KK7724

I have been a NICU nurse for 4 years. I recently had a baby in October of 2008. Lately (and even before my daughter was born), I am just burnt-out on NICU. Tired of nights, tired of the emotionally draining chronic babies, tired of ungrateful parents, just tired and ready for a change....too much stress and it's not making me the mommy I want to be. So, I decided to interview in the Main OR. I liked surgery during my nursing school clinicals. I also have 2 co-workers that left and went to the OR in our hospital's newest facility (Heart and Vascular surgeries). They LOVE it! I shadowed over there, but there were no jobs there. I got the one in the Main OR and I believe we have 21 operating rooms, are a Level I trauma center, teaching hospital, many many services etc. I will go through a 5 month orientation. I will scrub and circulate. I will tell my mgr towards the end of my orientation which 3 services are my favorite and I will spend 3 extra weeks in each of those. Now, the reason for posting....I'm scared now! I'm leaving something that is making me feel burnt out, but is at least familiar. I like to do a good job and I don't like feeling stupid. I don't particularly like being yelled at either! The nurse manager is really great and so is the educator, so I am hopeful it will be good. She already warned me it was going to feel overwhelming at first. I really really like the idea of working dayshift, working better hours, and really hope this is a good fit. With my background in Peds/Perinatal, do you guys think I can hack it??

Hi everyone... Well, I have decided that since my husband is in grad school, it is time for me to go back also. I have worked in two Level III NICU's in the past 2 years (we're military...had to move after my first year) The program I am entering is a completely online CNS program which allows the individual to specialize in Adult Health, Community/Mental Health, and Maternal/Child. Of course, I am going to choose the Maternal/Child route because it is basically my background and what I am interested in. I am worried about the program being completely online. I have never taken online courses before and wonder how a medical program/degree can be taught that way. How does one coordinate their clinical experiences? I am taking a 6 semester CNS program, so I will still be able to work full-time while I go. I work night shift, and the program I'm entering has a clinical affiliation with the hospital I work at now...so...do you think the night shift thing will get in the way?? My main motivation for doing this program is to give myself more options and to get away from night shift and working every holiday and weekends! Plus, I wouldn't mind an increase in pay! Advice, Thoughts, Opinions?? Will I be able to find jobs going the Maternal/Child route?? We have a clinical nurse leader and a neonatal educator here at my current hospital already (a large university hospital) Would I have better luck at a private hospital??

Hi, I recently married my active duty Air Force husband in August. We PCS'd to Charleston AFB and I'm working at a large university hospital in the area. I graduated college May 05' and he went to Kunsan AFB the whole first year I started my career. Of course, being a new grad, I worked straight nights and that was fine for me...then. Now that I'm married though, I am feeling burnt-out with the whole hospital atmosphere and most definitely the night shift thing. I have heard that the clinics on base hire civilian nurses, but I've never used base healthcare and I'm not really sure what their duties are. I know they work a schedule that I am desiring. What's a good way to get my foot in the door?? Will the pay be better?? When we PCS again, will I be able to find another civilian nursing job at our new base?? I have a lot of questions and I will be very thankful to anyone who responds. Thanks, -Kristina-

Also, Dash Monitors. These are sooooo nice! Man, I miss my old hospital!! I miss the confidence I used to have, since now I'm at a place where my way of taking care of my babies is not "per ____ protocol".

"Little Suckers" brand yankuers and nose suctioners. Never realized how good I had it at my private Level III; now working in a university hospital.

You know is it the whole country right now? I am struggling to find something in South Carolina myself. I have an opportunity to work in PICU, but I agree with you--I love NICU. I would only take PICU until a NICU came open....is this wrong? I need to keep my vent skills current. Plus, PICU might make me a better NICU nurse??

Thanks Gompers, I'm glad to hear you said try PICU..because that's what happened! The NICU was completely staffed (it must be good!)...and I applied for a PICU position. The nurse manager called and she is wonderful! She was thrilled that I had ACLS...but things didn't work out...I was supposed to be moving in June...but my DH's job won't let us move until the end of August now.....I emailed her to let her know...she said something about possibly being able to "overhire" and that she could be selective about filling the positions. That sounds good huh?? :)

The neos do come in for admits and they insert their lines. They wait for the x-ray to come back. They're called if we have to do a code...they have to pronounce the baby dead in that unfortunate event. I agree with you about the too much autonomy thing and if I didn't feel comfortable in what my charge nurse told me, I would go over her head and call the neo. I have done that before. I chart books on my babies! Very very defensive charting. Everything we're doing is legal. We do have legal teams at the hospital. We are joint commission certified and they have been in the area, so we're probably due soon to be surveyed. I do have a lot of issues with the unit, but I just have to be very careful. Afterall...I get to move out of state soon and go to a university children's hospital (hoping there are NICU positions open). I have only been out of school for 10 months, so I question everything and I chart extensive notes. Supposedly...from what I got from Education when I went through NICU Hospital Orientation (this is before going to orient in the unit). We were told about needle aspiration of the chest in an Emergency situation. Basically, the state covers you if it's an emergency only and absolutely no physician around or NNP....(like a transport for example). I know I never ever want to have to needle a chest. That is 100 miles beyond our scope! I think I have only heard of a transport nurse having to needle a chest en route and that was her only one ever.

I'm sorry. I forgot to post that we do have transport nurses. We have an on-call Neo and a backup.

