I've only been a PICU nurse for three months, but I have gained a huge perspective in that time! Being a PICU nurse is exciting, heart-breaking, frustrating, scary, and wonderful all at the same time.
Imagine taking care of a child on ten seperate medication drips who is on a ventilator, has three central lines, arterial line, a CVP and a foley. You're drawing hourly blood gases and blood glucose levels, counting all of your I&O's hourly, monitoring the ventilator settings, constantly alert for any changes in vital signs, making sure your syringes of pressors don't run out, hanging so many medications that you are running out of lines to use. You're giving updates to the docs and making adjustments to your drip rates based on their orders. You need to turn your patient every two hours, which requires two other nurses to help move the patient and keep the breathing tube in place. To top it all off, you have angry family members scrutinizing everything you do and demanding that certain non-essential things be done immediately.
Being a PICU nurse is never boring. There is always something new, something that needs to be done. I've taken care of kids with so many different diagnoses that I couldn't possibly list them all. Our unit is a 19 bed PICU that takes all different kinds of kids. Our hospital has a pediatric cardiac surgery program, so we always have at least a few cardiac patients with various congenital cardiac defects. Depending on the season, we usually have a couple kids with viral illnesses, particularly RSV in the winter months, one or two babies on observation for apnea, asthma exacerbations, ex-preemies with chronic medical issues and heme-onc patient. Most of the pediatric surgical cases bypass the PACU and we receive them directly from the OR. So we get tonsillectomies, thoracotomies, traumas, amputations, appys, cardiac cath's, neuro surgeries, etc, etc. Our general peds floor does not have monitoring systems, so any patient that requires continous monitoring of any kind (HR, rhythm, O2 sats, respiratory) comes to PICU.
Solid assessment skills are crucial. Kids can't tell you when something is wrong. You have to know what's normal and what isn't and be alert for any changes that might indicate the child is deteriorating.
Critical thinking: why is this patient presenting like this and what does it mean? What am I going to do if this kid goes south? What do I need to have on hand in the room in case of an emergency?
Prioritization and time management: You've got a lot to do. You need vital signs on all your kids at noon time and you also have three IV meds to hang, several po/GT meds, one kid needs an enteral feed and the other needs labs drawn and another has an infiltrated IV. What's most important? What can you get done early?
Communication: With docs, with parents, with the kids. Parents of sick kids are nervous wrecks. They have a lot of questions. You need to be able to explain what is happening in terms that they can understand. You need to explain things to the child. You need to convince a sick and scared child to swollow their medications. You need to explain to the doctor why you think one of your kids needs a different type of treatment. A big part of your job is communicating. And don't forget giving and receiving report.
My day begins at 6:45am and on a good day I leave at 8pm. Most days I eat lunch at the nurses station in five minutes so I am never far away from my patients. If I use the bathroom once I am lucky. But these are "my" kids, as I refer to them. They are my responsibility and whether I've taken care of them for an hour or three shifts, I love them. There is no other specialty like PICU, and there is no other place I would rather be working.