Thinking about a change.

SteveNNP, MSN, NP · Dec 28, 2007

I am currently a RN in Med/Surg and have been practicing for 4 1/2 yrs. I am looking for a change. I feel like I would have a unique style of nursing to bring to NICU, because I care. I think it would be exciting to nurse a child from being nearly fatal to well enough to go home with there parents. I am just tired of the stress of MS. I see the NICU and L&D nurses leaving from there shift smiling. Meanwhile, the MS nurses are sore, feet hurting, HA, stressed out:uhoh3: and leaving late more often than not. Please help me.
--What advice can you give me?
--Do you think my Med/Surg experience would be helpful if I transfer to NICU?
--Is there anything I need to know before I decide to make that change?

First of all, NICU nurses also suffer from sore feet, headaches and stress ;>P We are a critical care unit after all!

MS experience will of course be helpful, as you have (hopefully) learned time management and critical thinking. You will have to learn pretty much everything else from the ground up, which is what we all did when we started NICU, such as ventilator management, critical med drips, etc. it'll be a steep learning curve, but with a good orientation you can do it!

There's still lots of stress, heartache and hard work, and you need to really want to do NICU nursing. Maybe you can arrange to shadow someone in your hospital's NICU.

BittyBabyGrower, MSN, RN · Dec 28, 2007

I have precepted several girls from med surg and while you have learned time management, ours is very different. I have found that many of them want to go back and back-chart where as we do it right at the bedside and don't wait. Also, med calculations are very different, we don't have a standard "pill" or pre-made injection to give. Like Steve said, it is a steep learning curve as going from adults to neonates is a huge leap.

That being said, you have to be sure that this is what you want to do. Ask the unit manager of the NICU if you can shadow for a shift to see what is done in there. I can tell you that we don't all leave there on time and smiling as we also will be running our butts off for 12 hours sometimes. I've had 2 people leave and go back to their home units after being in orientation for 6 weeks...there parting comment "I didn't know it would be this busy and I thought with only 1-4 patients it would be easy. After all, they are just babies!" Another one commented on her 4th day "Are we going to be on our feet this much all the time?" :uhoh3:

llg, PhD, RN · Dec 28, 2007

I've spent 14 years doing orientation/staff development in a couple of different NICUs in different parts of the country. As other posters have said, it is a very steep learning curve and many MS nurses who think they'll "give NICU a try because they need a change" end up not staying very long because they can't handle the emotional stress of having to start over in a new field. They feel as if the rug has been pulled out from under them and that makes them feel insecure, unsafe, and scared. They go overnight from being an "expert" to being a "beginner" again and that's not fun for most people.

If you are prepared to endure that tough period of transition -- and understand that you will be "uncomfortable" in your practice for at least a year -- and still want to do it, they by all means, give it a try. I've known people who have done it and been happy that they did. But don't underestimate how difficult it will be -- difficult in ways you may not expect as you will have to re-learn a lot of pbasic ways of doing things.

elizabells, BSN, RN · Dec 29, 2007

Things you might want to know before you make the switch:

1) You will have to learn all new lab values

2) You will have to learn how to put in an IV/draw blood all over again

3) You will have to learn all new med dosing calculations

4) Your feet will still hurt, your head will still hurt, and you will still cry in the clean utility room sometimes. You will not always leave work smiling.

and to me, right now, the most important,

5) At some point in your career, you will have to wrap up a baby you thought you could take from nearly fatal to going home, hand it to its mother, and say the words "I'm so sorry."

If you want to do NICU because you want to do NICU, more power to you, you'll be great. But if you want to do NICU because you think it's easier or less stressful? It's an ICU. We don't play with babies all day.

RainDreamer, BSN, RN · Dec 29, 2007

It's an ICU. We don't play with babies all day.

Exactly my thoughts. I'm not saying that's what you're thinking, but I think some people think that is what we do.

Some people may think it's easier than med/surg because we don't have 8 patients and we're not running from 8 different rooms answering 8 different call lights with 8 different people wanting something right NOW.

We don't have to deal with demanding patients that are talking back to us, but we have to deal with parents that are going through hell, as their child is very sick and may not live and burying a child is something that shouldn't happen.

I do walk out of work sometimes smiling because one of my babies that has been there for months is finally able to go home.

Yet sometimes I walk out of work crying with an ache in my heart because a baby that has been there for 6 months has finally died, and he needed to die a long time ago. And I feel like a bad person because I am glad he finally went to heaven.

elizabells, BSN, RN · Dec 29, 2007

Yet sometimes I walk out of work crying with an ache in my heart because a baby that has been there for 6 months has finally died, and he needed to die a long time ago. And I feel like a bad person because I am glad he finally went to heaven.