We're a regional Level III...so we do transports and pick up babies that are as far as two hours away. I looked some stuff up: "Although the TIOP designations provide a general framework for classification of NICUs, both interpretation and application vary widely within the United States, and no national definition exists."http://pediatrics.aappublications.org/cgi/content/full/114/5/1341

We're a Level III

I think when I originally replied to the original poster....I was a little stressed with things in our unit. Also....I think you might work in same unit as me BamaGirl and I know your opinion is a lot different from mine???....I wish to clarify a few things.... First...only the experienced nurses will intubate the child if necessary. I won't lie...I have seen countless admissions where the neo is present and he tells the nurse to intubate the kid. If the child is going to have surgery on their eyes for example....the nurse will intubate. I haven't taken NRP yet, but I know that even if I had it, I wouldn't be expected to tube a baby. A lot of times when your baby is doing something bad...a herd of people will rush over and take over most of the time. This is good and bad for the new learner. Also...about "Reading x-rays". No we don't have to "read" them...for lack of a better word I said "read" at the time. Yes, the radiologist writes his comments on there, but we have to count how many ribs are expanded and make sure the ETT is where it's supposed to be. If not...we are expected to push it in or pull it out a little bit. I will tell you....I cannot tell where PICC lines and UAC's and lines are on the x-rays. I am terrible at this. I am also really bad at looking at the KUB's. I usually will just take mine to the charge nurse and let her look at it and tell what she thinks. Seriously...the radiologist might write: "Questionable NEC? Free air. ETT High or ETT Ok". It's not like he writes a detailed report that comes with the x-ray. He comments on what he sees in the form of "ETT Ok", NEC ?" etc. Also, we don't have an in-house Neo or resident or NNP. We have a few NNP's in our unit, but they don't function as such. We have to get several opinions, go to the charge nurse, see if anyone else needs a doc and then make the call. Sometimes we wait till 6 a.m. to call for small things we want him/her to know. Two weeks ago, I had a two-vent assignment. One was a new admit that was a micro premie and on minimal stim. She had issues from the start....hyperglycemia, low BP, needing second dose of Survanta. The other child was a 3 month old active vent that did not receive much sedation all day long! My charge nurse was having to help me a LOT! I was the only person in the room with two vents. Another nurse had two CPAPS....someone overheard me say this and told the nurse who had made the assignment before she left. She said, "It's just two vents!" The evening shift charge nurse sympathized and said the assignment was stupid. Last week, I was in a room with another nurse who had a two vent assignment as well. So...our assignments are heavy...yes. We give survanta without a dr. present. I think this is okay? I don't know. Every hospital is different. We have respiratory therapists...they don't usually tube although some will if the nurse doesn't get it. 1 or 2 of them might adjust the vent....the main ones I work with just hand the blood gas reading to you. I don't really mind the vent settings deal....most of the babies have parameters on their bedside of a range of acceptable pH, CO2, and SaO2.... I know most of the time if they're blowing off too much CO2, to go down on the rate, and when to go up etc.... If I'm confused about a gas, I ask the RT or another nurse and the ultimate--take it to the charge nurse. Our unit does have a lot of autonomy for nurses and we take really good care of the babies. I do agree that we do a lot of things that most nurses are not expected to do. As you can see from BamaGirl's post, she likes the opportunity to be hands-on and get experience from these things. I think I am just a little bit more timid about it. Also, I realize I will probably have to move around a LOT because of my DH's career and the fact that I'm a new nurse...I just want to know what to expect at other hospitals. Hope I cleared things up a little bit better than before. I hope I didn't make my unit look bad. We all work hard and we could work harder on teamwork....sorry...I'm just a little bit opinonated, although I whole-heartedly admit I'm just a nurse of 10 months....I'm still very very very green!

I am a a NICU nurse of one year. (Level III). I am moving out of state to a great city with a university children's hospital. Their NICU sounds fabulous...however...there are no positions open. There is an opportunity to do an RN internship in PICU. I just want some advice on going to this type of unit. I know that in PICU I would get a broader skills range and be able to keep my skills current on vents and critical care...etc. I am nervous about the age ranges of the patients and that I won't love it as much as NICU. I think the chance to get into an internship program and really get molded and shaped into a great PICU nurse is a very great opportunity, but I am scared....should I just go for it? I think even if I decided to go back to NICU that I would go back as a much better nurse?? Please give your input and opinions. Thanks.

Thanks for your advice about PICU. I am definitely interested and I thought that it would give me a broader skills range too! I will check into the committment involved. I know at my current facility, it's 6 months. I'll keep ya updated! Thanks for the encouragement. :)

Well everyone... Just wanted to type a quick update. I did call the Nurse Manager at the hospital in Charleston. She said that they are fully staffed at the moment and have no positions open! I prepared and wrote a list of questions down. I asked her and she was very nice and answered all my questions. It is the dream place to work! Kangaroo care, in-house residents and NNP's, great patient/nurse ratios.....university hospital etc. I am bummed! I asked if I could still email her my resume` and she said yes. I don't know what to do. I can't see myself doing anything other than NICU....Level III Nicu.....i'm not sure what to do. There is a pediatric ICU position open....maybe I could do this until a position became available?? I don't want to lose my skills and I have to hold down a job....the nearest Level III Nicu besides the one I want is an hour and a half away. My fiance does not want me to do this...and I understand why. .......bummed!