post partum RN but wanting to work in NICU

Eris Discordia BSN, RN · Feb 27, 2018

Lower level NICU's tend to have assignments that are much lower acuity and lower technical skill requirement, but more babies to be responsible for...usually 4 to 1. These are busy because it takes time to PO feed/attempt to PO feed 4 babies on a set 3 hour schedule. Assessing 4 babies every 3 hours and doing the charting for each assessment and feeding every 3 hours. You also have lengthier parent education, because you are teaching parents how to hands-on care for and bottle/breast feed a fragile baby that usually requires care differently than a term or healthy newborn. This is fun...but it takes a lot of quality time from you.

High level NICU's still have these larger "feeder-grower" assignments as well (usually), but they also have higher acuity assignments that can be anywhere from 3 stable but intervention-heavier 3 babies to 1 nurse, 2 to one (like two less stable newish 26 weekers on bubble cpap with lines and fluids, titrating enteral feeds), or a highly critical 1 to 1.

A 1:1 could be an very unstable baby on the oscillator with a fentanyl and versed drip, a vecuronium drip, dopamine running as a pressor, in DIC getting multiple types of blood products.

It's really just preference...all of the assignments can be super busy, but the acuity of what you are doing will be very different. When I was in NICU, I was much more interested in high acuity, so I would not have been happy in a low level unit. I liked the technical aspect and ICU mentality.

That being said, there are also usually feeder-grower assignments in level IV's (unless they have a separate step down unit, which some units are large enough to have), so if you find acuity isn't your thing, they usually work with you to keep you in lower acuity assignments. But if you occasionally or more often would like to work with the sick babies, that will be hard to find those babies often in a low level NICU.

NICU's tend to be very open to training people without NICU experience. It sounds like you have some very good NICU friendly experience under your belt. I personally would go for a higher level NICU, because they tend to offer a huge variety of experiences and once you have come off of orientation, in my experience, they do *try* to work with your comfort level/preferences when making assignments.

Ultimately, only you know what you might like. When I did NICU for 8 years, I always worked high level NICU's until I did 2 years in a step-down NICU because I needed the hours/shift they provided. That wasn't my favorite.

Good luck in your transition!

llg, PhD, RN · Feb 27, 2018

I spent a lot of time in NICU's and ran NICU orientations for several years. How much exposure to level IV NICU's do you have? Are you really prepared to work in that intense environment -- deal with infant death on a regular basis -- and even more difficult, deal with the situations in which a baby doesn't die who maybe "should"? Are you prepared to deal with all the stress that the staff and families are under in such an environment?

If so -- and maybe you are prepared to deal with all that on a regular basis -- then go to whichever type of NICU appeals to you the most, the lower or higher acuity. But if you're not and/or if your idea of a NICU patient is "any baby on a ventilator," then you should probably avoid the most intense NICU's at first -- and seek a job in a level II or III nursing first. The level IV units are not for the faint of heart.