[jopadeevra]

Hi all,
I am a nursing student about to enter my last semester !!! I feel a calling to work in peds, and I think specifically PICU. I'm looking for advice in which direction I should go initially after gradutaion to give me the best knowledge base to carry me into the PICU. I currently work in the Emergency Room Admitting Department at my local children's hospital. Sometimes I think that (ER) would be a good place to start , but other times I don't because of so many run of the mill (sore throats, minor lacs, ect.) cases. Maybe peds med/surg? Any input would be appreciated. Also, any words of wisdom from PICU nurses regarding not becoming too emotionally involved in cases is greatly appreciated. Does it get 'easier' over time? I am not an overly emotional person in the first place, but we recently had a patient at our hospital that was heart-breaking. I know the best gift a nurse can give is compassionate care, but how does it not chip away at your soul?
Sorry so solemn, but thanks!
Paula

[janfrn]

Peds med-surg would be an excellent place to start. That would give you some good basic education on peds norms, practice for interactions with both kids and parents, organizational and assessment skills, critical thinking and a good grounding in med administration. You'll find all of that very handy when you make the jump to PICU.

As for the emotional attachment, I wouldn't ever want to lose that part of me. The secret is in keeping a professional distance. I can be attached to a child or a family, but not take their burdens onto my own shoulders. It's better to help them find ways for them to carry them and still function. Whatever we can do to make things easier for them qualifies as compassionate care, but we need to remember that we are not family members, we are not friends, we are health care professionals there to help the child and family cope with illness. When we get in the way of the people who should be providing the familial support and the friendship, the ones who will be there when the crisis is over, however it ends, and on into the future, we do everyone a disservice. I grieve when a child I've cared for dies, but it's a different kind of grief than I would feel if it were my own child or a friend's. I see too much inappropriate attachment in our unit, and it makes me very upset at times. Coworkers usurp the roles that rightfully belong to family members or friends, cause the parents to come to depend on them for the support they should be finding elsewhere and then when the child dies, the family has lost their anchor. No one knows what their needs are or how to fill them because they've been pushed aside. To me that is a crime. So please, if you find yourself heading down that path, stop and think about what will happen when you're no longer there to prop these people up, and back off...

[Jennifer, RN]

Originally Posted by janfrn

Peds med-surg would be an excellent place to start. That would give you some good basic education on peds norms, practice for interactions with both kids and parents, organizational and assessment skills, critical thinking and a good grounding in med administration. You'll find all of that very handy when you make the jump to PICU.

As for the emotional attachment, I wouldn't ever want to lose that part of me. The secret is in keeping a professional distance. I can be attached to a child or a family, but not take their burdens onto my own shoulders. It's better to help them find ways for them to carry them and still function. Whatever we can do to make things easier for them qualifies as compassionate care, but we need to remember that we are not family members, we are not friends, we are health care professionals there to help the child and family cope with illness. When we get in the way of the people who should be providing the familial support and the friendship, the ones who will be there when the crisis is over, however it ends, and on into the future, we do everyone a disservice. I grieve when a child I've cared for dies, but it's a different kind of grief than I would feel if it were my own child or a friend's. I see too much inappropriate attachment in our unit, and it makes me very upset at times. Coworkers usurp the roles that rightfully belong to family members or friends, cause the parents to come to depend on them for the support they should be finding elsewhere and then when the child dies, the family has lost their anchor. No one knows what their needs are or how to fill them because they've been pushed aside. To me that is a crime. So please, if you find yourself heading down that path, stop and think about what will happen when you're no longer there to prop these people up, and back off...

Excellent, excellent advice. Thank you!!!

[bwpcicuube]

I think that the best advice I can give you is to start where you feel the most comfortable. I began my career in a PICU as a GN. Unfortunately they did not offer any type of orientation and after 5 weeks of orientation they set me free. Well I fell flat on my face as you can well imagine. But I stuck with it and eventually it "clicked" for me and everything came together. I honestly believe that it was the right decision for me. Had I started anywhere else I would not have had to meet that challenge head on. 16 years later I am an educator for a peds cardiac ICU. The minimum orientation for an experienced nurse is 12 weeks.(Unless the experience is PCICU) and for GN's I leave them on for 6 months.

As for the emotional attachment I feel this way. The day I walk on to that unit and feel nothing or the day I don't cry when we lose someone is the day I get out of nursing.

[meesa214]

I'm a new nurse (graduated last Dec) and I started out in the PICU right off the bat. My unit has a very good orientation. 16 weeks for new grad, includes didactic and bedside time with a preceptor. It's also a large teaching hospital with lots of resources, which makes me more comfortable.

