Would like to move: best NICU/hospital from your experience

llg, PhD, RN · Apr 21, 2020

I spent the first 20 years of my career moving a lot from NICU to NICU as I was single, no kids, etc. and didn't mind moving to a new city. So here are a few thoughts off the top of my head for you to consider.

1. I recommend cities that have good travel connections to where you family lives. For years, I had to spend most of my vacation time (and budget) just trying to see my family twice a year. Long flights with connections are expensive and get tedious after you have missed a few connecting flights, lost luggage, etc. The glamour of air travel wears off fast. So make sure you can get a direct flight on a regular basis -- or consider living within driving distance, train connections, etc. Once my parents got older and I felt I needed to be a bit more accessible, I took a job only a 5-hour drive away. I am now really tired of that 5-hour drive, but I can leave in the morning and be there by mid-afternoon -- and do long weekends instead of whole weeks at a time.

2. I recommend cities where you already know someone -- maybe extended family -- or friends from college, etc. It will take you a while to make new friends and it's nice to have someone who can give you some advice on housing, shopping, health care providers, etc. It's also nice to have someone local you can share a holiday meal with. While I always made friends wherever I lived, they weren't the same kind of friends that "old friends or family" are.

3. Consider choosing a city/town where there is a graduate school that interests you. That way, if you can decide what you want to study, you can keep your job while taking a couple of classes at a time -- and probably get good tuition reimbursement.

4. Don't put too much emphasis on salary. Most people don't give enough weight to cost of living -- not just the published figures -- but the actual things you will buy as you live there (as in air fare if you plan to travel a lot). Also, look closely at benefits. Some places with higher salaries pay those higher salaries to make up for the fact that they have lousy benefits. Consider the whole picture, not just the pay. And your happiness is priceless. Don't be miserable for an extra $2.00 an hour. It's not worth it. Go where you will be happy.

Good luck!

Edit: I should have added a #5. I recommend a NICU where you get a chance to work with stable babies (feeder/growers, etc.) at least occasionally. I have found the staffs of NICUs where they never get to work with the cuties and happy endings tend to be more "burned out." The people who tend to be happiest in long-term NICU careers work with happy cases as well as the level IV cases. It's not mentally healthy to work with the most critical cases every day for years. Even people who love it need little breaks.

CRNAhopeful123 · Apr 21, 2020

2 hours ago, llg said:
I spent the first 20 years of my career moving a lot from NICU to NICU as I was single, no kids, etc. and didn't mind moving to a new city. So here are a few thoughts off the top of my head for you to consider.
1. I recommend cities that have good travel connections to where you family lives. For years, I had to spend most of my vacation time (and budget) just trying to see my family twice a year. Long flights with connections are expensive and get tedious after you have missed a few connecting flights, lost luggage, etc. The glamour of air travel wears off fast. So make sure you can get a direct flight on a regular basis -- or consider living within driving distance, train connections, etc. Once my parents got older and I felt I needed to be a bit more accessible, I took a job only a 5-hour drive away. I am now really tired of that 5-hour drive, but I can leave in the morning and be there by mid-afternoon -- and do long weekends instead of whole weeks at a time.
2. I recommend cities where you already know someone -- maybe extended family -- or friends from college, etc. It will take you a while to make new friends and it's nice to have someone who can give you some advice on housing, shopping, health care providers, etc. It's also nice to have someone local you can share a holiday meal with. While I always made friends wherever I lived, they weren't the same kind of friends that "old friends or family" are.
3. Consider choosing a city/town where there is a graduate school that interests you. That way, if you can decide what you want to study, you can keep your job while taking a couple of classes at a time -- and probably get good tuition reimbursement.
4. Don't put too much emphasis on salary. Most people don't give enough weight to cost of living -- not just the published figures -- but the actual things you will buy as you live there (as in air fare if you plan to travel a lot). Also, look closely at benefits. Some places with higher salaries pay those higher salaries to make up for the fact that they have lousy benefits. Consider the whole picture, not just the pay. And your happiness is priceless. Don't be miserable for an extra $2.00 an hour. It's not worth it. Go where you will be happy.
Good luck!
Edit: I should have added a #5. I recommend a NICU where you get a chance to work with stable babies (feeder/growers, etc.) at least occasionally. I have found the staffs of NICUs where they never get to work with the cuties and happy endings tend to be more "burned out." The people who tend to be happiest in long-term NICU careers work with happy cases as well as the level IV cases. It's not mentally healthy to work with the most critical cases every day for years. Even people who love it need little breaks.

