Pros and Cons of Adult vs Pediatric Critical Care Nursing - page 2

by meraki86

Hey everybody! So I'm graduating with my BSN in May and start applying to jobs in February. I know this is very subject to opinion but I'm looking for some insight on the pros and cons of adult vs pedi nursing in the critical... Read More


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    Quote from marycarney
    Not to get off-topic too badly but here goes: How do you even stay alive with a CONTINUAL O2 sat of 70%? I never fail to be amazed by the adaptations the human body can make.
    haha I wondered the same thing :-) but these kids do and some do it well! The 52 year old I mentioned sated low 70's her whole life and had Eisenmengers syndrome which is the result of that. One of the things included in that and how the body adapts is having a hematocrit in the 50's, in fact when hers dropped from 58 to 52 (she was coughing up blood) we transfused. The body adapts and sometimes amazingly so and others never adapt. However even with good adaption as she had there are a lot of complications and every organ system is affected, renal issues, gi issues, pulmonary issues, you name it.

    Interestingly enough this woman lived longer than any fontan I know which is the type of repair she would have had done if she were born today.
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    I have a homecare kid who completed her Fontan several months ago. She's four and has clubbing already, and likes (no demands) to go barefoot. We call her Madame Blueberry because her little clubbed toenails are so blue.
    Mom recently had another baby (who has all four chambers in his NORMAL heart!!) and she says baby brother is 'kinda boring' - what with no home vent, oximeter, trach, g-tube etc.
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    I have worked with both in the ICU and ER settings. I like both, but children are fighters! They are innocent; when I was with adults my exterior was a bit harder and I didn't smile half as much. Families help with kids not like adults. Adults whine like they are kids and are actually more needy. Does the adult unit have adequate ancillary staff to assist in turning, dressing changes, bathing, ect. Think about your back. Peds don't go through alcohol withdrawals day 3 in the ICU turning your once nice patient psychotic. Peds can be much more interesting with all the congenital diseases seen. Adults are pretty straight forward; tons of co-morbities from unhealthy living.
    On the other hand you don't have to see senseless child abuse cases, car accidents from parents drinking intoxicated. I loved trauma but never pediatric trauma; adults can do stupid sh*t and it be funny but never a child.
    umcRN likes this.
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    Quote from Julia77063
    I have worked with both in the ICU and ER settings. I like both, but children are fighters! They are innocent; when I was with adults my exterior was a bit harder and I didn't smile half as much. Families help with kids not like adults. Adults whine like they are kids and are actually more needy. Does the adult unit have adequate ancillary staff to assist in turning, dressing changes, bathing, ect. Think about your back. Peds don't go through alcohol withdrawals day 3 in the ICU turning your once nice patient psychotic. Peds can be much more interesting with all the congenital diseases seen. Adults are pretty straight forward; tons of co-morbities from unhealthy living.
    On the other hand you don't have to see senseless child abuse cases, car accidents from parents drinking intoxicated. I loved trauma but never pediatric trauma; adults can do stupid sh*t and it be funny but never a child.
    True. All the adult patients I have cared for have whined WAY more than any 2 or three year old I've taken care of. Watch out though, those little ones can go through drug withdrawals hard and can be just as miserable and psychotic as the adults, though usually not as strong if they start fighting.
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    Quote from marycarney
    I have worked adult ICU, PICU and NICU and the most difficult - in my experience - is PICU. You have the incredible range of developmental differences (birth to 18 year olds who are parents themselves), you have a much more clinically diverse population (cancer, congenital heart defects, accidental poisonings, victims of child abuse and neglect and on and on and on...)

    Our PICU does a lot of heart surgery, and its a challenge keeping up with the thousand-and-one ways you can be born with a jacked up heart. (I mean, we had a patient who had Transposition, dextrocardia AND heterotaxy - makes your head swim!)

