Pediatric CVICU experience, can I travel to NICU?

adventure_rn, MSN, NP · Dec 19, 2019

As someone who has worked in both peds CVICU and several different levels/settings of NICUs, I think it might be tougher than you're expecting.

Yes, peds CVICU has a large infant population. However, depending on the peds CVICU, they don't generally have a very large preemie population, which accounts for the vast majority of NICU stays. Preemies aren't just tiny infants; they're developmentally quite different, and consequently so are their assessments, cares, and medical complications. Unless your CVICU was actually caring for little kiddos (i.e. isolette-bound, less than 1500g, etc.), you may find that you're out of your depth.

In addition, NICUs tend to have a vastly different way of managing patients than PICUs and peds CVICUs. For instance, peds CVICUs love to push bicarb because they hate acidotic hearts; in NICU you almost never push bicarb because preemie brains are so friable that it causes IVH. Peds CVICUs follow and supp electrolytes religiously, whereas NICUs almost never supp electrolytes (they just adjust the next batch of TPN 18 hours later). Peds CVICUs allow their kids run a little cool (since heart kids tend to get so darned hot), whereas mild cold stress can literally kill a micro-preemie. NICUs let their kids brady/desat for 30+ seconds to several minutes before intervening by literally tapping a foot, whereas peds CVICU nurses would already have started compressions. NICUs tend to manage their kids in a very particular way which you've probably never been exposed to in peds CVICU, L&D or PP. I found the transition from NICU to peds CVICU really jarring, both leaving NICU and coming back, and that was with a full 3-month orientation in each direction. I get the sense that you may not fully grasp how different the patient management and nursing cares actually are.

Maybe you'd do better in a Level II setting that explicitly doesn't take kids < 32 weeks, since you wouldn't be caring for micropreemies. Still, I think that managers may be extremely hesitant to accept a traveler with no actual NICU experience for the reasons that I've described.

PeakRN · Dec 31, 2019

Another thing to consider is the massive difference in independence in between the NICU and PICUs, even if the latter cares for preemies.

We will take premies as long as they present with serious congenital heart disease, but our management is very different than in the NICU.

In the NICU small details are held with more importance than in the PICU, which often means that you have to talk to the NNP or Neonatologist before something so minor as even starting a new IV.

Whereas in the PICU nurses have a lot of independence. We have very extensive standing orders and may have replaced several different electrolytes, transfused multiple products, titrated or started multiple pressors, and even runt the first several minutes of a code without a provider.

More than just a matter of skill, the NICU and PICU have very different nursing personalities. Not only would I think about whether you could do NICU, but also consider if it is even something you want to do.