Dear PICU Nurses...

  1. Dear PICU nurses...

    I am a NICU nurse with <1 year experience. When I began looking for jobs I knew I wanted peds ICU. NICU was not my first choice but I was ecstatic to receive any ICU job in a Children's hospital. I work in a large Level IIIc NICU - ECMO, cooling, iNO, HFOV, surgery, rare disorders, Prisma, drips, the whole sha-bang. I have become to love it though I do still think I will try my feet out in the other ICU's especially PCICU.

    WHat bothers me is the attitude the other ICU nurses have towards the NICU nurses, especially the PICU nurses when they have to care for some of our "graduates" know the ones I'm talking about, genetic nightmares, brain dead, severe CP/DD/MR, trach/gtube whose parents want it all done.

    I had the pleasure of floating to the PICU the other day for my first time. I was to take care of one of these children, one who had left our unit a few months ago. One I knew well and had sat in on a family meeting for where the neonatal docs and neuro docs told the parents very clearly "she will never open her eyes, never walk, never talk, never breathe without a vent, never know who you are, never go to kindergarten, etc". It didnt matter, the parents still wanted it all. As medical professionals we have to respect what those parents want and give them all the options.

    Well shortly after my first assessment of this baby I was sitting charting when one of the PICU nurses came to me and said "See, this is what you NICU nurses do, you tell them their kid will be normal and give them hope and then they will never let go, then we have to take care of these nightmares for the rest of their lives. Thanks."

    That comment hurt a lot. As a NICU nurse there are times I take care of babies and to myself, wish their parents would let them go, wish the docs had the right to make that decision instead of placing the decision in the hands of the parents who at that point are not emotionally ready to let go of their child and believe if they do they are killing their baby. I have never seen a nurse or a doc be untruthful with parents when it comes to that point, when they know for a fact what the long term outcomes are going to be, it's the parents who make those decisions and it's unfair for those who end up taking care of them when they're older to place the blame on the NICU team and then to even blame an I had some big say in whether that child lived or died.

    I still hope someday to get working experience in PICU or PCICU but I'm afraid I will never be able to do that where I am now because there is so much dislike between the nurses in each of the units.

    I realize it is frustrating to take care of children who you believe have no quality of life, but as with anything we have to do what the parents wish 99.9% of the time. Please try not to take out your anger on the NICU just because that's where the kid started their life, you don't know what went on there and it was especially not the nurses "fault" any child ended up the way they did.

    Also please be nice to us, we are helping out with your assignment load so you don't have to take on an extra pt, and we would really prefer taking care of a sick baby than a "stable" 14 year old! We can code a baby but I have no idea what to do if a 14 year old goes bad!

    Sorry for the vent, thanks for listening
  2. Visit ittybabyRN profile page

    About ittybabyRN

    Joined: Jan '09; Posts: 245; Likes: 129


  3. by   NotReady4PrimeTime
    Trust me, ittybaby. That sort of scenario happens in PICUs all the time too. Some PICU nurses forget that the "futile" patients we've kept breathing that are no longer on our units haven't just evaporated, they've been transferred to a skilled nursing facility or some other alternate level of care arrangement and are now somebody else's moral dilemmas. There was a highly publicised case here last winter that reflects pretty much what you've described, and it led to a public and acrimonious debate about futile care that never truly served anyone's best interests. Although we in PICU were not directly involved in that case, we all felt very badly for the NICU staff and were as supportive of them as we could be.

    Some advice for your personal situation: don't let that one nasty person (who would probably be just as nasty a person if she were a grocery store clerk or a waitress or a librarian - some people just have no filter) deflect you from your goal. If you're equally interested in PICU and PCICU, maybe you could transfer to the PCICU where it's unlikely that the staff will have the same level of contact with those saved-at-all-costs babies who rarely receive cardiac surgery due to all their comorbidities. Then after you've been there for a while, getting comfortable with big kids, you could try transferring to the PICU. There'd be a buffer period between units and you'd no longer be considered one of "them" from NICU. It's worth thinking about.
  4. by   cara1017
    How interesting that you posted this. I just started my senior practicum experience in PICU after debating between NICU and PICU. On my very first day, I overheard a nurse, during report, say that that NICU's successes were often the PICU failures. Just thought it was interesting
  5. by   ittybabyRN

    Thanks for the post, it is frustrating the animosity between the specialties, and I will say there were a few picu nurses who were wonderful to me but that ones nurses comments just stung a lot. I also know its a common problem between all three ICU's. PICU gets the traumas parents want alive at all costs...CICU take 6 months to fix the heart but the kid may be left limbless or with severe brain injury, I know its not just a NICU problem, its really more of a healthcare wide issue and we just work in it.

