peds heme/onc or mother baby if end goal is NICU

[Semper_Gumby]

Hi all!

I have wanted to work NICU since I was in my early teens. I am drawn to and fascinated by preemies, developmental care, the highly technical environment, etc. In nursing school I precepted in a small level III NICU which, unfortunately, did not hire new grads and ended up taking a position in a newborn nursery, where I worked for two years attending deliveries, assisting with breastfeeding, and gaining familiarity with healthy newborns.

I'm now looking for a new position and interviewed with a nice level III but sadly was not offered a position. I've since had a couple more interviews with a mother/baby (couplet care) unit and a pediatric hematology/oncology unit.

My question is this: if I were theoretically offered both positions, given that I am already familiar with well neonates, which would you recommend for someone who eventually wants to work NICU? Mother/baby would give me further experience with healthy newborns and breastfeeding assistance as well as learning the care of the postpartum patient, but the peds position would give me experience with higher acuity patients, central line care, and working with families who have very sick kids.

I'm kind of leaning towards the pediatric position because I think it will give me valuable experience outside of my current area and I'm concerned about pigeonholing myself as well. Plus kids are amazing, resilient people and I've always enjoyed working with them. I also think the experience with infusions and IVs will be helpful and translate more broadly than my current experience (very little IV experience, sadly). As much as I love working with newborns and their families, I think branching out might be invaluable.

Any thoughts?

[prmenrs, RN]

No question, mother-baby. Oncology will send your career in a way different direction. For all the reasons you mentioned, mother-baby is a better fit.

[llg, PhD, RN]

I'm not so sure.

If you didn't already have the newborn experience, I would definitely recommend the mother-baby unit. However, that job is not going to add much of anything you don't already have -- and there is a danger you could become stuck in that specialty if you don't some experience with sick patients. The peds oncology would give you the higher level acuity, etc. Are both units in the same hospital as the Level III NICU you want to work in? If not, I would choose whichever one is so that you get your foot in the door of that hospital.

I guess in the end, it comes down to a gut-level decision. If you don't get a NICU job within a couple of years ... and you have to develop another career path and goal ... which path would you choose? Would you be happy staying in mother-baby / well nursery for the rest of your career? Or would you rather become a peds nurse? (maybe Peds ICU, then to NICU ... or any other peds path)? Which "plan B" would suit you best?

[Semper_Gumby]

No question, mother-baby. Oncology will send your career in a way different direction. For all the reasons you mentioned, mother-baby is a better fit.

Even with my two years of well baby experience? Is it difficult to transition from pediatrics (even heme/onc) into NICU?

I'm not so sure.

If you didn't already have the newborn experience, I would definitely recommend the mother-baby unit. However, that job is not going to add much of anything you don't already have -- and there is a danger you could become stuck in that specialty if you don't some experience with sick patients. The peds oncology would give you the higher level acuity, etc. Are both units in the same hospital as the Level III NICU you want to work in? If not, I would choose whichever one is so that you get your foot in the door of that hospital.

I guess in the end, it comes down to a gut-level decision. If you don't get a NICU job within a couple of years ... and you have to develop another career path and goal ... which path would you choose? Would you be happy staying in mother-baby / well nursery for the rest of your career? Or would you rather become a peds nurse? (maybe Peds ICU, then to NICU ... or any other peds path)? Which "plan B" would suit you best?

I read your comments last night and took some time to think about them before responding--very insightful. I absolutely do not want to do well babies for the rest of my career and had a number of days where where I'd be in the middle of something and think "I really do NOT want to do this forever!" Though I do love working with families in the immediate postpartum period, I have always wanted to work with higher acuity patients (and the subsequent lower ratios). I do better when I can focus more on a smaller number of patients requiring more detailed attention than when I have to spread my attention to a wider range of patients requiring less in-depth attention to detail, if that makes sense. I like to know the ins and outs of my patients' conditions and care. I also found it to be a bit boring at times, if I'm honest (not knocking it at all, but I can see myself becoming rather complacent if I kept working with such relatively stable patients for a long period of time and that's not what I want). Long-term I'd like to learn how to manage patients with central lines, multiple lines/drips, vents/CPAPs, feeding tubes, etc., and do so with a high level of competence.

After giving it thought, if I couldn't do NICU, I absolutely would prefer to do pediatrics rather than mother-baby nursing. I loved my pediatric clinicals (on a progressive floor at a children's hospital) and would enjoy doing that sort of work in the future. And perhaps the pediatric experience would segue into a NICU at some point, as well. Both the positions in question are at the same hospital system as the NICU so perhaps either one would open the door to transferring at some point. Of course, I haven't heard back about either position, so it's all theoretical at this point.

Thanks for the insights, both of you. I appreciate your thoughts!

[llg, PhD, RN]

Based on your description of yourself, Gumpy, it sounds like NICU would be a good fit for you. (I worked NICU for 16 years, most of it doing NICU staff development.) The peds route also sounds like a good fit for you. So that it what I recommend.

Good luck to you! Please post how this turns out.

[babyNP., APRN]

If there is a NICU within the hospital system of peds/onc, I would go for that. Generally it's not too hard to move within departments after a year or two rather than as an out-of-system applicant. One of the children's hospitals i worked for actively recruited those within regular peds positions in the hospital for a "fellowship" in our NICU. You already have basic baby care down. Keep us posted on what you get/decide

[Semper_Gumby]

Based on your description of yourself, Gumpy, it sounds like NICU would be a good fit for you. (I worked NICU for 16 years, most of it doing NICU staff development.) The peds route also sounds like a good fit for you. So that it what I recommend.

Good luck to you! Please post how this turns out.

Thanks, llg! Currently waiting to hear back...figuring the holidays have had people in and out so I'm hoping to hear something later this week. Would love to do the peds position if possible!

If there is a NICU within the hospital system of peds/onc, I would go for that. Generally it's not too hard to move within departments after a year or two rather than as an out-of-system applicant. One of the children's hospitals i worked for actively recruited those within regular peds positions in the hospital for a "fellowship" in our NICU. You already have basic baby care down. Keep us posted on what you get/decide

All the positions are in the same hospital system. I'm not sure if the NICU is considered part of the children's hospital or not (I get the impression it's in the same building as the mother baby unit, whereas the children's hospital has its own building). Hoping for good news soon!

[Semper_Gumby]

Well, I wasn't offered either position, which is a bummer but it is what it is. I just got a call to interview with a labor and delivery department though! I've also applied to a few more NICUs so we will see what happens.

[Semper_Gumby]

Well, I went in for an interview with L&D and it turned into an interview for the mother-baby unit at that particular hospital. I was then invited to shadow one of the mother-baby nurses and did so (I'd been asked to come in scrubs for the interview). All told, I was there almost 4.5 hours and left with a big smile on my face! I should hear something next week. :)

There is a NICU at this hospital as well so perhaps in the future a transfer will be a possibility...

[llg, PhD, RN]

Good luck!

[Semper_Gumby]

I got the job! I start next month! I am so excited to be working with babies again, I've missed the heck out of them! :)

[llg, PhD, RN]

Congratulations!