting a kid skin to skin, celebrating a baby coming off of respiratory support, a baby taking a full bottle for the first time). Bad outcomes are terrible, but they are relatively rare (depending on your unit).

Just a couple of other thoughts: Any unit that hires you 'new to specialty' will recognize that you don't have a background in babies, and will train you accordingly. You are right that babies are totally different from adults. There is a steep learning curve, but within a few months it will become second nature.

My second thought is that depending on your unit, NICU may or may not actually be true 'intensive care' much of the time. Some NICUs have separate 'intermediate care' step-down style units, but most are integrated. One day you may have a 23-weeker on the vent with drips and an art line. The next day you may have two 'feeder-growers' and a term NAS kid. I personally love this mix: the high-acuity is exciting/challenging and keeps your skills up, and then you can cuddle/rock/feed babies in between to decompress. However, if you specifically thrive in the intensive care environment, you may get bored or frustrated getting stuck with low-acuity kids (unless your hospital is a large referral children's hospital, with a separate intermediate care unit).

It sounds like you have to prioritize what is important to you: location vs. specialty population vs. skills mix.

I'd ask if you can shadow on the various units, if possible. It might give you a better sense for the unit culture and nursing care.

[meanmaryjean, DNP, RN]

Also: NICU patients never try to climb out of bed. They're 'confused', but in the best possible way! :)

[iggyalligator]

Thank you for your advice. I had my interview on Friday and just finished shadowing. I feel both went really well. I like it a lot, from what I have seen, and there is a ton of room for growth at this hospital. At this point I am just nervous to relearn everything!