Which of these would best prepare me for PICU?

Specialties PICU

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I'm about to finish nursing school and I'm pretty sure I want to go into the PICU (I teched in a PICU before school). The problem is, there is no PICU where I am currently. We are "stuck" here for another year or two due to a commitment, so I'm looking for the next best thing. There is a community hospital with a Level II NICU and an adult ICU, both of which I rotated through during school. I've gotten an "unofficial" offer from the adult ICU and the manager of the NICU wants to talk to me as well.

The NICU is small (8-12 beds) and is mostly feeder-grower babies (all inborn). They occasionally get vents, but during the time I was there, we only had one and he was only on the vent for a few hours. They "typically" transfer out anyone on the vent longer than 24 hours to a nearby children's hospital. They do take babies greater than 28 weeks and have a decently busy high risk OB service. Mostly, the babies I had were not on drips (other than TPN/lipids) and typically once they transitioned, they were pretty stable. Mostly 2:1 - 4:1, I never saw any 1:1.

The Adult ICU is also small (12 beds) but busier. They are about 40% medical, 40% surgical and 20% cardiac (no open heart, but there is a larger hospital nearby that they send new grads to work a few shifts in the CTICU to get practice with SWANs). They do SWANs, vasoactive drips, CRRT, balloon pumps, etc (of course, CRRT and balloon pumps aren't tremendously common, but they do get them). The manager there told me she'd want me to get ACLS and PALS because the hospital MIGHT admit a kid (unlikely since they usually ship them to the Children's Hospital up the road, but...) as well a balloon pump and CRRT certified.

Which one would be better for PICU? We're planning on moving in a year or two (whenever this commitment is up) to a city with 2 large Children's Hospitals and I'd like to get in one of the PICUs there (or even the CVICU). The NICU is kids, but the adult ICU is more critical care. Presuming I get the chance to choose, which one would be best?

Thanks!

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Specializes in Nursing Professional Development.

The adult ICU. The NICU you described is not intensive enough.

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Specializes in NICU, PICU, PCVICU and peds oncology.

I totally agree with llg. In the adult ICU you'll get exposure to and experience in the critical care skills needed to succeed in PICU so that when you do have a PICU position you'll be able to concentrate on the peds part of it.

Even if the NICU was a high acuity unit, there's a world of difference between a sick neonate, for whom there are fewer than a dozen diagnoses, and a sick child. There's also a world of difference in the way NICU and PICU nurses approach the same patient. That's not a bad thing, but the transition would be smoother from adult ICU to PICU in my opinion.

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Specializes in PICU/NICU.

I have to agree... go with the Adult ICU- you will get more experience with drips/vents/and procedures. Doesn't sound like this NICU will give you the right experience. Good Luck!!!

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Specializes in Pediatric Intensive Care, ER.

Absolutely the adult ICU. We have a very large NICU, and serve as a regional referral center for both NICU and PICU. Even at that, the great majority of NICU kids are feeder growers - prolly only 15-20% require "intensice care" support, and they usually give those to the more senior nurses. Our PICU does very intense kids, and the range of knowledge/skills is very different - like Janfrn said - different, not more or less. Adult ICU will get you MUCH more comfortable with multiple diagnosis, multiple drips/meds, vent management and complex patients. Good luck!

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Thanks to everyone who has replied. What you've said is pretty much what I was thinking, but it's nice to have confirmation. So, let me add this to the mix...I mentioned that this ICU sends it's new grads to a nearby hospital with a large CTICU to get practice with SWANs.

Currently, there aren't any openings in the CTICU, but here's my question: If a position opens up before I officially accept this job in the med-surg ICU, or after a period of time in the Med-Surg ICU (6-12 months) I am feeling comfortable there and there is an opening in the CTICU, would you take it (the two hospitals are owned by the same company, so lateral transfer is possible)?

I would really love to work in this unit, because I love CT (my experience is limited to a tech in the PICU where we did a fair number of hearts, but...) and the acuity is higher. The acuity would be higher, it's a 24 bed unit almost all fresh hearts, with some ICU overflow from the rest of the hospital thrown in. Higher acuity, but more of the patients would be the same basic thing (CT surgery, which I love) instead of the mix in the smaller unit.

