New Grad starting in NICU has a few questions

NICU_Nurse, BSN, RN · Jun 11, 2002

Originally posted by Heather333
I just got hired into a Level III NICU. What is the difference between Level II and Level III?

Hi! I work in a teaching hospital in both the Level II and Level III nurseries. This may be different than your unit ('s) but we float between the two; two weeks a month on Lev. II and two wks on Lev. III. Here's how ours is set up (I'm assuming that most of them are fairly similar). Level I nursery, obviously, is for healthy babies. Babies that are born term, with no major genetic defects or serious infections or difficulty breathing, etc. Level III is the unit for the sickest, smallest babies. On our unit we see a whole lot of babies born to moms who were using crack, heroine, or cocaine during pregnancy (sometimes up until the moment they go into premature labor), or alchohol abusers. We get a lot of underweight, underdeveloped babies (including those who are relatively healthy but simply small because mom was smoking all throughout her pregnancy and recieved no prenatal care). Level III is where all the babies go if they need to be on a ventilator, and it is where our isolation rooms are if the babies have a serious infection, like MRSA, that needs to be treated carefully. Level III gets lots of babies that were born at, say, 25-27 weeks, as opposed to level one, where babies are usually born between the 38th and 42nd week of pregnancy. Babies with serious heart defects, etc., all of these go to Level III. Our level II is considered a step-down unit (if a baby improves enough and is able to move from Lev. III to the Lev. II), or a transitional nursery (if a baby is initially brought to Level I but has trouble 'transitioning' to life outside of the womb). Level II typically has babies that may need oxygen, but instead of a ventilator, they may only have a nasal cannula or an OxyHood. II also gets babies that need antibiotic treatment, or have more than one IV drip, but don't need super-specialized care in the like the care they would get in Level III. Many of the Level II babies are feeder-growers, meaning that they have improved tremendously and need little specialized care, but because of their histories will stay in Level II to make sure that they gain weight and have no difficulties eating or keeping down food. In Level III, our babies may stay up to ten months or so, but in Level II, they can stay anywhere from three to five days to, say, two months before going home. I hope this made sense. I just came home from a night shift. ;>)

Heather333 · Jun 11, 2002

Thank you! That definitely helped me in understanding the differences. I'm a little nervous about starting out in the NICU but I cannot imagine being anywhere else!

Dez · Jun 12, 2002

Hello Heather333!I had a question for you.I have not started school yet.But I made the decision to become a nurse about 3 months ago.I know this is the perfect job for me.I have 4 year old twin boys who were in the ICU.So my question is,is how hard is the school?Ive never been very good in school because of moving around so much and home problems.I would like to know if Im getting in over my head

Heather333 · Jun 12, 2002

Dez,

Nursing school is hard. It is time consuming and a lot of work, but it is definitely worth it. Before you know it, you'll be finished and think to yourself "How in the world did I ever make it through?" I don't have any children, however I did plan a wedding during the first year of nursing school and got married between semesters. Quite a few of my classmates were moms and had young children and they managed just fine (very tired but did well). If this is what you really want to do, then I don't think that you will have any problems. It's hard work but it is definitely worth it in the end. Good Luck and keep me posted.

Heather

Dez · Jun 12, 2002

Heather333,

Yeah, I know thats exactly how I will feel. And I cant wait to start school. I just have to remind myself I can do just like thousands of others! For once in my life I know exactly what I want so Im going for it! Thanx for your response!

