umcRN 14,504 Views
Joined Nov 28, '10.
Posts: 872 (33% Liked)
This past week has been very, very hard for me. A primary patient of mine passed away very suddenly, from a cause no one saw coming. He had been on our unit 2 months but that was short considering the prior 16 months he had spent in three other hospitals. Never once making it home. This was the hospital he was supposed to go home from. On the same day that he died it was the 2nd birthday of my last primary patient who had died (as a baby, it took a long time for me to agree to being a primary again). Emotionally it has been an exhausting week. Couple that with the extreme acuity and high stress of my unit at the moment (daily ECMO cannulations, codes, open heart OR's etc) and we are all exhausted.
Last night I received a text message though from the mother of my previous primary, the one who would have been two this week. She is having another baby. Hearing that made this week better for me. Knowing that this family, who went through so much and suffered so much, has finally gotten to a place where they can have another child makes me happy, and gives me hope for the family of the little boy I laid in the morgue on Wednesday, that one day they too will be able to heal.
Sometimes this job s*cks! And it's hard and emotionally draining. But I wouldn't work anywhere else.
hmm I would have to say we are all jaded.
Last week I was taking care of my units miracle baby...one of the few I would truly call a miracle. He survived heart surgeries, two times on ecmo and multiple other procedures. He is 13 months old (was hospitalized from 6mos-12mos), he was in for a short visit post a trach change (he had a very special trach). Despite his trach, gtube and medical history he is probably one of the most appropriate 13 mo olds my unit has seen. I was playing with him, throwing him up in the air, parading him around in the wagon. Well the student I had with me seemed absolutely terrified of him! I had to do my other patients assessment and this one would bust out the crocodile tears any time he was left alone so I sent her in there to play with him while I was away and she basically just stood there and looked at him. We forget that most people are not used to these types of patients. To me he was like a day long, fun, babysitting shift but anyone outside our world would not see that.
I work NICU/Peds CICU and when people outside my nursing friends ask me what I do I don't get into much detail. They can't understand and most don't want to know about the world we live in where children suffer and die.
Loved Mary Anns book but maybe im biased because she was my professor and we went through her review book with her
you can apply for license in another state and have your boards apply for that state. My advisors helped me out with it but I took my test in MA but got a license for DC. Unfortunately I can't remember exactly what I did to make that work so I'm probably little help to you
Placing a PICC poses no clear or inevitable threat.
This is your patient "J" got back from surgery about 4 hours ago (open heart on an itty bitty). He's been acidotic since arrival, heres your last gas - 6.9/98/21/16 with a lactate >20, CV surgery is here and prepped and he's going on ECMO now - have fun!
You need to consider your feelings towards each age group. You can become a clinical instructor in any of the units though I would say more likely so from Adult icu or picu.
Having worked in both NICU and Peds CICU I can think of a few things to consider.
How are you with families? Family members are going to be a much bigger presence in peds & nicu, there is a lot of teaching them and a lot of learning from them. They are another member of the childs care team and we must work together to have the best outcome for the child.
Are you good with kids? Silly question maybe but this is an important part of working in a PICU, you have to be able to identify with all age groups, neonates, toddlers to teenagers and if its a cardiac unit then even adults with congenital heart issues. You have to be a little silly, willing to do an assessment on the floor and sometimes chart with a toddler on your lap (yes, even in the ICU). More so you need to understand developmental levels and how to approach painful/difficult tasks with each age group.
What's your patience like? Even in a level 3c NICU you will spend days trying to encourage an old preemie to eat, it's time consuming, frustrating and actually takes quite a bit of skill.
And then there's your own personal beliefs and ethical issues to consider. Every ICU has ethical issues. In the adult world it's the 92 year old with breast cancer and mets to every organ in the body but family refuses a DNR, in peds its the child abused right to the brink of brain death by moms boyfriend, mom won't press charges or leave said boyfriend and wants everything done for said child who, if he survives, will never walk/talk/see/hear again. In the NICU its saving the smaller and smaller babies. The "23" weekers who by the time they've been resuscitated really appear more like 22 or even less and now parents want everything done to keep essentially what was trying to be a miscarriage, alive.
Now picture yourself someday doing chest compressions, because in an ICU it will happen, what is the age of the person you are working on and does it seem like something you can handle? For me I could never do compressions on that 92 year old and feel ok about it. Sometimes I still don't feel ok about it with the kiddos, but when we have a good outcome, and many of them are, I feel satisfied that I've helped that child potentially have a meaningful life.
Don't go after something because of what you think you might want to do someday because that can always change once you've spent time being a nurse. Think about the present and what appeals to you right now. Also what is available to you. It's much easier to move around in nursing after getting that initial experience and you may find what you thought you wanted to be completely different in a few years.
llg is also right in saying that there are few ICU focused clinicals to teach. I do have a friend of mine though who works in the peds cardiac icu and she teaches a clinical elsewhere in our children's hospital, but she's in school to be a peds NP therefore has done her own work and additional clinicals outside of the ICU setting
I work with babies, so it's different, but there's one in my unit now who occasionally still has a 'Mac attack' and sats single digits. She's always been really sensitive and would go from 99% to 9% in a heartbeat. I'm hoping she doesn't have residual damage from all these spells, she always recovers beautifully, but you never know.
I don't work private duty but in my pcicu we have 24/7 cameras above every patient bed. They are used so codes and other serious safety events can go back and be reviewed and see if procedures (like rapid ecmo deploying) need adjusting. At first people were freaked out and upset by it, now we don't even realize it's there. Initially nurses were very afraid though of doctors using the cameras to "point fingers" at something the nurse did wrong. This hasn't been an issue of yet that I know of
I've recently been caring for a baby being cooled on a cooling blanket. He's a big, beautiful term baby, and his parents are so sweet...I want more than anything for him to be ok. I've seen a few concerning neuro movements and possible seizure activity, but it's so hard to know what the long term prognosis is for these children.
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