Talk me through this...ER to NICU just for NNP opportunity?

babyNP., APRN · Feb 10, 2019

We cannot tell you what will be best for you, but I can offer that the longer you wait, for many people, the harder it will be to transition not only to the NICU as a RN but also to the provider role of being a NP. Your salary potential will also be less because you will get a new grad NP salary, which may be close to what you get if you have extensive RN experience.

I've seen very experienced NICU RNs struggle with being a NP because the mindset is very different and I've also had colleagues who had 20 years of bedside experience get paid the same or less as a new grad NP than they did as a RN. Neither issue is set in stone, just a trend I have noticed.

I can't speak for the hospital for which you are applying, but many units have more camaraderie on the night shift. You should try to get day shift later on if you can so you can learn more from rounds and procedures.

best of luck whatever you decide...

adventure_rn, MSN, NP · Feb 28, 2019

Hmm. NICU has a very, very different flow from ED. ED is great for people who get bored easily because no two shifts are the same, and you never know what you're going to get. NICU has much more of a routine; the cares are relatively predictable, and you can plan your entire shift. Even the littlest micros who are intubated and have a-lines tend to be relatively stable.

The good news is that you probably won't be bored at the start just because NICU is such a specific niche; it's very different from just about every other specialty, and there's a steep learning curve. Night shift still presents some good learning opportunities. Unlike with peds and adults, we don't just let the kids sleep through the night; you're still waking kids up to do assessments and give feeds every three hours. On the whole, day shift will present more learning opportunities, but night shift is a great place to start when you're new-to-specialty.

It's interesting that you liked attending deliveries; I always thought of being the admit/delivery nurse as being like the ED of NICU. You never really know what you're walking into, or what your shift will look like. Sometimes you've got tons of downtime, and sometimes four pre-term laboring women show up at the exact same time.

The downside to NICU is that if your favorite part was attending deliveries, that might not be an option for a while. It varies by hospital, but many units will have a delivery team with specialized training. In many places, it can take at least a year (or sometimes several years) before you have enough experience and seniority to join. Some units will train everybody to attend deliveries so they can attend if they're going to take the admission, but those units are less common, and you'd only get to attend deliveries every few months (since everybody is rotating through the role).

Now, as an NNP, you'd get a ton of delivery experience, since they'll attend every high-risk delivery (as opposed to bedside nurses, who rotate in and out of the role). If that's what gets you going, NNP might be a great role for you.

If you're interested in NICU, it can't hurt to give it a shot, especially if you think you'd be welcome back at your current job. Just know that the workflow will probably be a big adjustment.

Party_of_five, BSN · Sep 3, 2019

OP here. I finally reached out to HR and have a phone interview for a NICU position. I told them I prefer days and they have open day positions listed online so fingers crossed!

TiffyRN, BSN, PhD · Sep 5, 2019

Awesome that they have day jobs. In the unit where I work they pretty much only hire to nights. Sometimes nurse residents may go to days for while so we don't release 1/2 dozen brand new grads but eventually they rotate to nights. Our day list is roughly 2 years long.

As far as the flow, really depends on the unit. The one where I work usually keeps a census of 50+ so the NNP usually takes calls from 11p to 7a unless it really requires the Neo. Most nights there are frequent calls. And at least in the local practice, pretty much all the NNPs take 24hrs of call so there will be overnights.

PeakRN · Sep 7, 2019

The NICU is a very different pace than the ED. Certainly there is a variety between NICUs, but there is generally speaking more of the high school feeling drama in the NICU than in most areas of the hospital. While there is some aspect of teamwork you are going to have your patients, and the other nurses will have theirs. Not only can you not count on someone helping give your meds when you get swamped you will be hated if you give meds for someone else (or helping with whatever other task) without being asked.

You will have far less autonomy in the NICU than in the ED. Things as simple as getting an EKG, starting a second IV, or taking critical results are things that many NICU nurses can't do without talking to one of the NNPs first.

You also have to deal with families who are often a bit crazy, granted most people would be if they had a kid in the NICU, for months. You will be taking care of some of the same kids for months. You will be seeing the same general group of problems the entire time you are in the NICU. You will see the same and a very small number of drugs and procedures. Most of your day will be spent performing cares, meticulously assessing for the smallest changes, and charting.

I don't want to seem like I'm only talking poorly of the NICU. Our NICU has great nurses and great outcomes, and they do a job that I could never do. But as what seems like a pretty normal ED nurse I want you to have a very realistic view on what you will be doing in the NICU. If you have a chance I would try to shadow in the NICU before you interview or accept a job, preferably for at least 12 hours.

adventure_rn, MSN, NP · Sep 8, 2019

I think that @PeakRN makes some interesting points. I loved NICU, but it definitely isn't for everyone, especially if you say that you love the pace of the ED (which, IMHO, is the polar opposite of the pace in the NICU).

It's very interesting to return to this post after six months. I do think it's awesome that you're exploring NICU; doing so is the best way for you to determine if it's a good fit or not, rather than just theorizing. It's possible that you'll love it, or it's possible that you'll find it kind of repetitive and boring (more than likely, you'll land somewhere in the middle). Like you said, if it turns out that NICU/NNP isn't for you, there will always be jobs available in the ED.

I do kind of wonder what keeps bringing you back to the idea of being an NNP? Is there any particular reason you aren't interested in being an NP in the ED (it seems like there are a lot of diverse, interesting opportunities in that arena)? I ask because even though there is the occasional crazy delivery, the day-to-day NNP role can be pretty predictable and routine (from my understanding).

Also, not to throw a huge wrench in your plans, but I have to include this idea (now having spent some time in the PICU world myself): have you thought at all about pursuing peds and a PNP degree? It can have a lot of overlap with the NNP role (if you work in PICU), but in my opinion, it is far more diverse. In the PICU you'll see the whole gamut of age ranges and disease processes, compared to the relatively narrow spectrum of conditions affecting preemies. It may be a great option if you worry about being bored, since you'll see all kinds of stuff. While most NICU nurses stay in the specialty forever, the handful I've known who left to go to peds did so because they were bored by the NICU routine. With an acute care PNP degree, you can also work in a ton of different settings, like Peds ED, peds cath lab, peds surgery, same day procedures, outpatient settings, etc. In comparison, if you get five years into your NNP role and find that you're bored, you really don't have any options to move into a different job setting. Just a thought...

Party_of_five, BSN · Sep 25, 2019

Update:

Turns out NICU wasn’t currently hiring but L&D was and they really liked my ER experience. I did a shadow day and loved it! This might be the best of both worlds for me. Fast paced, anything can happen environment plus babies and NRP. They do L&D only with a transfer after 2 hours or so to PP. the NM also said that a few times a year we float to NICU (as an extra set of hands) and PP so that would be fun. I am looking forward to starting. Thanks for all the great advice.