NICU RN level 3 transitioning to Level 4

NicuGal, MSN, RN · Oct 23, 2016

A level 4 really only means they do ECMO, although in my state we are all classified as level 3.

Did you work somewhere else before or has your patient population changed? We aren't seeing as many micronates due to better pre delivery care, etc. We are seeing a huge influx of drug kids or bigger babies whose moms have more medical problems. Our average ventilator dependent kids has dropped dramatically. Right now we have 45 kids, 3 vents, 2 of which are post op. The rest are withdrawl or vapotherm/NIMV or gainer growers.

My suggestion would be to shadow in a place you want to go, see the unit culture. Maybe NICU isn't your cup of tea and something like PICU or Peds CICU would be something to look into.

vanilla bean · Oct 23, 2016

A change in facility might be in order. In my (not super vast) experience, the smaller community hospital-like settings tend to have the more stable preemies (those that are perhaps intubated for a short time or need a little respiratory support in the beginning but turn into feeder-growers). The big, high-volume birthing center type facilities and children's hospitals end up with a lot more patients fitting the description of the patient population that you're not enjoying working with. That's not to say that that's always the case, it's just been my experience in two different markets. So, do your research on the area; find out which facilities have NICUs, how big they are, and what types of patient populations they serve. Smaller NICUs won't have the resources (generally speaking) to keep the super complicated kiddos requiring lots of surgical interventions and/or complex long-term care.

TheCommuter, BSN, RN · Oct 23, 2016

Moved to our NICU Nursing forum.

adventure_rn, MSN, NP · Oct 23, 2016

I'm sorry the experience isn't what you'd hoped. Here are a few thoughts, some of which I hope are helpful!

First, if you can, I'd try to stick it out at the new facility. Having Level IV experience will make you very marketable, and it will definitely allow you to grow your skill set.

Secondly, if you're in a city that's large enough to have a Level IV Children's Hospital, I'm sure that there must be Level IIIs and/or lower-acuity Level IVs nearby. Perhaps once you've settled into your new job and city, you could consider taking a PRN job at another unit. That would allow you to get a feel for other local units, and get your foot in the door as a potential full-time employee if you find one that's a better fit. I've known a handful of nurses who started full-time at one hospital, took a PRN job at another, then became full-time at the second hospital while staying on PRN at the first. Your current employer probably wouldn't be super-happy (especially in your first year), but at least then you'd be guaranteed a full time NICU job.

Third, not all Level IV NICUs are like your unit. I moved from a Level III to a Level IV, and our acuity is almost exactly the same; there were even some surgical procedures (i.e. in-unit PDA ligations) that we could do at the Level III but not at the Level IV (go figure). I think one of the most pertinent factors is whether or not the hospital has an associated L&D department. If so, you're going to get a range of kids, including micro-preemies, late preemies, NAS kids, etc; they don't require Level IV care, they just happened to be born at a hospital with Level IV capabilities. Meanwhile, if your unit is part of a stand-alone Children's Hospital and doesn't have an L&D department, you're only going to get transports requiring Level IV care (namely specialty surgery or ECMO). The 'Level' may matter less than the nature of the unit.

Best of luck!