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well baby nursey to NNP (it's long, sorry)

NICU   (900 Views | 13 Replies)

babynurse5x is a ASN, RN and specializes in nursery.

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I am not new to this site by any means, but this is my first post, so please bear with me.

I've had my heart set on NICU sense i found out such a thing existed.  We toured our closest NICU during nursing school and I completely fell in love.  I currently work nursery and LOVE it, but am always thinking about NICU.

I have worked in a well baby/level I nursery for 5 years.  Small rural hospital, about 35 deliveries a month, 1 nursery nurse per shift, no NICU in house.  While I do not claim to be a NICU nurse by any means, I say all this to suggest that I have more than just "well baby" experience.  I attend all my own deliveries (with the Pedi if premature or expected difficulties), am involved in resuscitation if needed, stabilize sick kids until transport arrives (usually 1-3 hours, so minimal critial care) start IVs, insert NG/OG tubes, we keep RDS kids on high flow canula for 24-48 hours depending on severity, hypoglycemic kids on IV therapy, IV antibiotics pending BC or long term (up to 2 weeks) if needed.  We occasionally keep 34/35 week feeder/growers if weight is the only complication.

I did a very short stint (about a month) in the NICU in 2018 and, due to family obligations, had to resign from that position and returned to my level I nursery. What I did learn during my short stay was how stable even alot critical babies are. I expected a mad house, high adrenaline and to be coding/resuscitating often, but that was not the case. Now, I also realize a month in the NICU is no time and there are streaks of good and bad in any department, so I do not assume that this is always how things work in the unit.

My favorite parts of my current job are attending deliveries and transitioning or stabilizing kids. Well babies are great, but I look forward to my shifts with sick babies, high risk deliveries, and interesting cases that we didn't expect. I like feeling like I helped "fix" a kid, or after a resuscitation feeling like what I did really mattered.  I also know that in the NICU, these circumstances may not come my way for a long while.  Only the designated, experienced nurses get to attend deliveries, and once babies are stable, they generally tend to remain stable. (Please know, I do understand how sick these critical babies can be and am not attempting to play down the care it takes to keep their tiny bodies in perfect harmony. I oriented with a PPHN kid on NO and HFOV with the works.)

Life circumstances have changed, I am currently working on my BSN, and i feel like this may be the right time to try and get back into the NICU. I am now interested in becoming an NNP but need feedback on whether or not the NNP role would fill the expectations I have. The NICU I was in had NNPs but only on nights. I oriented on day shift, so I have not had the opportunity to observe an NNP in the capacity.

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adventure_rn is a BSN and specializes in NICU, PICU.

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It sounds like your best option is to seek out a NICU job. The vast majority of NICUs staff NNPs; working alongside NNPs should give you the best sense of what they actually do and whether or not you'd enjoy the job. NNP programs require at least two years of Level III/IV experience to apply. By transitioning to NICU, you'd start building up your experience. If you work with NNPs and think you'd like the role, that's great. If after working alongside NNPs you decide that you wouldn't like the role, then that's fine too; no harm, no foul.

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babyNP. has 12 years experience as a APRN and specializes in NICU.

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Actually there are a couple of schools that consider people with PICU experience, fascinatingly enough, and there are several schools that let you get the 2 years NICU experience while in school, meaning you can apply prior. The board exam doesn't require NICU experience. I created a spreadsheet detailing all the schools requirements and tuition last year.

that being said, definitely recommend getting the level 3/4 experience before you apply and seeing how you like it and talking with NNPs to get a sense for if you would like the job. The delivery skills you have are a great starting point. Keep us posted on how your journey goes and let us know if you have other questions...

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adventure_rn is a BSN and specializes in NICU, PICU.

3 Followers; 1 Article; 1,255 Posts; 18,140 Profile Views

19 minutes ago, babyNP. said:

Actually there are a couple of schools that consider people with PICU experience, fascinatingly enough, and there are several schools that let you get the 2 years NICU experience while in school, meaning you can apply prior.

Wow, the PICU experience substitute is pretty shocking to me. Having done both, I was astonished by how differently peds intensivists manage their patients. Even when we have patients transferring back and forth between NICU and PICU, I've seen providers get into pissing matches over how they differently they would have managed certain patients (i.e. bicarb vs. no bicarb, rapidly bolusing volume vs. no volume, electrolyte supplementation vs. no supplementation). Even when the skills are the same (umbi lines, intubated patients, etc.) the mindset of care is radically different. That doesn't even take into consideration that most PICUs won't touch micro-preemies with a 10-foot pole.

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babyNP. has 12 years experience as a APRN and specializes in NICU.

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lol, yeah I side eye that quite a bit. To be fair the wording is something like “will consider” and there are some units that are NICU/PICU combined. I have a hard time thinking of a regular NICU hiring someone without the requisite experience. The CNS programs do not allow this, but there are only a few left...

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babynurse5x is a ASN, RN and specializes in nursery.

