Wanting to go to level IV from level III NICU

[mslema]

I work at a smaller 20 bed community level III NICU. I have 7 years experience. We care for micropremies and sick neonates, but our facility transfers out patients who require body cooling and surgery. I would really like to work in a higher acuity unit, but I feel it's impossible as most places require that you already have surgical experience. I'm not a new grad so I'm unable to apply to those positions. I feel like I'm just hitting every road block in my desire to work in a level IV NICU. I see many posts about people going from level III to level IV. How were you able to do so? Thanks.

[NICU Guy, BSN, RN]

What hospitals are you referring to that require surgical experience. I looked at all NICU postings in Cali. on indeed.com and couldn't find any that had the requirements you say. Most require Level III/IV experience which you have.

[mslema]

The regional NICUs in CA such as UCSF, CPMC and a Kaiser which I know for sure. These are the only ones that I'm able to travel to. Everything else is a pretty far commute. One hospital didn't state that surgical experience was required, but the manager asked if I had the experience. After I explained, I found out that they weren't able to train. I guess it all comes down to their willingness to do so or their budget. I'll keep looking out for postings and applying anyway.

[NICU Guy, BSN, RN]

After I explained, I found out that they weren't able to train. I guess it all comes down to their willingness to do so or their budget.

They probably have many applicants with Level IV experience, so they can be very selective. Just one more thing that makes Cali. unique from other states. We would snatch you up in a heartbeat, but this is the Midwest and not California. We hire almost exclusively new grads and give them 12 weeks orientation before being on their own. Then, they are assigned higher and higher acuity patients as they get more experience.

[cmary]

That's interesting. When I made the move from level III to level IV, I only had one year of NICU experience. I was never asked if I had any surgical experience, they seemed thrilled that I even had just one year of NICU experience! I would think NICU experience would be much more valuable than general surgical experience. However, I practice on the east coast...

[NICU Guy, BSN, RN]

I would think NICU experience would be much more valuable than general surgical experience.

I think she is referring to pre-op and post-op surgical patients, not OR experience.

[adventure_rn, MSN, NP]

That's interesting. When I made the move from level III to level IV, I only had one year of NICU experience. I was never asked if I had any surgical experience, they seemed thrilled that I even had just one year of NICU experience! I would think NICU experience would be much more valuable than general surgical experience. However, I practice on the east coast...

I had a similar experience. Most of the places I considered were just excited that they wouldn't have to train a new to specialty nurse about basic newborn assessment from scratch.

Perhaps you could consider applying to higher acuity Level IIIs? Level III and Level IV can be misleading labels. I've worked in Levels IIIs that had higher overall acuity than Level IVs. Many Level III units do cooling and specialty surgeries, like hydrocephalus shunt placements and PDA ligations. Applying to a higher acuity Level III might make for an easier transition than applying to a Level IV at an academic, tertiary care referral hospital.

Also, unless specifically asked, you don't need to draw attention your lack of surgical experience in cover letters or interviews. Rather, once you're on orientation, when they ask you what you'd like to focus on simply tell them that you'd love to take any pre- or post-op patients that come through. TBH, with the exception of fresh open-heart kids, NICU post-op care generally isn't very difficult. The surgeons will often do initial dressing changes, and leave very specific instructions about the nursing care they have ordered. There should be unit protocols for the procedures your hospital performs, and you can always ask for help/clarification from your charge nurse, your experienced peers, and the off-going nurse during report.

[mslema]

You are correct. Thank you.

[mslema]

I work at a level III but the facility I mentioned above is actually a higher level

III as you mentioned. They have body cooling and surgeries (non cardiac). Thank you so much for your response and input.