umcRN 14,075 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.
I made the switch from NICU to CICU for several reasons. One; my original "5 year plan" was (like many new grads) to get my two years experience and move on. I am not from the state where I work and I always wanted to travel then move home. NICU was not my first choice but it was my first and only offer and I wanted to work in a large children's hospital so i took it. I loved it but the long stretches of time not having a "sick" kid really dragged me down, there's only so many times I can encourage a pokey preemie to eat and the PPHN/CDH/ECMO and other more interesting surgical kids were just fewer and far between. I also had some personal issues with some of the docs (work related and mostly all boiling down to one patient whom the docs refused to listen to many nursing concerns, not just mine, until it was too late). I got ready to go traveling but figured while I was in such a great children's hospital I should get a little more experience and try another unit to make myself more marketable. PICU was out for me, I'm just not interested in it and the varying cardiac anatomy was always interesting to me, especially since every so often we would get a cardiac baby in the nicu and have to transfer it out once we figured it out.
Shortly after starting in the CICU I got sick and was out of work for a few months. Once I went back it was really more of a necessity to stay in order to keep my great health insurance and benefits (luckily I did since I got sick again a year and a half later and doing that on travelers health insurance would have been hard). I'm now going on almost 4 years in the CICU (total of almost 6 at my hospital) and I am happy. I love the intensity of the CICU and am soon taking the class to sit on the ecmo pump side (take over the care of the pump not the patient), I am happy in my unit, I have great coworkers and the patients keep my on my toes. I have found love in this state (for now though I do hope it lasts) and while I never got around to travelling I am ok with it right now. In two weeks I will be going on a cardiac surgery mission trip and couldn't be more excited, I love these heart kids.
I'm sorry that was the really long winded answer to "why did you leave the nicu" but it's just sort of how my life happened.
Also as far as new grads in the ICU all of the ICUs at my hospital have new grad programs (I was one in the nicu) and I think with appropriate training, support, classes and flexibility with orientation length that new grads can do very well in any ICU setting. We have had new grads that didn't do well for whatever reason and in those instances (in both units I worked in) the educators worked hard to find them a more suitable unit within our hospital if possible.
Whichever unit you choose will give you a solid ground for icu experience and make the transition to pretty much any unit more feasible than having no icu experience at all. Let us know which you choose and good luck!
I have done both and prefer CICU which is where I work now. While there is a MAJOR focus on the heart you also have to remember that the heart effects every organ system, and many kids with congenital heart defects may have a syndrome of defects which affects multiple organ systems. We have kids with kidney, respiratory, liver, bowel, neuro, endocrine, oncology issues and hosts of others. Just an example I had two patients today, one is a premature neonate with a prenatally diagnosed congenital heart disease, now that the baby is out we actually don't think there is a heart defect at all but a brain MRI showed severe abnormalities. The parents are now facing decisions related to quality of life and palliative care - completely unrelated to a heart issue. The other kiddo is a few months old with a corrected complex heart defect, unfortunately this patient has a host of complications and a syndrome. Active issues aren't even related to the heart but to inability to wean from the vent (trach dependent), inability to advance feeds, dialysis dependence and new seizures - none of those things are cardiac but are all issues she has and that we deal with in the cardiac ICU.
Some kids are born with their problems and others acquire them later in life, we'll get older kids who end up with post chemotherapy induced cardiomyopathy and other diagnosis that can turn up later. Yes most of the patients are babies but we get all ages, in one day you can be taking care of a two day old and a 56 year old (yes I had that day) at the same time.
Generally speaking I think the patients in the CICU are sicker but it's because they have such little reserve to begin with. I worked in the NICU (Level IV) for two years and I will tell anyone that the babies up there can be sick as snot, especially the term PPHN/CDH kids and the preemies who get NEC and spiral down fast however looking at the units as a whole the cardiac kids are much less trustworthy. My first cardiac code was a three year old who spent the morning bouncing on his bed watching mickey mouse and waiting for a bed on the floor to open up. One moment he was fine next we were coding him, cracking his chest and putting him on ecmo. Sadly he didn't survive. Their hearts are so tenuious, one point drop in a base deficit or a half point rise in a potassium level can completely knock them off the edge and into a deadly spiral. Many, MANY of the babies have their chests left open after surgery so consider that too, is that something you feel like you'll be able to handle? Literally watching your patients heart beating with the possibility of needing to use three fingers to do chest compressions on it?
I don't think you can say the units are similar at all personally. I think the transition was easy enough though there were a few things I struggled with initially but I think any ICU to ICU transition shouldn't be all that hard, so long as you know how to code a patient technically you should be safe in any of them but to say they are similar I don't think that's true.
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