Hi. I was just wondering what level III RNs think of level II RNs. The NICU I work is a level IIB and we have a big tertiary center 2 miles down the street which is where our neos come from. It seems whenever we have a transfer to go to the level III the transport team comes and acts like we are a bunch of idiots.
Example: I had a baby a couple of months ago that was term, out on mother/baby and at 24 hrs. of age became lethagic, poor feeder. After an ECHO/workup, it was found the kid had major CHDs, ductal dependant. We started prostaglandins, O2 and set up for a transfer to level III. Because of insurance reasons and some other stuff the kid didn't get transferred until like 12 hours later, but was doing fine, was stable. When the transport team came and were doing their assessment, the baby was crying. The one nurse goes "O, it's ok baby. They did ok for you here". OK?!?!? She's still alive and stable!!!! I think she's doing great!! It just hit me hard because I am not stupid nor are any of the nurses I work with.
I was just wondering what other nurses think of this... anyone ever have similar problems?
In a very simple nutshell: Level III is higher acuity such as vents, drips, maaybe CPAP. Level II kids are more stable and usually called feeder/growers.
There is a difference between being on your game like the OP's post, and not being on your game like my post. I don't care where you work as long as you know what you're doing.
I noticed you have just 1 year experience in NICU. Over-confidence can and very likely will get you into trouble. Remember, it is those level II and even lower nurses that are most likely in outreach areas, that keep the babies stable until someone from a level III unit can take over their care. I have worked both level II and III. There is way more "attitude" in a level III...which is unfortunate.
I will bite, please nobody take personal offense...
I have a somewhat negative view of level II nurses. ONLY because I have had some not so good occurances involving them. My unit has a pretty strict separation between level II and level III. Occasionally we will float between the two (usually level II comes to level III more-so than the other way around) but 99% of the time you are in your own little bubble.
So, there have been times when I've taken report from a nurse that floated, only to find some details omitted. Like the three times my primary was having a large amount of output out of her ostomy (had already passed her total output goal for the day at 1900) with no mention of it all in report. I realize that the fact she was my primary makes me even madder but for it to happen three times? And the time this other kid was having stidor so loud you could hear it in the next room "but the docs were OK with it"...And the time they wrote TPN D12.5 was running at 4.0 all day on the flowsheet, but it was really D15 running at 4.1 all day. Did she even look at the fluids hanging? Sigh.
That being said, I have gotten reports from many great level II nurses before and I've gotten bad reports from some level III nurses before. It just seems more things get missed with the level II nurses, that is all. And thank god that they chose to be a level II nurse because I could never do that. I am ready to chunk my 3 screaming kids out the window by 10 pm whenever I have a stepdown assignment. Give me an HFOV with multiple drips and blood products anyday!! (unless they are cardiac..)
I've gotten crappy reports from level 3 nurses like what you describe, so i don't think it's just level 2 nurses that would do that.
I think this sort of behaivor goes on in all areas of nursing. There will always be those nurses that think they are better. In the adult world it is the floor vs. ICU nurses. ER vs. floor nurses. CCU vs. ICU. Community hospital ICU vs. teaching hospital ICU, etc... I think you get the point. In NICU it will be Level II vs. Level III and it can even be Level III vs. another Level III. We all know that there are some big differences on what Level III's can handle. The Level III I work in does not do surgeries, nitric, but we do HFOV so we do have some pretty sick kids, but if I went to the downtown Children's hospital and took care of a kid on ECMO I would be scared to death. It's important that we respect everyone's individual skill level. We all bring something to the table so to speak. I have learned things from NBN nurses and I hope they have learned something from me as well. I always try to stay humbled and not think I am better than anyone else. It is the overconfident, know it all nurse that can be the most dangerous.
I worked in well-baby nursery at one point and I have never ran so much in my life! Constant .... all.night.long.
Give me a 23 weeker on a jet and drips any day. But give me a fussy kid that won't eat .... won't eat, but fusses because he's hungry, but then cries while you feed him. Ahhhhhhhhhhh!! My nerves get shot in situations like that ..... I just get so stressed out.
I wonder if this has anything to do with the anymosity. Our unit works as 1 big blob. Meaning there is no difference between those that work criticals and specials. As anywhere there are those that prefer 1 over the other. And of course there is tension/anymosity between certain individuals or cliques.
Ditto. We all are capable (or should be) of taking a FT 48 hour r/o sepsis kid or a 23 weeker on HFOV and multiple drips. Most of the time, the charge nurse making assignments kinda knows who prefers what, but there is no "she's a level II nurse, so she can't take that sick kid." We deal more with days vs. nights.
