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"...you 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 individual...like 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
Aug 25, '10
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