[googabin02]

Wow- KellieNurse06- You are truly an inspiration! You seem like you're wonderful with your daughter. One thing that I try not to ever do is assume...you know what they say about that! I will let you know how my time is. I don't start until July so we'll have to keep in touch!
RNNPICU- What a great story. These little folks are fighters, thats for sure!! Keep the stories coming!

[KellieNurse06]

You're entirely welcome googabin......I hope I didn't come off as a ranting maniac....rotflmao..... I just wanted to give you the perspective from the family/patient side ....actually I was thrown into nursing not by choice (at 1st) because I HAD to do it......I only decided to become a nurse 7 years ago....and believe me I love it & wish I did it years ago.......
I can't wait to hear your experiences in PICU......and please do keep in touch...absolutely!
Lots of fantastic advice on here & especially from nurses who have been PICU/ICU nurses.
p.s...thanks for giving me a chuckle about the assume thing......you made me remember an old history teacher I had who was a gas.......he would always say......never assume....because you make an *$$ out of you and me....lol.....

[googabin02]

KellieNurse06- You are an angel. I'm sure you take wonderful care of your child. It takes a strong person. Oh, and about the assume- You hit the nail on the head!! I love that line. I definately will keep in touch! Wish me luck and pray for me. I am just really nervous that everything is going to overwhelm me and I'm not going to learn everything that I need to. For some reason I think everyone will know more than me. I am trying to stop these thoughts, but it is hard. I try to be as confident as possible, and everyone is telling me I'll do wonderful, but I am just nervous!

[KellieNurse06]

googabin..that's a good thing I think. My last nursing instructor when I finished my RN program was a nurse practitioner..she always said being nervous is a good thing because it makes you know you don't know everything ...and if you aren't nervous then you aren't learning. She was so right on the money there. She always said the students who didn't feel nervous or worry were the ones that scared her because then you get over confident & thats when things get away from you....... She was so right on.....one of the best instructors I have ever had!
You'll be great..don't worry!Plus I think a good thing is you will probably have a 1:1 or 1:2 ratio when you are on your own after precepting.
Plus the other nurses will be right there and the docs too. From what I have seen those picu staff really do work like a fine tuned machine........I really admire them and am always amazed at how they do their work and make it look effortless even under very stressful situations.......You'll do fine!

[janfrn]

I'm going to echo what KellieNurse06 said. I've been the parent of a PICU frequent flyer and am in my 10th year of working in PICU. The new staff who recognize that they don't know everything are the ones I have to greatest respect for. I have a couple of pearls I pass on to my preceptees: 1) The only stupid question is the one you don't ask, and 2) take responsibility for your own education needs. Ask to help with difficult dressing change, ask to watch a new procedure a couple of times so you know what your role will be, ask to help with a challenging admission. You're there to learn how to be the best PICU nurse you can be, not to do somebody else's work; you can't allow yourself to be stuck in a rut with a million patient care tasks you're already proficient at when you could be soaking up new stuff. Use your resources... all of them: the other nurses, the clinical instructor, the physicians, the respiratory therapists, the pharmacist, the dietician, the nursing assistant, and most especially THE PARENTS!! They may not know much about critical care but they know that child! Involving them in care is also extremely important. There is always something a parent can do for their child, no matter how sick the child is, even if it's just washing face and hands a couple of times a shift.

You have the right attitude for a new PICU nurse and that will take you far. Please do keep us updated!

[KellieNurse06]

Jan you are awesome! You are so right! 10 years, huh? Good for you!
When ever my daughter was inpatient ( only can go to PICU due to her vent regardless of what illness it is), I'd do tons of stuff that I could of just let the nurses do...I would suction her trach & mouth, change her briefs, wash up, do mouth care, do chest pt.....all of it ( & this was even before I went to nursing school)..except of course the obvious things no one but the nurse could do like meds,...unless of course they handed them to me & watched me give them........I really think they appreciated it when they were swamped.....and I'd even mark the time on a brief I changed, or tell them I flushed the feeding tube with xx amount of water..............and I always made sure they didn't mind first.......none of which did (I think) because they knew us so well....
How do you feel about parents doing those things???? Seeing you as well are on both sides of the coin??? I always wondered if they really minded but didn't want to offend me...... they seemed to be ok with it.......and I'm sure they would of said so if it wasn't ok.
I also never hounded the nurses with questions about every little thing they were doing....like some who can be a nightmare parent....maybe because I am so adapted to it after dealing with it for so long....I don't know......I would love to get into PICU nursing....that would be my ideal job right now...