I think this sort of behaivor goes on in all areas of nursing. There will always be those nurses that think they are better. In the adult world it is the floor vs. ICU nurses. ER vs. floor nurses. CCU vs. ICU. Community hospital ICU vs. teaching hospital ICU, etc... I think you get the point. In NICU it will be Level II vs. Level III and it can even be Level III vs. another Level III. We all know that there are some big differences on what Level III's can handle. The Level III I work in does not do surgeries, nitric, but we do HFOV so we do have some pretty sick kids, but if I went to the downtown Children's hospital and took care of a kid on ECMO I would be scared to death. It's important that we respect everyone's individual skill level. We all bring something to the table so to speak. I have learned things from NBN nurses and I hope they have learned something from me as well. I always try to stay humbled and not think I am better than anyone else. It is the overconfident, know it all nurse that can be the most dangerous.
Beautifully said, and filled with wisdom. I will have my daughter, who is a nursing student, read this. Should make all of us take a minute and do some personal inventory..... thank you
Hi. I was just wondering what level III RNs think of level II RNs. The NICU I work is a level IIB and we have a big tertiary center 2 miles down the street which is where our neos come from. It seems whenever we have a transfer to go to the level III the transport team comes and acts like we are a bunch of idiots.
Example: I had a baby a couple of months ago that was term, out on mother/baby and at 24 hrs. of age became lethagic, poor feeder. After an ECHO/workup, it was found the kid had major CHDs, ductal dependant. We started prostaglandins, O2 and set up for a transfer to level III. Because of insurance reasons and some other stuff the kid didn't get transferred until like 12 hours later, but was doing fine, was stable. When the transport team came and were doing their assessment, the baby was crying. The one nurse goes "O, it's ok baby. They did ok for you here". OK?!?!? She's still alive and stable!!!! I think she's doing great!! It just hit me hard because I am not stupid nor are any of the nurses I work with.
I was just wondering what other nurses think of this... anyone ever have similar problems?
Thanks!!!
Since I can not know the tone of voice used it's hard to really know...but you took this as an insult? I wouldn't have....I don't think it was intended as one anyway....
That being said; I work in a level III and we have a close working relationship this our level II in our sister hospital. In fact I have worked over there and know many of the nurses as many used to work here! I totally respect the level II nurses and think many Many times they have to be even more on the ball! They are doing the intial assessments and often catch things and notify the docs if something needs to be addressed.
I guess I just have bad tastes in my mouth because my 1st NICU job was in a level III and I had a terrible experience with the nurses... they basically told me my skills were excellent, but my personality didn't fit. I am such a good nurse and nice person I don't understand how they can say that and then the whole transport nurse thing happens. I came to work my currect level II to get some more experience before I go back to a level III, but many times I am so scared to think of being treated like I have been again... but I love a level III for the thrill, excitement, and opportunity to use my brain!!!
You hang in there! Where I work...well I've been in the biz many Many years and now am experiencing not being in the "In Group". It's difficult cause I used to get many of the micro premies and now hardly ever do as the young up-starts now aways want these assignments. Still I feel I contribute where ever I work due to my experience and positive personality. Hey sometimes even in the step-down things get rough and parents need the more experienced nurses to calm them down.
I understand your frustration. I am a transport nurse and go to smaller Level 2 units to pick up babies. I try to never treat the RN as if she is stupid. We have all been in her position where we are a bit overwelmed. We like to compliment the team on how well they did at stabilizing the baby. Delivering compliments increases there confidence and gets them to help us during the transition. Everything takes 10 times longer because we don't know where anything is. If the nurse feels like she is still part of the team she is more willing to be a runner for us which is extremely helpful. Level IV transport teams come to our hospital. They are usually pretty nice but often times I feel less qualified than them and I have been doing this a looong time.
There's no shortage of these kinds of attitudes in all critical care areas in particular. I've been a nurse for a good deal of time now.
Many times when it is the old, "It's not the right fit," it means that you are an individual that don't necessarily become the camillion enought for them. For many of such folks, it will take a hydrogen bomb or a major change in landscape for them to see that they need to adjust their perspectives and attitudes a bit. It is easier for them to say you have to change rather than them seeing the importance of changing and being more open. So they let you go and try to look for someone else who will more fit their mold. So be it. Until that bomb or major change in landscape, well, it's ultimately better to be free to fly elsewhere and leave them to their limited perspective on things. They will either find out or not. As I said in another post, integration is a two-way process--not a simple one-way process for the nurse on orientation.
Keep the faith. Apparently God had something better for you. Go with God. He accepts you as you are.
NeoNurseTX, RN
1,803 Posts
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In a very simple nutshell: Level III is higher acuity such as vents, drips, maaybe CPAP. Level II kids are more stable and usually called feeder/growers.