Unsure about going from NICU back to Adults

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So I have been an RN for 2 1/4 years now. In nursing school I worked on a Stepdown Unit - first as a unit clerk (one year), and then as a nursing assistant (about a year and a half). I started my first nursing job on the same Stepdown unit and worked as a nurse for 9 months before starting a position as a NICU nurse on a level III NICU. In nursing school, my goal was to always work with babies and to go into critical care. I thought the NICU was going to be my dream job. When I got the job, I was so excited. I prepared so well for the interview and was so proud to call myself a NICU nurse. Orientation was extremely tough, I cried all the time and really had to prove myself. My confidence took a huge hit. Especially since I had to change my habits from working on an adult Stepdown unit for three years. Now, here I am, one year and 7 months later still working in the NICU and I am still unsure. I can't say I am happy with my

job. I knew from the beginning that I had a lot to learn and that I still do, but I thought by now that I would have gained more passion for this specialty. I haven't. It's hard to tell the reason why I am not enjoying it because I am absolutely hating the night shift schedule, that sometimes I wonder if it affects the way I feel about my job as a whole. The night shift schedule has been affecting my personal life in so many ways that I feel like I can't function optimally anymore. Also, the nurses on the unit are extremely cliquey. Many of these cliquey nurses are hard to get to know and they are also in managerial positions, which makes it extremely difficult to to communicate my issues to someone without putting a "target" on my back. Once you get on someone's bad side, it seems like they turn all of their friends on the unit against you and you feel isolated and alone. I've seen it happen to other nurses (especially new nurses) on my unit. And lately, I have been just feeling less compassionate, which I really don't like. I have always prided myself in my desire to help my patients, to be thorough in the quality of care I give, and in how detailed I assess them. So now I am asking myself, should I stay in the NICU or should I go back to adults? Another thing I've noticed is that I am not getting the critical care aspect that I wanted when I applied to this job. The unit is capable of managing 23 weekers on oscillators, term babies being cooled after resuscitation, and other kinds of very critical babies; however, we don't frequently have an abundance of them, so I've seldomly had nights where I really enjoyed the critical care aspects (which is what I have yearned for), steady work, and monitoring of neonate on multiple gtts with multiple central lines. More than likely, I'll receive infants on CPAP or high flow nasal cannula that are stable micro preemies who need to just grow, regularly episode (as preemies do), and stay stable. A reason i also consider going back to adults is that I miss being able to connect with my patients and talk with them. Thinking back, I feel like I did more for them. I feel like I felt more reward when I would see them smile after something I did for them. I'm not saying the NICU isn't rewarding, it is, but I just felt it more in the adult world.

Sorry for the long post, but I feel my situation is very complex and I am so confused. I felt the need to explain exactly how I feel. Any advice is welcomed! please please please HELP

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Specializes in Med-Surg, NICU.

I could have almost written this post.

Like you, OP, I started in adult med-surg. Worked there for eight months and went to a level III NICU. I have been in the NICU for 1 year and 10 months. I love working with the babies.

However, my coworkers are VERY cliquey, and I notice that some specialties attract catty people more so than others, NICU/maternity/L&D being some of them. I have learned to keep my head down and focus on the precious babies and families who need my care, and I have focused on my life outside of work via family, boyfriend and travel. It can be isolating sometimes, but sooner or later, the cliques will dissipate or the catty nurses will realize that while other coworkers have moved on to better opportunities and work environments, they will be stuck, not growing personally or professionally.

I also was taken aback by the lack of acuity. Oftentimes, on my unit, we have feeder-growers, bubblers, kids on nasal cannula...occasionally, I will take care of a vented kid, have had an oscillator only a handful of times. I have never had any baby on vasopressors, nitric oxide or an insulin drip. I have found that most of the critical babies go to a selected "clique" of nurses.

That being said, the vast majority of NICU patients aren't going to be critically ill. If that were the case, the mortality rates would be extremely high. Also, when a baby is critical, the prognosis is poor, and they end up graduating into the PICU. Pretty depressing, if you think about it. Have you asked for higher acuity? Is going to deliveries an option?

