Adult ICU nurse transitioning to PICU

meanmaryjean, DNP, RN · Oct 12, 2014

Your back will thank you! Brush up on your recent Disney movies- you're gonna need to be able to dial in 'Frozen' or 'Cars' at a moment's notice! :)

sugarmagnolia3 · Oct 12, 2014

Thanks for the advice! That's exactly the kind of thing I need to know...Will be watching some kids movies soon! Woo hoo!

Pediatric Critical Care Columnist · Oct 12, 2014

Keep in mind that children generally don't suffer cardiac arrest initially. They're much more likely to stop breathing and then some short while later their heart stops. Kids compensate a lot better and for a lot longer than adults do and will look pretty good, right up until the second they don't. It takes some astute observation and a high index of suspicion to pick up on their subtle signs of impending disaster. Hypotension is the very last thing you'll see before the feces hits the ventilator. At the same time, it's hard to get a "good" cuff pressure on small children because the second the cuff starts to inflate, they tense up and start to move. You might get a reading like 76/72/74... useless. If the cuff inflates and they don't really react it's already bad.

Never turn your back on a child in the ICU. They're so much better than Houdini at getting out of restraints and doing things you really didn't want them to do. I've had kids self-extubate with a foot, lose their PIVs just by wiggling, chew off the armboard on their art lines... I even had one kid pull his subclavian CVL without dislodging the sutures. Even if they're old enough to be cooperative, that's not always what you get.

Make the best use of all your resources. The very best of these is the child's parents. They know what's normal for their child and how to gain cooperation from them. Parents of medically-complex children can tell you their entire history, including how they've responded to treatments in the past, in the time it would take you to find a summary in the chart. Encourage them to help you with care. They'll reward you in so many ways.

sugarmagnolia3 · Oct 13, 2014

Thanks for the great response! I did know kids were more prone to respiratory arresting first. I love what you said about kids being Houdinis and utilizing the parents!

"Even if they're old enough to be cooperative, that's not always what you get."

^^^I find this to be frequent with adults too :jester:

HazelLPN, LPN · Oct 13, 2014

I know you asked for RNs who made the transition, but I'm an LPN who made the transition late in my career from adult MICU to PICU and NICU. I hope that my contribution is welcome.

Yes, kids compensate very well. Adults give you plenty of warning that they are going to crash. Kids are a different beast and yes...they can keep up appearances with the best of them and don't let you know until nearly as soon....but you'll get that nurses intuition about kids pretty soon and learn to trust it just like you have with adults. On the other hand, kids are tougher than they look and heal faster and better. It was very rewarding to see kids with serious injuries and health problems leave the hospital with no complications.

I understand your reason for leaving adult ICU. I felt like I was prolonging life, but doing nothing for the quality of life in the final years of my full time MICU career. So many chronic patients with the conditions you mentioned...many obese and morbidly obese and my old brown down self just couldn't manage as well as I once did. I was pushing 60 at the time and my knee even then was on borrowed time. While I prolonged life, I was shortening my own!

My transition was gradual. I maintained 8 hours a week in the MICU and picked up all of my extra contingent hours in the PICU. I found a true love for pediatric ICU. The smaller patients were easier on my aging body also. I felt young again as I constantly enjoyed learning new things about nursing. Old dogs can learn new tricks. I also did NICU once acuity in PICU went down and contingent nurses weren't needed as much and on the advise of my doctor, gave up taking care of adults for good. I was never a real NICU nurse, but it was a nice change of pace every once and a while. I had a wonderful 17 years in the PICU, retiring at the age of 75 once my surgeon decided I needed my knee replaced and I knew that I wouldn't be back after surgery.

I am now 80 years old, and I'm still active in nursing caring for special needs students in the public schools about once a week....prefer half shifts these days to full. The mind is still good, but body hasn't kept up with the mind and there is no way I could work in critical care nursing now. I often dream that I'm still working in the hospital, and almost always they are happy dreams of me working in the PICU. I can see the hospital where I worked from my attic widow and whenever I hear the helicopter over head I think "wonder what they are going to get in the PICU tonight" and feel proud that I was able to be a part of it.

Best to you,

Mrs. H.

sugarmagnolia3 · Oct 14, 2014

Mrs. H, thank you so much for the thoughtful and amazing reply, and yes of course it was very welcome!!!! So awesome that you are still actively working- you are proof that once a nurse, always a nurse, huh? =)

Guest343211 · Oct 17, 2014

Well, in my experiences, which are not few, I have found, in general, PICUs and SOME NICUs can be less toxic than say pediatric Cardiac Intensive Care Units. See my other post to the nurse that just landed a job in a CICU.

For some reason, PICUs seem more appreciative that you are there, and don't have this attitude like it's a privilege for you to work here in our CICU or Level III NICU. Some NICUs are relatively nice; but then you have some cutthroats in certain NICUs and definitely in the peds CICUs. It's a shame, really.

But PICUs are generally just glad you are there, and often the people will go out of their way to help you and make you part of the team. Of course, there are always certain exceptions--and certain people whom you wish had never become nurses, b/c they are just, well, evil, for lack of a better word. But they are often evil with a smile on their face or very, very sly about it. When these units run like that, nurses will try to stick it out for 6 mo.s to a year; but those people make it tough for them to do so.

Look for people that are honestly, genuinely into a team spirit and who don't have a desire to lord anything over anyone else or be afraid that another smart nurse will show them up with the docs or whomever. Yes, you can see this somewhat in adult ICUs, but NOT nearly as much, and that does make me sad.