[AliRae]

Originally Posted by KellieNurse06

How do you feel about parents doing those things????

We have a large population that we call "our kids" ... frequent fliers for one reason or another, most trached, many vent dependent. One of the very first things I learned was to listen to their parents. I actually got in a fight with the attending on my first day off orientation because mom and I agreed that "something wasn't right." If you're the kind of PICU parent I think you are, we love you. We have some kiddos who would not be alive but for their parents. I've been taking care of one guy recently who's the oldest living case in the WORLD of the syndrome he has ... by about 5 or 6 years! And I'm firmly convinced that it's because his mother loves him and cares for him the way she does.

That being said, there are some parents who are not such pearls. I admitted one such family recently, and they were physically pushing me away from their baby as I tried to get the CPAP on. I would go into the room when he desatted to find that they had turned the O2 right down because "it would hurt his eyes." (NICU grads) We eventually had a l - o -n - g chat and they began to let me do what I needed to do. If you get to the point that you're constantly clashing with your nurse, take a step back and see what's going on. Otherwise, you're my dream parent. =)

[janfrn]

Kellie, you would have SO much to offer to PICU! Go for it! But be prepared for the inevitable "What would you do if your child is admitted?" question, because it will come up. You'll have to be definite in your professionalism when you respond. It's hard to separate the nurse from the mom (and the mom from the nurse!) sometimes. Resist the temptation to try to "organize" her care: we don't let other parents choose who will be their child's nurse and we shouldn't allow staff to make that decision either. (This situation has come up in our unit and it created a LOT of issues!!!!) Your coworkers will make every effort to be fair and reasonable. And make it clear that when she's in the unit, you are her mom, not a nurse... don't get into the trap of taking over. You're not going to be legally covered for any nursing tasks you do while in hospital so you need to stick to what you'd normally do.

How do I feel about letting parents do for their child? I encourage it. I've been heard saying, "You were changing his diapers before he got sick and you'll be changing them again when he's better. If I show you how to do it here so that he's safe and you're comfortable, then there's no reason why you can't do it here too." I have a sense of which parents really want to do things and which would rather let me do it all. I never push anyone to do something they aren't comfortable with, unless it's one of those new facts of life, like enoxaparin injections, trach care, ostomy care, GT feeds, you know what I mean. Then it's more a case of demonstrating and teaching today, getting them to do part of it tomorrow, talking them through it, then working on getting them competently doing it on their own.

There are those nurses who are very territorial about "their" patients. And they are often convinced that no one can do their job better than they can. It's almost an "I'm the nurse, I'll decide" mentality. Nothing is going to change them; parents who actually do know what they're doing scare them senseless, and they go on the defensive. It's just better that they not be assigned those kids.

Last night I came very close to decking a nurse with about 30 years of experience. We have a teenager who came in with severe asphyxia a month ago who is in a vegetative state and is very hypertonic and spastic. This nurse asked for my help to reposition the patient. We got the kid boosted up in bed, limbs supported and all that, then I looked across the bed and she's trying to force the kid's very rigid right arm into a bent-elbow orthosis. I had already applied the left hand resting splint with no trouble. But this nurse didn't seem to realize that when you touch a kid like this, they stiffen and posture, and that repeatedly trying to make them do something only makes it worse. I finally said to her, "May I show you how to make that easier to get on?" It's all about patience (she has none) and calmness (ditto); if you hold the limb firmly and don't move it around but just wait, the spasticity passes. Then you can gently and firmly position the limb the way you want it by sliding the orthosis onto the limb, not jamming the limb into the orthosis, and get the straps on before they've noticed what you've done. I had to repeat the lesson with the AFOs, because of course the second she grabbed the kid's foot, whoops, rigid plantar extension. "Here, try bending the knee and just holding the foot firmly and gently, see how it relaxes and you can slide it right in to the heel of the AFO? Isn't that easier than trying to force it?" I doubt the lesson will stick, but I had to try...