Ahhhh thank you! That was actually very very insightful!! I really appreciate all of that input!

**NICU Guy, BSN, RN** · Apr 21, 2020

I would recommend finding a Level IV NICU job anywhere that will hire you. After getting 2 yrs experience, do NICU travel nursing. Most contracts are 13 weeks which will give you a good idea of what it is like to live there. Eventually, you will find the NICU that suits you, along with the city that fits your needs. There are many NICUs that are great places to work, but not in the best location. There are also great locations, but the NICUs are not the best environment to work in.

CRNAhopeful123 · Apr 21, 2020

1 hour ago, NICU Guy said:
I would recommend finding a Level IV NICU job anywhere that will hire you. After getting 2 yrs experience, do NICU travel nursing. Most contracts are 13 weeks which will give you a good idea of what it is like to live there. Eventually, you will find the NICU that suits you, along with the city that fits your needs. There are many NICUs that are great places to work, but not in the best location. There are also great locations, but the NICUs are not the best environment to work in.

Yeahh that's true. I'm already at a level IV NICU. I guess that would be a smart move to just gain the experience where I'm at and then start travel nursing..thanks for your input!

Nunya, BSN · Apr 25, 2020

I'll also say that most level 4 NICUs don't have staff nurses attend deliveries, the last place I worked with it was the NNP/resident and transport nurses, if they weren't already out. Sometimes a charge nurse went.

CRNAhopeful123 · Apr 25, 2020

7 hours ago, Elaine M said:
I'll also say that most level 4 NICUs don't have staff nurses attend deliveries, the last place I worked with it was the NNP/resident and transport nurses, if they weren't already out. Sometimes a charge nurse went.

Awww man. Wishful thinking LOL. Thank you!

adventure_rn, MSN, NP · Apr 25, 2020

8 hours ago, Elaine M said:
I'll also say that most level 4 NICUs don't have staff nurses attend deliveries, the last place I worked with it was the NNP/resident and transport nurses, if they weren't already out. Sometimes a charge nurse went.

Great point. I know a lot of people are suggesting traveling, however...

If you want to attend deliveries, it's really, really in your best interest to pick a place and stay put. Most higher-acuity NICUs have a specific group of experienced nurses who attend deliveries. In general, you have to be on the unit for a certain amount of time (often a couple of years) before you're allowed to train to this role. You have to demonstrate that you're comfortable admitting teeny tinies, responding to codes, etc. before they'll let you be the point person in the delivery room, since that's where most emergencies go down.

If you stay at your current hospital for two years, then travel for a few years, you could find that you're 5 years out, ready to start NNP school, and still have never attended a delivery. You can become an NNP without delivery experience (there are people on AN who have done it), but if given the opportunity, it's probably in your best interest to get delivery experience.

Moreover, as a traveler, you aren't going to be given the sickest kids (unless you renew your contract several times in a row and are basically staff). It's quite possible that you won't touch a vent or drips the entire time you're traveling, so you may feel as though you lose out on high acuity experience. As a traveler, it will also be hard to build strong NNP references for grad school, since it's hard to build relationships when you come and go.

If you don't want to go to NNP school right away, then yes, traveling is a great way to see what's out there and a find which hospital/city are a good fit long-term. However, once you find your 'permanent' hospital, I'd plan to spend at least a few years on staff before you pursue NNP school. If you want to apply to school sooner, your best bet is to find a Level IV that does deliveries in house and also takes surgical cases.

As for selecting a hospital...

@llg has provided great suggestions (as always ☺️). Honestly, I'd start by looking at cities/states that interest you, figure out the nursing salary vs. cost of living, and then investigate the NICUs at the different hospitals to find the best fit.

