UK NICU?

babyNP., APRN · Apr 10, 2016

I have a UK license although I've never practiced over there. From what some colleagues have told me (I met an American in my overseas nursing class that was required a few years ago), the ratios are typical of a community hospital- aka not like California RN ratios. The nursing autonomy isn't as good as it is over here and from what I hear, docs mostly put in the IVs and that sort of thing- you need special training to put your own IVs in. Lots of good research goes on over there though, the USA decided to start using ECMO for babies on the basis of the U.K. trials.

Keep in mind that the pay is quite pitiful. Because it's the NHS, there is a national standard called "band rate." I think RNs are on about band 5 or 6 if I remember correctly. On the flip side you get the benefit of national health insurance plus a ton more vacation than the USA, like 4-6 weeks. Although housing is probably more pricey, food is cheaper there.

wensday, MSN, RN, APN, NP · Apr 12, 2016

Hi I'm a trainee ANNP, 11yrs NICU nurse practice.

It all depends on the unit you go to, there is a great variety of acuity and levels. So the NNU I work in is a big tertiary level based in a womens hospital. A tertiary level will vent, HFOV, iNO, pre and post op etc. Level 2/1 will stabilise a sick baby and transfer out to us. Then accept back once well out of the woods and stable- started some feed, time off CPAP, no new sepsis etc.

New nurses are on a band 5, onto a band 6 after a couple years experience. This again depends on the hospital, what the band change means, in smaller hospitals it means managing the NNU, our place its managing your room of 5 ITU babies.

Payscale- Agenda for Change 2

may1787, BSN, RN · Apr 12, 2016

No, don't feel bad, this is actually really helpful. Do the units have respiratory therapists? Are your shifts 12 hours? Are there private rooms or mostly still open bay style units? Do you self-schedule?

I have almost 7 years of level 3/4 NICU experience and have my NICU certification. I worked at one unit I really, really didn't like and I don't want to make the same mistake again so I really want to know what I'm getting into to see if it's a good fit, so all the information I can get is useful.

Coffee Nurse, BSN, RN · Apr 15, 2016

Background: I started as a new grad at a tertiary NICU in LA and was there for a few years, and for the past few years have worked in a central London tertiary NICU.

YMMV depending on what hospital you're in, obviously. In my experience, acuity has been roughly the same, but staffing not as good (I'd never have a vent paired in LA, for example, whereas here it's standard to have a vent and Vapotherm/CPAP or even an HFOV and a more stable baby). As you get into the grower-feeders, you can have up to four or even five babies per nurse. My unit still does paper charting, which is painful, especially in an ICU setting. Pay and equipment are a bit laughable compared to the US, but then, the average service user pays a lot less into the NHS than an American would for insurance, etc.

There are no RTs in the UK. MDs and NNPs intubate, RNs set up and maintain all respiratory equipment and do suctioning and neb treatments. (Theoretically our MDs are supposed to set up and change vents, but as we're a teaching hospital the nurses are often the ones doing this.)

Both units I've worked in here have done 12-hour shifts, self-schedule (although we did have a fling with electronic scheduling, which was a disaster), and have bays of 4-6 babies. Both also use q1h feeds to establish enteral feeds for preemies (i.e. you start with maybe 0.5 ml every hour, build up to their daily fluid goal divided into 24 increments, then gradually compress to q2 then q3h volumes), which are TERRIBLE.

I've felt generally as respected/listened-to as I did in the states, but that comes down to unit culture and the particular MD you're talking to.

wensday, MSN, RN, APN, NP · Apr 16, 2016

Interesting to hear your perspective as this is my norm :)

We've just started e-rostering and most units locally are too.

Nurses here do all vent changes as standard, the medics wouldn't have a clue.

With feeds, what is the 'q' and how would you do it differently in LA? ta x

Coffee Nurse, BSN, RN · Apr 16, 2016

The Q is from Latin, can't remember what it stands for but it means "every" -- 1 hourly = Q 1 hour (Q1H), 3 hourly = Q3H etc. We would start with maybe 1 mL 12hrly, then 6, then 3hrly, then increase volumes once the baby is tolerated 3hrly trophic feeds. Much less crazy-making than feeding every hour (usually with multiple babies), IMHO.

wensday, MSN, RN, APN, NP · Apr 18, 2016

We start with eg 1ml every 2hrs, then go up by 1ml every 8/12/24hrs depending on how small/sick/tolerant the baby is.

So a little AEDF/IUGR 24wkr would start on maybe 0.5ml/2h and go up to 1ml/2h 24h later.

Yesterday I started a 34wkr on CPAP 2mls/2h, going up by 1ml every 8hrs as resp condition allowed.

Once fully fed 2hrly, we go up to 3hourly when we think they can cope with the larger volume.

jnniemeyer · Aug 31, 2018

Hi Coffee Nurse - I love your story and I'm just wondering how you were able to move from LA to the UK? Did you have to apply for a work visa? I am interested in doing international nursing, but I'm not sure if it's possible. Thanks!

Coffee Nurse, BSN, RN · Aug 31, 2018

Hi Coffee Nurse - I love your story and I'm just wondering how you were able to move from LA to the UK? Did you have to apply for a work visa? I am interested in doing international nursing, but I'm not sure if it's possible. Thanks!

I recently returned to the US after living and working in London for six years. I've written about the experience in a few places, probably most extensively in this thread. Happy to answer any questions you may have, although the registration process has changed substantially (and gotten much more difficult) since I went through it.