I don't know that starting out on a different unit would have prepared me for this. Being on this unit, I KNOW that these kids are really sick and we always have a bunch of docs that I can bring to the bedside at any hour if I even have a feeling that something might be going on. And I have a lot of support from coworkers.

My personal opinion is that ER is not the place to start out in. In the PICU you sort of know what you're getting into when you get report. There are certain things that you may be able to anticipate happening based on the previous shifts. You don't have that luxury in the ER. Generally you don't know the pts as they come in, you don't know what's wrong with them, and you really need to know your stuff which I think comes from experience not from books.

A peds floor will definitely give you experience in (sometimes) a more slower paced environment than a PICU. But I take comfort in the fact that I have all my resources right here. There's nothing we can't handle b/c we're at the top of the chain. We HAVE to handle it. Other PICUs in the area send their pts to us when things go bad!

And I feel like it's safer here than on the floor. I'm always watching my pts. If I have to leave, my roomie is watching. I'd be afraid that if I was on the floor, something would happen to the pt when I wasn't there. Or that I would get lax thinking "Oh the kid is fine, he's going home tomorrow" and miss something.

I love the 'taskyness' of the PICU. I like art lines and titrating drips and ICP monitors. But if you're into teaching, our unit's not the place. I feel parents get very little teaching b/c we're so focused on keeping the kid stable. The floors do the teaching...diabetes, trach suctioning, etc.

[CarpeDiemRN]

I went directly into PICU upon graduation- in my last semester of nursing school I did my practicum in the ER, thinking that it would be a good transition to PICU. I changed my mind. Let me say up front, that I LOVED the ER, but in the end I didn't feel that I would be challenged to develop my clinical skills to the degree that I wanted. In the ER you do a little bit for alot of patients, and you do it quickly - in the PICU you provide very detailed, in depth care for only 1-2 patients. In the ER you don't get to practice the very detailed psychomotor skills and analysis that are required in PICU (ie; working with art lines, ICP monitoring, titrating drips, etc.). For instance, in my hospital if there is a true "peds trauma" the PICU nurses are called down to the trauma bay and manage the medication administration- if there is a code on a peds med-surge floor, again the PICU nurses go on the code team.... not the ER nurses. The more critical the patient, the quicker it will be brought to the PICU. The trauma flight team is comprised of PICU nurses and docs- not ER. Don't get me wrong, ER nurses have special and unique skills of their own- my point is, I came to realize that ER and PICU are very different environments. I have found alot of nurses who start in PICU and go to ER... but not the other way around...for whatever reason. So, it all depends on what you are looking for and how your hospital is set up I guess. My opinion- if you find a PICU with a solid orientation for new grads (and you know you want to end up in PICU), go directly to PICU! By this I mean, 16 weeks with combined classroom and hands on teaching and working side by side with a preceptor. My PICU has very detailed policies and procedures and I think it is sometimes harder for people to come in from other units and have to "unlearn" old methods. However, some people in my PICU started on the floor and say that it gave them the opportunity to solidify their basic nursing skills and develop good time management- so depending on your personal comfort level that may be the way to go. A peds med-surg floor that has some rooms designated as "intermediate care" or "critical care step down", could be a good transition spot.

As for the attachment part- Janfrn said it well!

Good luck!

[2bnursenikki82]

This is a great thread!!! I'm also going into my last semester in June and want to work in PICU. I'm crossing my fingers for my last semester internship to be in PICU here at a local hospital and then moving off to Fort Worth, TX and hopefully go to a PICU there!!!

[heelgal]

Congrats on your graduation from school!

Let me say first and foremost that as a new grad, the most important thing to know is where you are- not just clinically, but emotionally. I did my senior practicum in a large PICU and literally ran out the doors when I finished my last day. I have always known I wanted to do peds, but knew I was not emotionally ready to deal with the tragedy we deal with daily in the PICU. I am so glad I took a step back and did general peds for a few years after graduation and then stepped it up to peds ED/ urgent care after that. Finally, at 30, I felt I was ready. And I have been in the PICU since.
I have said that teachability and enthusiasm are two of the most important characteristics of any new grad. If you carry those things with you, you can be successful in any area you pursue. The very fact that you feel 'called' to peds tells me you sense a purpose behind your career. That sense of calling will carry you far, as long as you accept the fact adversity will accompany your calling. Sometimes your job will be helping a child die with grace and dignity. Sometimes it will be helping a family let go. These things are a part of being a PICU nurse.

Good luck and Godspeed!