I had planned to respond to this thread on Wednesday but my wireless router packed it in and I had no Internet access until last night. By then I'd forgotten. But I digress.
I hope you find PICU as interesting, challenging, exciting and rewarding as I do. I've been at this since September 1997 and although there are days when I hate my job, I never could hate my work. If you know what I mean.
On our unit the #1 diagnosis is congenital heart disease. We're a referral centre for a very large catchment for pediatric hearts; we have a pediatric transport team and a very busy pediatric extracorporeal life support (ECLS) team. In the winter we see a lot of respiratory illnesses, even though Synagis has been availalbe for years now. Many of our patients are from remote areas where health care availability is spotty; many kids who would qualify for Synagis don't get it because their primary care provider isn't up-to-date on the "new" stuff. Then we also see a lot of traumas, particularly in May when the last of the snow is gone and the ATVs are brought back out and in the fall when the weather is starting to turn and people try to squeeze just a few more rides in. Our unit also is a transplant centre; we do hearts, livers, kidneys and lungs. Right now we have 2 heart recipients, one liver and one double lung and we have 2 kids waiting for hearts.
Our mortality rate is quite low, about 2.5%, but our morbidity is starting to creep up. The reasons for that have more to do with medical and surgical decisions rather than nursing care deficiencies. Our cardiac surgeons will do complex surgeries on patients other centres have turned away and they do transplants on people who are extraordinarily poor candidates. We also use ECLS a lot more than we used to and some of those kids are doomed to a very poor quality of life. But then there are the ones who defy the odds... go to http://www.canada.com/globaltv/edmon...ers/index.html
and look for "Unsung Heroes" from Dec 2, 2008. Kids like this are what keeps us going.
Great PICU nurses are born, as you say, and not made. We're part mother hen, part mother tiger... we protect our patients in whatever manner is needed at the time. We're part hands-on comforter and part technical wizard... we use touch and soothing voice to provide comfort and manage a dozen or more high-tech gadgets all at the same time. We're part student and part teacher... we are continually learning about new illnesses, new treatments, new drugs and new technologies and we teach parents and siblings about the problems faced by our patients so they can understand and deal with it all. These qualities are all wrapped up with a passion to provide our patients with the best possible care, the most worthwhile life and when necessary, the most peaceful passing.
Safety precautions are built into our practice. We utilize restraints when needed, we double-check every medication we give, we verify dosages before giving medications for the first time, we ensure that someone has eyes on the kids at all times. Our monitors alarms are tightly set so that any aberration is noted immediately. We also use anti-entanglement devices on IV tubing for chidren at risk. It's all just part of our culture.
Don't expect to interact all that much with your patients. They're usually sedated in PICU for most of their stay. Your experience with asthmatics will be useful though. Some children with severe asthma will need to be admitted to PICU for back-to-back albuterol nebs and other more complex interventions (we've had one youngster who has been on ECLS twice!) or medications that need close obs.
Please check back and let us know how you're liking it, won't you?