Quote from mattmrn2013
Thank you, HazelLPN! That was a great post. I had thought about PICU, but wasn't sure if it would be right for me. I do have a passion for critical care, I've wanted to be an ICU nurse since I was six, and I hope I will be good at it. I had thought about starting in an adult ICU just to gain experience and then possibly moving to PICU if I needed a change of scenery. Did you find PICU/NICU to be harder or equally as hard as the MICU/SICU? I always thought it would be ten times harder, and I was a bit frightened at the prospect of taking care of such critically ill children. But it is something that I am keeping in mind. Truth be told, I would work in any ICU: neurosurgical, burn, surgical, medical, pediatric, neonatal; I wouldn't refuse a job in any of the ICUs. I want to experience as much, and learn as much, as I can.
The big thing that I had to get used to when I made the switch to PICU was that everything was based on weight and your norms are different. Kids can also compensate better than adults do before they crump. An adult, usually, will give you plenty of warning. They'll look like hell first before their vitals or labs start to give you the empirical evidence that your intuition has already told you. Generally, kids are not that easy to read...they keep you on your toes. You can literally walk out of the room with a PICU patient and they will look fine....vitals are fine...labs are fine...and then they rapidly decline without the all the warning signs that adults will give.
At the same time, kids are strong. You will see most of your patients get better. Some will have quality of life issues, but not the majority. Rarely did I feel like I was prolonging life of a person with a chronic illness who continued to make poor lifestyle choices like I did as a MICU nurse. NICU is its own thing. Very specialized. You don't have to know nearly as much as a PICU or adult ICU nurse in terms of variety, but you better know premies very well because there is so little room for error. Its a simple matter of mass and volume. I was more of a PICU nurse who moonlighted in the NICU, never a real NICU nurse. I was great with two stable vents or three feeder growers. The very tiny premies (23-24 weekers) and the complex chronics were not my cup of tea and I rarely took care of that population for the good of the patient and my license. They needed a real NICU nurse, not a PICU nurse who is adventerous. I also had some ethical issues in the NICU. We had great technology to save these babies, but there were oftentimes quality of life issues that were challenging for me...and the real NICU nurses as well. It was a nice change of pace, and I loved the staff that I worked with, but I would not have wanted to spend my entire career in the NICU.
We had plenty of new grads who did well in the PICU fresh out of school, so don't be afraid of it. The ones who did the best were naturally bright and talented, were passionate about critical care, and knew that they had a lot to learn and were not afraid to ask questions.
You could always test the waters of the PICU by working as an NA or a unit clerk or tech if you have a local childrens hosital. Some of our best nurses in the unit started out in these positions and were hired immediately after they graduated. Human connections are so important in the work word, but thats a speech for another time.
Best to you,