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52 minutes ago, babyNP. said:

Actually there are a couple of schools that consider people with PICU experience, fascinatingly enough, and there are several schools that let you get the 2 years NICU experience while in school, meaning you can apply prior. The board exam doesn't require NICU experience. I created a spreadsheet detailing all the schools requirements and tuition last year.

that being said, definitely recommend getting the level 3/4 experience before you apply and seeing how you like it and talking with NNPs to get a sense for if you would like the job. The delivery skills you have are a great starting point. Keep us posted on how your journey goes and let us know if you have other questions...

I actually found your spreadsheet on another post and downloaded it. Thank you for that! Our closest NICU is level III and we also have a large level IV a little further away that I am considering. 

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Have you considered peds/neo CCT? You wIll need to gain experience but it’s an option. 

Edited by Wuzzie

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babynurse5x is a ASN, RN and specializes in nursery.

6 Posts; 98 Profile Views

4 hours ago, Wuzzie said:

Have you considered peds/neo CCT? You wIll need to gain experience but it’s an option. 

I definitely think this is also something I’d be interested in when I have sufficient experience!

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ThePrincessBride has 5 years experience as a BSN and specializes in Med-Surg, NICU.

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On 1/17/2020 at 7:13 PM, babynurse5x said:

I am not new to this site by any means, but this is my first post, so please bear with me.

I've had my heart set on NICU sense i found out such a thing existed.  We toured our closest NICU during nursing school and I completely fell in love.  I currently work nursery and LOVE it, but am always thinking about NICU.

I have worked in a well baby/level I nursery for 5 years.  Small rural hospital, about 35 deliveries a month, 1 nursery nurse per shift, no NICU in house.  While I do not claim to be a NICU nurse by any means, I say all this to suggest that I have more than just "well baby" experience.  I attend all my own deliveries (with the Pedi if premature or expected difficulties), am involved in resuscitation if needed, stabilize sick kids until transport arrives (usually 1-3 hours, so minimal critial care) start IVs, insert NG/OG tubes, we keep RDS kids on high flow canula for 24-48 hours depending on severity, hypoglycemic kids on IV therapy, IV antibiotics pending BC or long term (up to 2 weeks) if needed.  We occasionally keep 34/35 week feeder/growers if weight is the only complication.

I did a very short stint (about a month) in the NICU in 2018 and, due to family obligations, had to resign from that position and returned to my level I nursery. What I did learn during my short stay was how stable even alot critical babies are. I expected a mad house, high adrenaline and to be coding/resuscitating often, but that was not the case. Now, I also realize a month in the NICU is no time and there are streaks of good and bad in any department, so I do not assume that this is always how things work in the unit.

My favorite parts of my current job are attending deliveries and transitioning or stabilizing kids. Well babies are great, but I look forward to my shifts with sick babies, high risk deliveries, and interesting cases that we didn't expect. I like feeling like I helped "fix" a kid, or after a resuscitation feeling like what I did really mattered.  I also know that in the NICU, these circumstances may not come my way for a long while.  Only the designated, experienced nurses get to attend deliveries, and once babies are stable, they generally tend to remain stable. (Please know, I do understand how sick these critical babies can be and am not attempting to play down the care it takes to keep their tiny bodies in perfect harmony. I oriented with a PPHN kid on NO and HFOV with the works.)

Life circumstances have changed, I am currently working on my BSN, and i feel like this may be the right time to try and get back into the NICU. I am now interested in becoming an NNP but need feedback on whether or not the NNP role would fill the expectations I have. The NICU I was in had NNPs but only on nights. I oriented on day shift, so I have not had the opportunity to observe an NNP in the capacity.

You really need level III experience, preferably 2-3 years, before being an NNP. Well-baby nursery isn't appropriate experience, regardless of how many high-risk deliveries you've attended. You need to be familiar with the ongoing care of NICU patients, not just a shot in time.

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babynurse5x is a ASN, RN and specializes in nursery.

6 Posts; 98 Profile Views

47 minutes ago, ThePrincessBride said:

You really need level III experience, preferably 2-3 years, before being an NNP. Well-baby nursery isn't appropriate experience, regardless of how many high-risk deliveries you've attended. You need to be familiar with the ongoing care of NICU patients, not just a shot in time.

I understand that completely and most definitely don’t think I have adequate experience to to believe I could go straight into NNP right now. My question, or concern maybe, is will the role of NNP meet my expectations. I really enjoy attending deliveries, resuscitating, and stabilizing. 

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How much do you thin you will enjoy the more mundane things like rounds and phone calls and notes?

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babynurse5x is a ASN, RN and specializes in nursery.

6 Posts; 98 Profile Views

17 minutes ago, Wuzzie said:

How much do you thin you will enjoy the more mundane things like rounds and phone calls and notes?

I mean, obviously, any job in healthcare comes with ample paperwork and charting, and I’m not expecting to get around that. I do enjoy getting to know my patients and watching kids make progress. I enjoy being at the bedside and every day tasks, I am just curious about the balance. 

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