    Also with some babies often there isn't time to consider the long term outcomes, for instance I admitted a little guy two weeks ago...had previously been cooled at an outside hospital for unknown birth hypoxia, when they rewarmed him he became extremely hypotensive and they maxed out their pressors. He came to us for ECMO...I have never (in my 1 year of experience) witnessed so much fluid pushed into a baby. We kept him alive to rapid deploy ecmo and get him on. Well last week he decannulated, this week hes extubated, never had any IVH on ultrasound but his MRI is awful...but in the midst of all the action there wasn't really any time to make a decision to not treat him, or to consul his parents, we just did what had to be done to save his life...but who knows what kind of life we saved now? His parents think he looks great and are so happy of course...he looks like a baby, sleeps, eats, poops...but is that all he will be doing 5, 10 years from now too? You just can't know.

    I do think I may try to get my foot into the CICU first, the cardiac stuff really interests me, plus the one big thing I dislike about the NICU is that we don't have a step down, so one day can be a whirlwind of excitement while the next day is feeding kids who don't want to eat...which really bores me, I feel like CICU probably has more "rush" most of the time as they have a stepdown.

    Thanks for letting me vent!
    Last edit by ittybabyRN on Aug 25, '10
  6. by   NotReady4PrimeTime
    cara1017, I'm just guessing here but what that comment probably meant was that oftentimes, a child who was one of those critically ill and subsequently brain injured infants will come into the PICU as an adolescent, in septic shock from aspiration or urosepsis and despite all the high-tech complex therapies we have at our disposal, they end up dying.

    ittybaby, your comment about there not being time to consider the long-term outcomes for the babies you see also applies to peds. During a crisis the focus is on the present... getting the heart beating again, keeping the heart beating, correcting the electrolytes, all the things we do with a short-term goal in mind. And the end result is often a neurologically-devastated child and a family that will never be the same again.

    CICU definitely has its moments but it can also be pretty routine. My shift yesterday was one of those holy-crap-this-kid-is-SICK days where I gave fluid boluses, electrolyte boluses, blood transfusions, intubation drugs, mixed and initiated 8 infusions, drew what seemed like a hundred gases, gave stat antibiotics and barely had time to think. (I had great help from my coworkers, thank heaven, and the doc who was on is one who knows his stuff but doesn't get cranky about rapidly shifting situations like this.) Today with the same patient, now MUCH better but still fragile and needing more CV surgery in the future, I had time to help the nurses on either side of me with their patients. If you're interested in cardiac stuff, then make the leap.
  7. by   canadian_girl75
    Its terrible to hear that you were treated that way when floating to another unit. The simple fact is that some people are just miserable and don't think before they comment. I wouldn't let it deter you from your dreams. I have been a CICU nurse for 3 1/2 years now. I have travelled the USA as a travel nurse in PICU and CICU for the last 1 1/2 years. I love the CICU but I also enjoyed the combined CICU/PICU I spent 6 months in recently with the variety. The poiint I'm trying to make is that I never would have figured out that my passion was CICU if I had not stepped out of my comfort zone and tried something else. There are going to be good and bad people no matter where you go and I have learned to just really tap into those positive people around me no matter what unit I end up on!! I have also had to float several times to NICU and I have to say NICU nurses have always been nice to me...thanks!!!and good luck.
  8. by   walkingrock
    It's vey unfortunate that you were the recipient of that thoughtless remark. I don't think that is representative of PICU nurses. I've floated to PICU's for years, and have found the nurses to be generally very helpful and appreciative. PICU has gotta be one of the most difficult places to work, with all the different age levels and diagnoses; especially in a trauma hospital. I hope that your future experience there is positive and enjoyable. :heartbeat