[KellieNurse06]

(((Ali)))) awwww you are so sweet!!! Thanks!!!
Wow Jan...I can tell you really are awesome & one of those who "get it" lol. Speaking of those nurses you mention...who have the "I'm the nurse" mentality....omg..there is one on the unit my daughter goes to...who is exactly like that! I almost spit my coffee out because when I saw that, I saw her...lol! You know how patients are on precautions sometimes.....well one time my daughter was on precautions and this one nurse had her this time....now they never have me gown up because I am around her 24/7.... one of them told me it's more for the nurses/docs due to going patient to patient( unless they are mistaken) & cross contamination.....well you know..why am I telling you???....lol...She actually told me I was not not going in there until I gown/mask/glove up, and this was her coming onto 2nd shift, we were there all day,had gone to eat & came back up just as shift was changing (no gowning/gloving/masking all day)...and my mom was so taken aback..she said to her.."you know this is her mother, right?"..she actually said yes.......and still told me to put the garb on.......now all the other staff up there told me because I am around her 24/7 & not going around other patients that it was ok for me to not garb up...just wash my hands extra well etc.
She also is one that gets all paranoid & questions every stinking little thing I do.......& will stand there & watch me. & is very condescending when talking to me.....lol...one of my daughters home care nurses who even has encountered her up there said she probably needs to......well I won't go into details. but you probably know what I was going to say...lol!
And the nurses up there have been there as long as I can remember......so they know us very very well...and one like you mentioned about knowing the patients/ parents well....my daughter got a fracture while in there, not good; but thankfully happened in there...what a nightmare that would of been trying to explain... (she has very brittle bones, proven medically) she had argued with one of the docs to get an xray because she knew something just wasn't right, pain, restless & uncomfortable & no one could tell why.... and I practically kissed her feet....she argued for an xray because she new something just wasn't right......and lo & behold......fracture.......they figure it happened from turning her .......anyway, it's nurses like her that I trust my childs life with because because they know these kids so well after having them for so long........ and I can see you are one of those nurses........I have the utmost respect for those nurses....
If my daughter ever was admitted if I were to work there....I would never try to do anything but be the mom.....except of course if I thought something wasn't being done that should be.....other than that.....the plus is I could be working and see her....lol...... Maybe that's why they haven't called me....conflict of patient/employee??? oh well............ Anyways thanks for the insight!!! I learned alot of great info from "the inside" lol!

[janfrn]

Originally Posted by KellieNurse06

If my daughter ever was admitted if I were to work there....I would never try to do anything but be the mom.....except of course if I thought something wasn't being done that should be.....other than that.....the plus is I could be working and see her....lol...... Maybe that's why they haven't called me....conflict of patient/employee???

As long as you can just be her mom and do the things you'd have done anyway, anywhere, that should be fine. (Like pointing out those little things that sometimes get overlooked, or suggesting an easier way to do something that you'd done a gazillion times!) You might find that management will ask you to take family sick time if your girl is admitted. That way no one will be able to point fingers or talk about you behind your back. It will happen, trust me.

I would guess that you have some kind of relationship with the management there already, since your girl has been there frequently. Maybe you could ask for a meeting where you can express your understanding of professional boundaries, your willingness to revert to Mom-mode when she's there and your desire to help other families in the way that yours has been helped. They might see that positively and give you a second look for hire. It certainly can't hurt! As I always say to my daughter, "What's the worst that can happen?" You still don't get the job? Nothing ventured, nothing gained. Good luck! I'm rooting for you.