NICU_Nurse, BSN, RN · Jun 13, 2002

I agree, I agree, I agree!!! Nursing school was the best thing I ever did for myself. I had started out as an English major straight out of high school, and dropped out within four WEEKS!! because of various reasons, including the fact that I had no idea what I REALLY wanted to do. It took a very long time, a couple of college-major changes, and a lot of soul-searching before I decided on nursing, and when I did, it was like a revelation for me. I was absolutely, hands down terrified of starting school. I kept thinking, okay, I will never be able to remember all of those things. Those people are all smarter than I am. I am going to kill someone. I was completely intimidated. Add to that the fact that every one I had known had already recieved their MASTER'S degrees, and here I was contemplating what a 'friend' termed 'a TWO-YEAR degree at a little community college' (said snidely, I might add)! I got minimal support from other people around me. Thankfully, the people I cared about most (my parents and then-soon-to-be-husband) supported my decision and encouraged me to stick with it. I remember taking my pre-req's and thinking, Jeez, I can't picture myself actually in nursing school! It seemed sooooooo far away. When it was time to start, I thought I would vomit and pass out on the first day. I knew absolutely NO ONE in my program- I walked into lecture feeling like a total stranger and very lost and afraid. I met my closest friend that day, in our clinical group orientation. We both were so nervous, and were cracking semi-naughty jokes to break the ice! We now laugh about that over margaritas every other week. ;>P I think we all could talk about our experiences at length, over margaritas, of course, but suffice it to say that we ALL felt at least a little intimidated and a little insecure and a little unsure that we were making the right decision. It's what bonds us, it is what makes this board so successful. I mean, look at how all of us come together at this place to help each other and reassure each other. It's like a whole new family, one who painfully understands every night you spent with only two hours of half-sleep trying to finish a care plan that just HAD TO BE PERFECT OR YOU WERE GOING TO DIE RIGHT THERE ON THE SPOT. I miss the hell out of some of my classmates; nursing school was not only educational and interesting and challenging, but it was FUN. Congratulations on your choice. I hope that it fulfills you. Don't ever doubt that you are capable of succeeding in school- EVER. If you get down or get nervous, just think of yourself through your sons' eyes: Mommy is a superhero! She can do anything, and she will!!! ;>) Let their love for you empower you and know that you CAN do this!!! There are people out there that need compassion and love and tender care, and there is no reason in the world that you should not be able to give that to them. If you're feeling overwhelmed, remember also that soooooooooo many of us have kids or are married or broke or working on our second or third careers. I, personally, went through a marriage, a near divorce, a nervous breakdown (not mine!), a family death, near starvation, and bankruptcy!!! Here I am. Kristina B., RN. And I am not alone. And neither are you. ;>) GOOD LUCK!!!!!

Teshiee · Jun 13, 2002

Level II and III what Kristi states is pretty much the difference. I know in California in a level II we have ventilators, ocillators but we don't have cardiac kids or ECHMO which also would make it a difference between a level II and III. Either way you will learn so much. Asorb all you can. You will not regret it. I have been in NICU for 2 years and still have a ways to go. Whenever you get a chance to to the seminars and workshops they are so informative. I recently joined some organizations. Good luck please keep us posted on your progress.

Heather333 · Jun 13, 2002

Thanks Teshiee,

I plan on joining some organizations just as soon as I get settled and finish taking my boards. I was doing some research about Level II/III and found out that the hospital I will be working for is one of only three in the county that is Level III. I love learning and I love a challenge so I know that NICU will be a wonderful experience. I will definitely keep you posted.

Heather

NICU_Nurse, BSN, RN · Jun 13, 2002

In our level III, we do not do ECMO or nitrous oxide therapy; we transfer those babies to the Children's Hospital. Certain heart defects are also transferred, but we do care for just about every other type of baby. Our particular hospital is known for its perinatal drug abuse program and detox capabilities (we're in a large, poor, urban area) so I would have to say that most of the preemies we care for are in some way related to maternal polysubstance abuse. You'll find that your hospital may specialize in an area like this, and may transfer certain babies to other hospitals, like for ECMO therapy as Teshiee mentioned. Our level II, unlike hers, does not have vents or oscillators. Every hospital and region is different, but I echo what she said: You will not regret your choice, either way! In a way, I'm glad we don't do ECMO, because I have enough to learn as it is right now! Perhaps later on, as I've gained more experience, I'll begin looking to move to a hospital that does offer that. For now, it doesn't matter. On a slightly different subject, I also agree with joining professional organizations and going to as many workshops, inservices, and conferences as you possibly can. I've just recently joined NANN and The Academy, which not only provide discounted conferences and CEU's, but also provide periodic journals to read. Though some people may feel (and I am certainly not one of them!) that we are limited in our field, there are soooooooo many things that you can do to enhance your basic nursing education and not only make yourself more marketable in the job field but help your babies and their parents as well. Becoming a certified specialist in your field, becoming a perinatal or childbirth or postnatal educator, becoming a breastfeeding educator or a lactation consultant, becoming child safety-seat certified, as well as learning what you need to know to hold perinatal education classes at your hospital, all of these things can help you when you are ready. Good luck!

Heather333 · Jun 13, 2002

Thanks guys for the reassurance! It makes me feel better to know that someone out there has been in my shoes at one point or the other.

drmehlhorn · Jun 17, 2002

I also work in a large teaching hospital with a level III NICU and also a Intermediate Care Nursery. The difference here is that the NICU generally has the smallest and earliest babies, as well as cardiac, ECMO, and multiple drips (i.e. dopamine, etc.). With the limited # of NICU beds, the ICN gets lots of complicated cases pushed over. So we have lots of vents, along with post-ops, CPAPs, genetic, as well as the feeders and growers. Kind of confusing, but you get a ton of experience. Also, we hold on to the long term BPDers, usually until their 1st birthday.