    Having said that - I like PICU the best of all three.
    I had to throw this in, my patient today: Heterotaxy (RAI - two, three lobed lungs, all abdominal organs flipped, no spleen), dextrocardia, d-transposition of the great arteries, unbalanced AV canal, double outlet right ventricle, pulmonary stenosis - took a while to go through that one with my orientee! Also had a tracheal esophageal fistula with esophageal atresia. Has already had three major surgeries at only 5 weeks old and many more to come.
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    Thought I would throw my 2 cents in, as well. I started in an adult MICU as a newer nurse (only 1 year of exp when I started), and I think that is probably the best option for a new nurse who is unsure if they want to specialize in PICU/NICU. Also, you will more likely get hired into an adult ICU since many PICUs/NICUs require at least 1 year of ICU experience, though some will hire new grads if they have a good orientation program.

    I occasionally take care of PICU patients in my MICU (not really PICU, per se), but teenagers who may be 17 or those who have chronic conditions and are now 19 or 20. Having some experience with those patients and their parents will help you to know if PICU is something you would enjoy doing. (You would at least know if you wouldn't ever want to do it).

    PICU/NICU isn't something I considered for the reasons that many people elect not to do it. Those that do find it very rewarding, though, but I just would have a hard time leaving work at work if my patient who was 3 or 4 died, or a 3 weeker, for that matter. If you think you could leave work at work, and it's something you're interested in, go for it. But, like I said, those that do PICU or NICU typically enjoy that specialty because it's their niche, wouldn't want to do anything else. If you're wondering, I really enjoy adult MICU/SICU, and wouldn't want to do anything else. I may venture into another ICU down the road, CCU or something along those lines, but I've found my niche in ICU. Later on, I would like to get my MSN, and teach, as well. Best of luck to you. Just be open-minded at this point; I didn't think I would do ICU when I was in school, but kept an open mind, and here I am
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    I was just wondering for those who work two jobs (one full-time and one PRN, or however it's scheduled), is it possible to work in an adult ICU and picu/nicu at the same time?
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    Yes, it is possible to work with adults and peds. I did this for many years. I had been an adult ICU (later MICU) nurse for nearly 30 years and was reaching a point in my life that I needed something different. As luck would have it, the Childrens' hospital was experiencing high census and acuity and asked if any adult ICU nurses would volunteer to get cross trained and pick up contingent shifts. I jumped at the chance. I ended up cutting back my hours to .2 in the MICU (one day a week) and started working regular shifts in the PICU. It was a steep learning curve for me, but I met the challenge head on and spent time doing a lot of studying on my own. In a matter of a few months,I developed a new love for pediatric nursing and was excited about nursing again after getting physically and mentally burned out from the chronic type patients that were so common in the MICU. Kids really are much tougher than they look and heal faster and more completely than adults do. Taking care of smaller patients was also much easier on my body! Later, I added NICU to my repertoire, although NICU is so very specialized that I never felt like I was a real NICU nurse...more of an adventurous PICU nurse who could do two stable vents or three feeder growers pretty well but was never fully comfortable with the very tiny micropremies or the complex chronics who were often ex micropremies. If I would have done it all over again, I would have done PICU from the start. Eventually, I stopped working MICU only worked contingent in the PICU and the NICU as adults, even one day a week, were just physically more than I could take.When one is a young nurse, one does not think about the wear and tear on one's body. Adult critical care is extremely physically demanding and you don't see many nurses in their 50s and beyond who work full time in adult ICU. Even if you lift right and have lots of help, the wear and tear adds up.
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    Sounds like my current favorite patient- 5 weeks old DORV with side by side great vessels, bilat choanal atresia, severe reflux, colobomas....yes CHARGE, but the parents don't accept the diagnosis.
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    Update - so I was offered a position in a level 1 trauma center for their adult surgical/trauma ICU. I also have a formal interview coming up for a CVICU position at the children's hospital. I am soooo excited and humbled by these opportunities. Both are excellent facilities, teaching hospitals, and provide numerous opportunities for growth in the specialty. I'm going to have an EXTREMELY difficult decision to make pretty soon :/


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