PICU Nurses

Hi all, happy to find this site. I've been an RN for 28 years, always pedi, and a PICU nurse for 24. I couln't imagine doing anything else, though I've tried! My unit is 16 beds, is multidisciplinary and affilitated with Brown Univ. medical school. We don't see cardiacs other than for stabilization and transport to Boston. We do have a very active transport team and care for some extremely ill children. Due to the general nursing shortage, our institution has initiated a critical care intern program where new grads can make the leap into the ICUs without prior experience. We offer them an extended orientation, an identified resource nurse when newly off orientation but.......then what? Several of my "older" colleagues and I want to offer some sort of support group to help them after they lose their first patient, encounter their first code, have the day from he** that we've all had (but know how to deal with). Is there anyone out there who has similar experience or wishes they had that or has a suggestion of how/what we could do for our new little chickens. Thanks. Keep up the good work. Mimsy

We've actually just agreed to implement a peer support group of experienced "old-timers" who will be available at anytime for new and not-so-new staff to take their issues to. We've slid into a really dysfunctional state and are now identifying and beginning to address the underlying causes. This was something that both management and bedside staff agreed was a significant problem. One of our staff nurses has taken on the development of our group. The goal is to provide support in any type of situation and to act as a sounding board/hand-holder for issues that may need to be taken further. There will be a letter written to be included in tthe orientation package all our new hires get, introducing the team and providing contact information. There will also be a list posted in the union binder in our staff room. All interactions will be held in confidence unless to do so would be against the law, the nursing professionals' act or would endanger someone else. I've already been acting in this capacity for several years in an informal way.

Unfortunately our unit doesn't provide the same level of education and nurturing of new nurses as yours does, Mimsy. That's something we've also agreed to address. Our nurse-educator is brand-new to the role in our unit and has good insight into how to change our orientation so that new nurses are better prepared and supported. We'll see how it goes, but I'm hopeful that we'll be able to improve the conditions in our unit at least a little.

This is my first post. I have worked in pediatrics for 6 years and PICU for almost 2 years. I live and work in South Texas. I have recently changed jobs and will be working in a fast paced high acuity PICU. I am really looking for websites to brush up on my knowledge. I would like to put together an education notebook of information for PICU nurses to reference.

Give me a few minutes, I have a bunch of good resources for you, but I'm kinda multi-tasking right now and will need a little while to sort it all out so I can devote my full attention to this!

Rayne31,
When you get your resource book together could you post it on this thread or PM me a copy ,if possible. I am thinking of finally returning to PICU within the year and would love to brush up on some things over the next "9 months". Good luck with your endeavor.

Okay, here are some of the resources I've found helpful in the past:

Pain Assessment: http://www.medscape.com/viewarticle/452694?mpid=13281
Cardiovascular Care: http://www.cincinnatichildrens.org/h...-encyclopedia/
Cardiovascular Pharmacology: http://www.medscape.com/viewarticle/452691?mpid=13759&WebLogicSession=Pswqr2Tn0hKPWtpV nAJT0Ef15gBhojklVtAly1mTXgFjOBKseUWG|7728315570410 925416/184161393/6/7001/7001/7002/7002/7001/-1
RSV and other LRTIs: http://www.medscape.com/viewarticle/452573?mpid=13481
Genetic disorders: http://www.ncbi.nlm.nih.gov/sites/entrez?db=omim
Orthopedics: http://pediatric-orthopedics.com/Topics/topics.html
Pediatric Critical Care: http://pedsccm.org/ (This one is hugely helpful on many topics)

I also have a copy of the AACN's Core Curriculum for Pediactric Critical Care Nursing. It's an amazingly comprehensive reference; I like it so much that when the second edition came out, I bought it even though there aren't huge changes from the first edition.

I would be interested in hearing what steps you took as nurses to better the communication and overall relationship with the md's. At my facility we have one intensivist that we struggle with everyday. We have had a great unit for last several years until she came. She doesn't allow any autonomy and criticizes everything, even that which doesn't even involve her. We have had an extremely high turnover rate with people stating her as reason for leaving. We have talked to her about respect, but she just blows us off and doesn't think there is a problem with her.

I think I've worked with her!

We're still working on building better collaboration with our physicians (we have 7 intensivists and four fellows!). Some of them are very good and will listen and explain when they don't agree then listen again while the nurse offers more input, others who shut things down without saying a word. But for us part of the issue is that we have a HUGE contingent of very inexperienced nurses who really don't know what they don't know, who don't undesrtand or recognize ominous changes in patients, and the physican group doesn't trust them. We oldtimers are given a lot of autonomy over certain things and none over others, and whenever there's been an incident with one of the newer nurses, we are all lambasted by our management, who sends out blanket "you're stupid" emails. I keep them in a file that someday I will find a way to use to improve things.

One thing that might help in our unit is that our medical management has made some changes. The intensivists will now be dividing up responsibility for the patients in the unit along cardiac and noncardiac lines. We always have two on during the day, so one will round on the cardiacs and the other will round on the rest, at the same time. The back-up intensivist will be the fire-putter-outer for the time rounds are in progress. They feel this model will accomplish several things... rounds will be over and done with before supper time , the physicians will have more time to work directly with the nurses on improving patient care and more time to spend with the families and the plan of care will change less often. (Right now it might change every single shift... and isn't that a problem!) We'll have to see how it plays out; this is the first week it's been in practice and I'm on vacation so I have no idea if it's working or not.

Does your hospital have an official respect-in-the-workplace policy? You should be documenting incidents with your problem doc so that when there's enough evidence you can go to the medical director and human resources and file a formal complaint. Documentation has to be first-person and signed, but the identitie of the complainants will be kept confidential in most cases when the complaint is acted on. Best of luck...

i work in a combined neo-picu in st gallen, switzerland. we get everything here except for cardiac surgery, which goes to zurich. i only came to picu 2 years ago, and am also on a steep learning curve, but love the work and the atmosphere. we have the usual problems with staffing, finance, etc so you are not alone.

I work in the PICU at Women's and Children's Hospital of Buffalo. We are a 20 bed (can flex to 22) multidisciplinary unit. We generally have adequate (or near adequate) staffing. We see a mix of medical, neuro, cardiac, and trauma, with some high-risk OB thrown in. Our kids range from days old to adult. (i think my oldest pt. to date was 45!) We have a fairly active ECMO program, and VERY active transport team.