Peds vs. Adult ICU

sergel02, BSN · Apr 9, 2015

Wondering this myself from some folks with experience.

From the short stories I've heard from nurses, they told me that they get lots of respiratory patients. A lot of PICU's I've heard of have many patients on vents and trachs. Don't know how it is in adults.

I believe the medication is weight based since it's peds.

As for broader range of illness, I can't really tell you. It also partly depends on your PICU. One of the PICU's near me sees relatively minor stuff compared to another PICU in the area that gets lots of trauma and burns.

sugarmagnolia3 · Apr 12, 2015

These are my pros and cons, and would vary from person to person, or facility to facility.

Adult ICU- my job felt like death prevention, while PICU is lifesaving (most of the time). Adult ICU I felt like I had a lot more autonomy to make clinical decisions (eg. bolus my pt, hold meds, give meds early or late, order and send labs, or ABGs and PCXRYs, start levophed- of course everything needs to be followed by an order), whereas in PICU there is almost no autonomy. PICU is much kinder to my body; adult ICU is physically HARD work. PICU is still physically hard too, but nothing compared to Adult ICU. In PICU, you take care of anything from premature newborns to adults that are either physically really small, or severely developmentally disabled. Adult ICU you take care of 18 - 100+. In both, you see a lot of suicide attempts and overdoses, and it's more depressing with the teenagers in PICU than adults. With adult ICU, I could forget about work and detach. With PICU, I think about my patients all the time. I like the docs better in my PICU, but I feel like I use less skills in PICU. As far as range of diseases, it depends on what type of unit you work in for either! The general consensus I've heard from nurses that have done both is that it's easier to go from adult ICU to PICU, than PICU to adult ICU.

guest769224 · Apr 12, 2015

These are my pros and cons, and would vary from person to person, or facility to facility.
Adult ICU- my job felt like death prevention, while PICU is lifesaving (most of the time). Adult ICU I felt like I had a lot more autonomy to make clinical decisions (eg. bolus my pt, hold meds, give meds early or late, order and send labs, or ABGs and PCXRYs, start levophed- of course everything needs to be followed by an order), whereas in PICU there is almost no autonomy. PICU is much kinder to my body; adult ICU is physically HARD work. PICU is still physically hard too, but nothing compared to Adult ICU. In PICU, you take care of anything from premature newborns to adults that are either physically really small, or severely developmentally disabled. Adult ICU you take care of 18 - 100+. In both, you see a lot of suicide attempts and overdoses, and it's more depressing with the teenagers in PICU than adults. With adult ICU, I could forget about work and detach. With PICU, I think about my patients all the time. I like the docs better in my PICU, but I feel like I use less skills in PICU. As far as range of diseases, it depends on what type of unit you work in for either! The general consensus I've heard from nurses that have done both is that it's easier to go from adult ICU to PICU, than PICU to adult ICU.

How do you feel you use less skills in the PICU vs adult ICU?

Do you think it's easier to make a mistake in PICU because of the 0-18 group range? Medication wise

sergel02, BSN · Apr 12, 2015

I'm also a bit curious how you feel that you use less skills in PICU compared to AICU (okay not an actual term).

I heard that in peds you have to get a lot of things double checked, like the meds. Perhaps that might be part of the feeling of the lack of autonomy

sugarmagnolia3 · Apr 12, 2015

Regarding using less skills, it's mostly because that the PICU I work in is overall lower acuity than some of the adult ICUs I have worked in. I used to start a lot of IVs, use a lot of hemodynamic monitoring (Physiflo, Vigileo/FLo trac, and use it to guide treatment), Rotoprone, recover pts right from the OR, go to a lot of codes, rapid responses and stroke alerts, use more equipment in general and titrate gtts (In PICU, you don't really titrate your gtts, you get orders for titration almost every time).

Double checking meds has nothing to do with the lack of autonomy, it's just an extra med check, and everything about what I stated above.

So far I don't feel like it's harder to make a mistake. We double check out meds with another nurse, and if it's something puzzling we both do our own calculations multiple times, and discuss until we're both confident and of course clarify with the provider if necessary.

sugarmagnolia3 · Apr 12, 2015

Other things in adult ICU that I used to do- sheath removal, pace pts, set up abdominal pressure monitoring, therapeutic hypothermia, EVDs.....

Gosh, I feel really sad now remembering all the things I used to do!=/

meraki86 · Apr 13, 2015

I work in a pedi cardiac icu. I've started here as a new grad so I can't compare with those that have worked adult icu but my coworkers who have say the same thing - tons more autonomy in adults, in peds you have to ask for everything. As for pros - we are a high acuity cardiac surgical unit. Always admitting pre and post op patients, a lot come back with open sternums. We do tons of procedures at the bedside. ECMO, CVVH are commonly seen here. You get a lot of experience. I also feel like I'm actually saving lives and helping these kiddos. Cons - you really do take a lot home with you, it can be really stressful if you haven't gotten the hang of balancing work and home life. Because of the complexity and multitude of cardiac defects and post op complications you see a lot of chronic "trach and g-tube" kiddos that suck the life out of you love my job but it's definitely not a easy.