So, I guess, how much does acuity vs variety come into play? The Med-Surg ICU does get sick patients, but it is lower volume and overall, it probably doesn't get as many REALLY sick patients.

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Specializes in NICU, PICU, PCVICU and peds oncology.

Personally I'd pick variety over acuity. Unless your PICU does a LOT of hearts you could find you're missing out on knowledge base and assessments for the rest of the patients you'll be responsible for. I work in a primarily CTPICU (our hospital has the best reputation and best outcomes in Canada) and in the 6 1/2 years I've worked there I have seen exactly ONE swan. In a 16 year old (so for all intents and purposes an adult) s/p Berlin heart explantation. But of course that's purely my :twocents: worth.

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Specializes in NICU.

Reading your descriptions of the two units, I would definitely agree with adult ICU. However, I want to throw in my two cents that that's not necessarily a general truth that adult ICU and PICU would have more in common than NICU and PICU would. It really depends on the type of NICU a person would work in. Like one poster mentioned, a lot of NICUs have a large population of stable feeder-growers and a person would have less experience with critical kids and a variety of diagnoses. However, it might look different in a big referral level III that does not keep kids their when they become feeder growers. Example...the last shift I worked, these were the kids in my room in the NICU. A 33 weeker, several weeks old, vented, on continuous chemo for a unspecified myeloproliferative disorder, drips, CTs, the whole bit. A full term baby, relatively well, with a prenatally diagnosed brain malformation. A very early bird preemie who is now several months old, still vented, with a whole variety of multi-system issues. A full term baby who had required a double volume exchange for hyperbili. A pre-op heart kiddo on multiple drips, vent, etc. And a full-term baby on an oscillator, CTs, etc. but I never had time to get down to that end of the room and learn his story. And a new late pre-term kiddo who was having unexplained seizures on the first day of life. The range of diagnoses is still more limited than PICU, but it's pretty wide relative to a smaller NICU. I am constantly reading up on some new syndrome, surgery, or condition. Lots of kids who spend time in an NICU early in life spend time in a PICU later in life. My friend (who works PICU) and I have a lot more common experience and knowledge and then our other friend who works in a large med-surg adult ICU. But on the other hand there are some things they talk about that I don't experience. So, if other readers find themselves with similar questions, I think it's really valuable to consider each unit and it's population carefully. And to think about...if I didn't get to PICU for awhile for some reason, where do I think I would be happier?

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A little update...we're finishing our last preceptorship rotation of school and I happened (by really random chance) to get assigned to the adult ICU that I'm going to work at after graduation (still no formal offer, but the manager the other day told me I was lucky to be doing my preceptorship here because WHEN I'm full-time, I'll be aahead of the game)!

It's been really good. I've already had several pts on the vent, swans, multiple drips etc. My preceptor told the manager that the only problem they'll have with me after graduation is keeping me challenged! So, the manager has agreed to get me cross trained and oriented in the CTICU down the road and let me pick up overtime shifts there as soon as I feel comfortable. They're also toying with the idea of letting any staff who are interested do the same and then, if our unit is slow (which it sometimes is) rather than getting floated to tele or the floor, we can "float" to the other hospital's ICUs if they need people.

Also, I'm going to get to get not only ACLS and PALS, but balloon pump, CRRT, TNCC, ENPC and any other course I can think of! This manager is really great and she realizes that the better trained her staff is, the better it is for her unit. So, anything I learn in the CTICU, I will bring back to our little ICU. I'm really excited about the opportunity!

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Specializes in NICU, PICU, PCVICU and peds oncology.

Also, I'm going to get to get not only ACLS and PALS, but balloon pump, CRRT, TNCC, ENPC and any other course I can think of! This manager is really great and she realizes that the better trained her staff is, the better it is for her unit. So, anything I learn in the CTICU, I will bring back to our little ICU. I'm really excited about the opportunity!

I'm SO jealous, I can hardly think. Our unit really likes us to have all those wonderful tools but when it comes to arranging time for the classes well, you know, operational requirements just won't allow that! And paying for the courses? Not in this lifetime. So we either take them on our own time and on our own dime, or we wing it.

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