Moving to a city with no CICU?

[BabyHeartsRN]

Hi,

I am newer pediatric CICU nurse with only one year of experience, but so far I absolutely love CICU. I love how complex and unpredictable the patients are and I enjoy the fact that they are almost all babies. I would like to stay in CICU for a long time since there is so much to learn and I enjoy it a great deal. That being said with only one year of experience I can't say for sure I will want to do it forever.

My husband and I are hoping to soon move back to our home state of North Carolina and want to either live in Charlotte or Asheville. We would strongly prefer Asheville but Mission Children's hospital does not have a CICU and I don't think they do any cardiac surgeries. Levine Children's hospital in Charlotte seems like a good place to work and has a CICU, but we both are wanting to live in a smaller city and closer to the mountains.

So my options in Asheville would be PICU or NICU. I have floated to the neuro/trauma ICU a couple of times and didn't like it much at all, but maybe a general PICU would be more interesting... I'm just not sure if living in Asheville would be worth giving up CICU.

Anybody out there who has switched from CICU to PICU or NICU? Was it just as challenging and interesting? Anybody who switched back? Any seasoned CICU nurses out there who would never dream of doing anything else? I'm sure both have patients just as sick as cardiac kids but I think I would get bored with the feeders/growers in NICU and I prefer not to have lots of bigger kids like I would in PICU.

Thanks!

[NotReady4PrimeTime, RN]

I can't comment on North Carolina, Asheville or Charlotte. But I can comment on CICU, PICU and NICU... having worked all three. I took my current job to get CICU experience. That was more than a decade ago and in retrospect, I really prefer PICU to CICU. Initially I really enjoyed learning about the particular anatomy and physiology of cardiac anomalies and their repairs. But over time I found it to be more and more routine. The kids all came from the OR with a predictable assortment of lines, drips, drains and problems. Some kids are clearly not meant for long lives, but all stops are pulled far beyond what I feel to be in the best interest of anyone involved... except maybe the surgeon. We used to have criteria for certain treatment modalities but they seem to have fallen by the wayside. So CICU has become an uncomfortable place for me.

PICUs do have bigger kids, as a general rule, but during respiratory virus season there are LOTS of babies. Liver transplant patients are typically small, under a year - and they're VERY sick. They can keep 2 nurses busy for several days post-op. Most of the ENT kids are little - supraglottoplasties, tracheal slings, tracheoplasties and neo/infant tracheostomies will spend at least a short time in PICU. Babies also occasionally have oncologic diseases that send them to PICU. I'd say the patient population is likely at least 60% small people. Oh, and I was forgetting the kids with metabolic disorders... they're often admitted to PICU early in life.

NICUs aren't always just feeder-growers. The NICU at my hospital is a surgical NICU so the babies admitted there are the ones with gastroschisis/omphalocele, meningomyelocele, cleft lip/palate, exstrophy of the bladder, malrotation, hydrocephalus and cardiac anomalies for example.

I hope your decision becomes easier over time. Maybe you could arrange a tour of the units where you'd plan to apply, to get a feel for the lay of the land. It might make it easier for you to make up your mind.

[BabyHeartsRN]

Thanks so much for the reply and the perspective! He hasn't heard back about the job in Asheville so we will probably end up in Charlotte and I can keep working CICU for now. Though I definitely agree about the kids not meant for long lives. I still want to end up in Asheville one day though so it is good to know that PICU and NICU can be interesting and I can still care for babies in PICU! :)