No kidding, Rain.

And it's interesting how people who don't work in the NICU perceive us. I nearly got INTO it with a peds onc nurse a couple of weeks ago. We had a neuroblastoma kid who we transferred to the onc floor once he was stable enough. They don't have the facilities to store breast milk down there, so they kept it with us. So this nurse comes up to get it, and I'm showing her where it's kept, and she just goes off. Lays into me (who, by the way, never took care of this kid) that we should tell parents that once their kids leave thay can't come back to the unit. Says the parents are complaining about the nurse/patient ratios because on HER floor, they don't have time to "babysit". Her word. If I hadn't been so shocked I'd have told her what was what. The best part is that I had an ECMO that night, and was sitting at that bedside when she found me. How does anyone look at a neonate on ECMO and assume we're just babysitters? Bizarre.

BittyBabyGrower, MSN, RN · Dec 29, 2007

We get complaints from parents all the time when they are transferred to the comp care floor. We do tell them in advance that it isn't like the ICU and that the nurse taking care of their child will not be in the room as we are. I would have told that nurse to stuff it. There is always a rift between ICU and floor nurses, at least where I work there is. They tell us that we spoil the parents...what ever.

We don't want to discourage anyone from making a change, but you have to make sure this is what you want and that you know what you are getting into. Babies aren't just little adults, they are a breed of their own!

Sweeper933 · Dec 30, 2007

Yet sometimes I walk out of work crying with an ache in my heart because a baby that has been there for 6 months has finally died, and he needed to die a long time ago. And I feel like a bad person because I am glad he finally went to heaven.

The day that I don't feel horrible when a situation like this happens - it's time for me to find a different part of nursing to work in...

TiffyRN, BSN, PhD · Dec 31, 2007

Since you've had plenty of dire warnings; I'll take a different stance. I went to NICU after 9 years of med/surg/telemetry. My feet don't hurt nearly as often, though they do hurt sometimes. I do seem to have more headaches from the stress. I take my lunch break WAY WAY WAY more consistently since I transferred to NICU, having only missed 2 lunch breaks in over 5 years (my stint in NICU so far).

My back and neck don't ever hurt anymore. I have time to read books now at work. The rest of the folks may give you warnings that not all is happiness and contentment, and it really isn't, there is a lot of stress (remember, I have more headaches), but my body is not suffering overall like it used to. Yes sometimes I might spend the whole shift on my feet, but I'm not fighting a 200 pound incontinent grandma 6 times to change dirty linen and my body knows it.

No, it's not all happiness and smiles, but I do leave my shift with a smile on my face more than half the time whereas before I left feeling defeated about 90% of the time. The skill set is very different but my time management skills did transfer over and were an asset to me when I started NICU. LLG mentioned something I did experience, which was I did go from being an "expert" to being a "novice" and that was a little hard to take, but I was in a supportive unit, so not a big deal.

Also in my unit I get to have a little bit of choice because we kind of split up the acuities. I tend to take more the feeder/growers or level 2 kids and don't really care to have the admissions, micros or high frequency kids. You don't get this choice in all units and is one reason I'm probably staying with this unit long term.

So I say it's worth a try as long as you go in with your eyes open, do the thing where you follow a nurse in NICU for a shift, that's a great idea. It's not all cuddling babies, but a little cuddle now and then goes a long way. . .

Sweeper933 · Dec 31, 2007

It's not all cuddling babies, but a little cuddle now and then goes a long way. . .

No kidding... :-)

Nothing better after a horrible shift than coming in the next shift and doing nothing but feeding and holding babies all night...

perfectbluebuildings, BSN, RN · Jan 1, 2008

Elizabells, while that nurse was patently a jerk to express herself to you that way, I think it is a byproduct of how difficult a lot of parents find it to adjust from ICU to floor nursing (not just NICU, but PICU too) because they have to do things like change diapers and feed their son or daughter, etc. and do not often have to do that in the units, or else we cannot be at the bedside as constantly, and often take it out on the staff "well in the unit they did it this way", in a way that clearly shows they feel that the nurses on the floor are inferior.

However, of course as adults we learn to just deal with that- adjust our care if need be, roll our eyes privately if need be, and move on!!! Not go to the NICU and insult people!!! You all work so hard and if she thinks you are just babysitting... yep I don't get that.

Sorry, I don't know if I really got my point across, and I know I am off the actual original topic so I apologize, I am sleepy... Thanks for listening.