I kept my adult med-surg job PRN and I am glad that I did. I am using all sorts of skills and feel challenged. Is finding a PRN med-surg job an option? Also, have you considered trying to go to days? I worked nights for over a year and have been on days for eight months, and I must say that while I miss the night shift diff and the laid-back atmosphere of nights, I don't miss sleeping through my days off.

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Thank you so much for commenting! I feel that when we do admit the more critical babies, they do try and give it to a newer nurse with less experience, as long as a senior nurse is on to help with anything the newer nurse needs. I have had babies on pressors a couple times. I've only ever had one baby on an oscillator who was extremely septic and ended up passing. Even though it was sad, it was still one of my favorite experiences on the unit because I felt like an actual ICU nurse because there was so much going on and so much to learn.

We do have to go to deliveries, depending on which assignment you get and if you're open to for an admission. However, I really don't like that aspect of the job at all, it is my least favorite thing because oh never know what that phone is going to ring and if you're going to have to stop doing care to go up to a delivery. You also never know what you are going to get, it could be an easy term baby that is a possible chorio or it could be a 25 week Mom walking in off the street ruptured. I just am very type A and don't like the whole "fear of the unknown" aspect. I'm very thorough and detailed and I like to pay as much attention to my assignment as I can, which is why I yearn for the critical assignments.

I have asked for a day shift position, but I have to wait at least until the spring I was told, because my manager needs to find a replacement. The replacement would need to be hired for nights, go through orientation, and off be off orientation before I can transfer to days. And I just don't know if I even want to wait at this point. I'm not sure if I'll even be happier with the job on day shift. Other options I was thinking were that there are other pediatric hospitals in the city with NICUs but none are hiring for a day shift position.

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Specializes in Pediatric Critical Care.

Have you ever considered PICU?

NICU, while definitely being a critical care environment, also tends to be a lot of the same from day-to-day. They almost are all preemies, they almost all have feeding issues, they almost all have lung issues. Sure, there are more specific diagnoses like CHD, CDH, renal anomalies, genetic syndromes, etc. But overall, its a lot of just helping them survive preemie-hood. Assess, change diaper, feed, don't touch in between.

In PICU, you will get babies, kids, teens, even some young adults (for instance, a 20 year old with CF or other chronic disease who is still treated by peds doctors for whatever diagnosis). You will see respiratory disease, infections, oncology, neurological disorders, overdoses, trauma, and everything else in between. Depending on the acuity of the unit, you will see lots of sedation and vasoactive gtts, vents, oscillators, VADs, ECMO, renal replacement therapies, etc. It might give you that mix of seeing both young patients and older patients, and also giving you more variety to prevent feelings of monotony.

Narrowing your search to only day shift positions can limit the opportunities available, but I get it. You could also look for float staff positions at pediatric hospitals - some even have float pools specific for the critical care units, so you would get to do NICU and PICU and really get a lot of variety.

Good luck.

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In general terms, a year is long enough to know if you enjoy a specialty.

And yes, some units are hatefully cliquey.

You said you're not in with the in crowd, but are you actively disliked, or just not included?

The reason I asked is if you're being targeted, then you want to try to get out before they fire you. Otherwise, you can take your time with your decision.

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No I am not being targeted at all. I don't have any personal problems with anyone and I think I am mainly liked by eveyone, but it's just the environment some of the people create that can be awful - especially some of the nurses that are in higher positions. It's weird, because sometimes I'm fine and have a couple of people on that night that I am closer to and I wanna stay because I do like taking care of babies (which is why I am trying to stick it out till the day shift position), and then other times I just wanna be somewhere else due to the hatefully cliquey environment. I'll be there two years in a little over 4 months and I'm trying to stick it out until then at least before I decide to go anywhere else.

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Thank you so much for your response. I never thought about what PICU entailed. It does sound very interesting. I am so back and forth with NICU. Sometimes I have a good week or two, i'm loving it (the actual nursing care) and wanna stay, and then other weeks I am thinking about other career options I can do. I really do think I'll be happier on day shift since it is busier, there is a lot more going on, and I will learn more, but I just have to wait it out.

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