One last point regarding Level III vs. Level IV: these distinctions aren't as clear as you'd expect. There are some parts of the country where there is no 'Level IV' distinction, and and Level III takes ECMO, etc. Furthermore, there are plenty of 'Level IVs' out there that aren't actually high acuity. I've worked at a Level III that actually took higher acuity kids than a Level IV (the Level III did VP shunts, maxillofacial surgery, PDA ligations, the IV did not). It's important to investigate what other hospitals are in the area (is there an even bigger level IV where they ship the train wrecks?) and find out what specialty services the hospital has.

**NICU Guy, BSN, RN** · Apr 26, 2020

20 hours ago, Elaine M said:
I'll also say that most level 4 NICUs don't have staff nurses attend deliveries, the last place I worked with it was the NNP/resident and transport nurses, if they weren't already out. Sometimes a charge nurse went.

Our Level IV NICU has a group of NICU nurses that attend all deliveries. Two nurses are scheduled per shift, that is their sole job for the shift (do not take a NICU assignment).

CRNAhopeful123 · Apr 26, 2020

13 hours ago, adventure_rn said:
Great point. I know a lot of people are suggesting traveling, however...
If you want to attend deliveries, it's really, really in your best interest to pick a place and stay put. Most higher-acuity NICUs have a specific group of experienced nurses who attend deliveries. In general, you have to be on the unit for a certain amount of time (often a couple of years) before you're allowed to train to this role. You have to demonstrate that you're comfortable admitting teeny tinies, responding to codes, etc. before they'll let you be the point person in the delivery room, since that's where most emergencies go down.
If you stay at your current hospital for two years, then travel for a few years, you could find that you're 5 years out, ready to start NNP school, and still have never attended a delivery. You can become an NNP without delivery experience (there are people on AN who have done it), but if given the opportunity, it's probably in your best interest to get delivery experience.
Moreover, as a traveler, you aren't going to be given the sickest kids (unless you renew your contract several times in a row and are basically staff). It's quite possible that you won't touch a vent or drips the entire time you're traveling, so you may feel as though you lose out on high acuity experience. As a traveler, it will also be hard to build strong NNP references for grad school, since it's hard to build relationships when you come and go.
If you don't want to go to NNP school right away, then yes, traveling is a great way to see what's out there and a find which hospital/city are a good fit long-term. However, once you find your 'permanent' hospital, I'd plan to spend at least a few years on staff before you pursue NNP school. If you want to apply to school sooner, your best bet is to find a Level IV that does deliveries in house and also takes surgical cases.
As for selecting a hospital...
@llg has provided great suggestions (as always ☺️). Honestly, I'd start by looking at cities/states that interest you, figure out the nursing salary vs. cost of living, and then investigate the NICUs at the different hospitals to find the best fit.
One last point regarding Level III vs. Level IV: these distinctions aren't as clear as you'd expect. There are some parts of the country where there is no 'Level IV' distinction, and and Level III takes ECMO, etc. Furthermore, there are plenty of 'Level IVs' out there that aren't actually high acuity. I've worked at a Level III that actually took higher acuity kids than a Level IV (the Level III did VP shunts, maxillofacial surgery, PDA ligations, the IV did not). It's important to investigate what other hospitals are in the area (is there an even bigger level IV where they ship the train wrecks?) and find out what specialty services the hospital has.

Ahhhh bless you! That was so informative and a lot to think about! But I have all year to investigate!! I'm excited to see what's out there

But I do agree. Wherever I move to, if I move, I plan on staying for awhilee and possibly going to school out there too. I've honestly been looking at hospitals that have a NNP fellowship. But thanks again!

1 hour ago, NICU Guy said:
Our Level IV NICU has a group of NICU nurses that attend all deliveries. Two nurses are scheduled per shift, that is their sole job for the shift (do not take a NICU assignment).

WOW! that's interesting! I shadowed at a level III before I took the job at a level IV. And they had nurses down in shifts. They'd leave their NICU assignment to go to said delivery if it occurred during their shift

Nunya, BSN · Apr 27, 2020

On 4/25/2020 at 8:05 PM, NICU Guy said:
Our Level IV NICU has a group of NICU nurses that attend all deliveries. Two nurses are scheduled per shift, that is their sole job for the shift (do not take a NICU assignment).

Yeah, but that's a special group of nurses specially trained I'm assuming. I think she was thinking she'd get to go right away, and that all the nurses would take turns. You must be in a really busy hospital!