NICU Before Moving to L&D

Jolie, BSN · Sep 9, 2017

I suggest you evaluate your job prospects based upon your clinical interest and a thorough evaluation of each facility's orientation, on-going education, mentoring and support of new staff, culture of professionalism, nurse to patient ratios, shift availability, pay, benefits, etc.

Either position will potentially prepare you for a long term career in Maternal Child Health as long as you are working and learning in a quality environment.

I hate to be a skeptic, but a new grad opening in L&D raises some red flags, especially if this is a community hospital setting and not a tertiary care center.

L&D is a highly sought-after clinical area. Many hospitals have current staff nurses working other departments on wait-lists for L&D openings, so these positions are rarely available to new grads. Some tertiary care centers have such busy L&D departments that they need large RN staffs and can justify hiring new grads and offering sufficiently long and thorough classroom and clinical orientation. That is rarely the case in small, community hospitals.

A level III NICU on the other hand, typically has a much larger staff than L&D and can absorb and adequately orient new grads much more readily. Managers of these units often prefer new grads over nurses with adult care experience, as it can be difficult for a nurse with adult experience to "unlearn" previous habits that are not compatible with neonatal care, something that isn't an issue for a nurse moving to L&D from a med/surg area.

Please investigate both of these offers carefully. Ask to shadow, or at least talk to some recent hires on both units. Learn the ratio of experienced nurses to new grads on both units. Learn the average tenure of the staff. If there are less than 50% experienced nurses working any given shift (2 years or more on that unit), that is a red flag for frequent turn-over, which will leave you without adequate experienced staff to teach and support you. Ask why this position is open and why they are willing to hire a new grad to fill it. These questions are a bit pointed, but an experienced manager with nothing to hide will be willing to answer and explain.

Good luck to y!ou

Amtrojan · Sep 10, 2017

Thank you for your input. Those are all great things to consider. For the L&D position, my school's OB tutor followed their new grad path and said she started precepting new grads after working there for 3 years. It is a tiny hospital that offers new grad programs in ER, L&D, and even ICU. I did my pediatric clinicals at this hospital. It is overflowing with Medical patients especially on the OB unit. In fact, the L&D department is at times understaffed. I also have a friend that works at the other hospital with the NICU offer. She entered as a new grad and has stayed for 5 years. She said that the NICU department will train me in everything I need to know. I will investigate each offer more thoroughly and see what happens.

jennylee321 · Sep 10, 2017

New grad programs in large NICUs are often known for being very extensive, like the previous poster said they are big units and can absorb the orientation cost. However I will say that I've only done NICU nursing and if I applied to an L&D job at this point I'd be great with the babies but not know much about the moms. And in reality L&D is mostly about the moms. The babies aren't there too long. It's one thing for the OB unit to hire you now and provide you a new grad orientation. But they may be more reluctant to spend the money providing you the same amount of orientation when you are no longer a new grad. I would need to be trained on CFM, labour management, obstetric emergencies, ACLS, ect. (sounds expensive for the hospital). In addition if I moved to L&D now I would have to reorient myself to taking care of adults again.

labordude, BSN, RN · Sep 10, 2017

I spent 9 years as a NICU nurse before moving to L&D. In some ways, it was very helpful as I had less to learn about the baby side of things and I already had tons of experience with breastfeeding support and handing the NRP part of delivery. In other ways, adults are a whole new ballgame and a baby still inside the mom is different than one outside. I also found that I got a lot of moms who were going to deliver preemies as if I was the preemie whisperer and could somehow will them to stay inside, though I'm actually more sure it was to be able to speak to what would happen with the baby at and after delivery. The preemie whisperer part is more fun though.

klone, MSN, RN · Sep 10, 2017

I hate to be a skeptic, but a new grad opening in L&D raises some red flags, especially if this is a community hospital setting and not a tertiary care center.

It surprises me that you would say that. I've worked at half a dozen hospitals around the country (both community hospitals and university affiliated high risk facilities) and all of them had new grad positions in L&D. I don't know why that would raise red flags?

klone, MSN, RN · Sep 10, 2017

OP, if you want to work in in OB/women's health, then you should take the L&D job. NICU is not OB. As others have said, as an L&D nurse, you spend very little time with the baby on the outside, particularly if you work in L&D at a hospital that has a dedicated NICU, because then typically the NICU nurses attend the delivery for the infant, and you will have little/no involvement with the infant transition.

NurseKait_11, BSN, RN · Sep 11, 2017

I think that if OB is the path you want to take, go with L&D. As other posters have said, NICU is not Obstetrics and you are mostly dealing with laboring mothers and the after-birth and spend little time with the neonate. Where I did my L&D practicum, there was a neonatal assessment nurse/ NICU that is assessing baby after birth and giving medications while my preceptor and I were taking care of the mom, but sometimes I was able to take vitals and give the shots just for a learning experience. If anything is predicted to be wrong with the baby, most likely NICU will be there to take over care of the baby and you;ll have little interaction. I hope this helps!

Good luck!

adventure_rn, MSN, NP · Sep 11, 2017

In addition to the above posters, I'd add that it probably wouldn't hurt for you to get some exposure to medical overflow patients if your end-goal is to be an adult NP (assuming that you're adequately oriented by your unit to care for those patients). Even as a WHNP specialist, some of your patients may have comorbidities. Gaining experience with a basic adult medical population might help you to be a more well-rounded WHNP.

Jolie, BSN · Sep 11, 2017

It surprises me that you would say that. I've worked at half a dozen hospitals around the country (both community hospitals and university affiliated high risk facilities) and all of them had new grad positions in L&D. I don't know why that would raise red flags?

Maybe it's this area of the country. I got the impression from the OP that the L&D position was in a community hospital setting. It has been my experience that community hospitals tend to have experienced nurses lined up waiting for these jobs, rarely, if ever hire new grads directly into L&D, and don't typically offer the thorough classroom and clinical orientation new grads need. It's typical here for nurses who desire L&D to start out in referral centers where high census and acuity combined with structured orientation programs make for ideal learning. They tend to work there for a few years, then eventually seek jobs in suburban community hospitals, closer to home. We see much the same pattern in NICU. Again, maybe that's not typical in other areas, but if a community hospital here advertised for NICU or L&D openings, we would seriously wonder why they couldn't attract experienced staff.

ssrn13 · Sep 11, 2017

As a WHNP student who has worked in both L&D and NICU, I would say if you are seriously considering WHNP in the future go with L&D. I absolutely loved working in the NICU, and the skills I gained there did help me as an OB nurse (and really, the NICU babies are just really fun :) ). But ultimately, my L&D experience has really set me ahead in my NP program compared to my other classmates who don't have experience in that field. In the long run it may not matter, but trust your gut. You may have time to dabble your feet in both areas! Best of luck to you :).

klone, MSN, RN · Sep 11, 2017

Yeah, I thought that was an odd thing to say. Sepsis, NEC, CDH, 24-weekers with intercranial hemorrhages, term newborns on head cooling 2/2 HIE from birth trauma. Not what I'd call fun.