advice requested= track to PICU

[jopadeevra]

Hi all,

I am a nursing student about to enter my last semester :) !!! I feel a calling to work in peds, and I think specifically PICU. I'm looking for advice in which direction I should go initially after gradutaion to give me the best knowledge base to carry me into the PICU. I currently work in the Emergency Room Admitting Department at my local children's hospital. Sometimes I think that (ER) would be a good place to start , but other times I don't because of so many run of the mill (sore throats, minor lacs, ect.) cases. Maybe peds med/surg? Any input would be appreciated. Also, any words of wisdom from PICU nurses regarding not becoming too emotionally involved in cases is greatly appreciated. Does it get 'easier' over time? I am not an overly emotional person in the first place, but we recently had a patient at our hospital that was heart-breaking. I know the best gift a nurse can give is compassionate care, but how does it not chip away at your soul?

Sorry so solemn, but thanks!

Paula

[Canadian_Nurse]

Hi all!

I had my interview today, and I think it went okay! I can think of a few things I wish that I had said or not said, but they seemed to like some of my answers and I hope all is not lost! They were very friendly and did mention that nurses starting there would come from all walks of nursing, from new grads to experienced PICU nurses. There is hope, maybe! I've written down all the questions that I can remember so that if I have other job interviews in the future, I can be ready. I won't know for a couple of weeks, but I'll keep you all posted. Thanks again for your support!

[PedsRN1991]

Hi,

I'm not a PICU nurse, I am a Peds nurse.

PICU can be very complex...and interacting with the parents and family can be intense at times.

Are they offering a ICU training class??

Will they let you go right into an ICU setting?

I know that the PICU nurses that I work with enjoy it.

Good Luck!!

[NotReady4PrimeTime, RN]

Canadian_Nurse, I'm sure your interview went well. You're showing a woeful lack of confidence by planning your next one already! You said they were nice, and reassuring about your nursing origins. I'll bet they call you next week and offer you the job. Just out of curiosity, where did you interview?

[Canadian_Nurse]

A woeful lack of confidence? I didn't think of it that way Jan, but you're right! :chuckle And here I thought I was being smart by trying to remember most of the questions...I hadn't had a job interview in about six years! I'm hopeful, but I'm of the inclination that the glass is half empty, that way I wouldn't be disappointed if they don't hire me. I know, woeful. The waiting is torture, but I know I did the best that I could, I have good references, we'll just wait and see. Next week can't come fast enough! Thanks for the vote of confidence Jan, if I'm ever back in Edmonton I'll look you up! I have enough family there, that's for sure.

[NotReady4PrimeTime, RN]

Sure, come on over!! The kettle's always on.

If you have good references, then I think you're going to be fine. I don't know about the folks who interviewed you, but I put much more stock in what others think of someone than what the individual thinks about themselves. Specific examples immediately pop to mind! Let me know when your orientation starts!

J

[Mischa G]

I am an RPN (LPN) and I am interested in pediatrics. I'm not sure if RPN's are hired in a children's hospital. I have over 5 years of experience in a long term setting. What are the requirements? Does anybody know of an RPN working in pediatrics. Thanks

[kmande]

You can also buy the critical care associations review book "Core Corriculum for Pediatric Intensive Care" as a resource - you can but it off their website.

Karen

[pcicurn7]

I have a related question...

I am a new grad, and i am 2 interviews in for a spot in a PICU internship program. In my last interview, the nurse recruiter asked me "who was the most critical patient i saw during clinicals, and what was my plan of care for this patient". I NEVER thought that someone would ask me such a question in an interview (haha, new grad)...then i read the comments that Janfrn wrote in response, and now i'm more worried...

My next interview will be a panel interview with several individuals who will ask me questions. Now, being that i am a new grad, just how much am I expected to know? I mean, i know my basics...this post just gave lots of importance in review my stuff...

[NotReady4PrimeTime, RN]

I have a related question...

I am a new grad, and i am 2 interviews in for a spot in a PICU internship program. In my last interview, the nurse recruiter asked me "who was the most critical patient i saw during clinicals, and what was my plan of care for this patient". I NEVER thought that someone would ask me such a question in an interview (haha, new grad)...then i read the comments that Janfrn wrote in response, and now i'm more worried...

So, how did you answer that one? Nursing students don't often have the opportunity to be involved in the care of truly critical patients, but perhaps you spent sometime with a post-MI who could have gone either way? Or someone with respiratory distress... Always remember your ABC's and tailor your answers accordingly.

My next interview will be a panel interview with several individuals who will ask me questions. Now, being that i am a new grad, just how much am I expected to know? I mean, i know my basics...this post just gave lots of importance in review my stuff...

Panel interviews can be very nerve-wracking. (How well I know... I had many of them when I worked Level 2 neonatal.) Again, ABC's. Some sense of what drugs you might need in a code situation (atropine, epinephrine, bicarb, calcium chloride, sedation and neuromuscular blockade for example). Look at my and AliRae's previous posts to Canadian_Nurse. But because you're a new grad with no experience to fall back on, they aren't likely to ask you anything about in-charge decisions. They will expect you to know what you're getting into and what kind of nursing care you're going to be expected to provide. Think about this: Why do you want to work in PICU? They WILL ask you that, or a variation on it. Have a knock-their-socks-off answer ready. Good luck!

[pcicurn7]

Thanks for the reply!

The nurse recruiter asked this question specifically relating to a pediatric patient. And, honestly, i had NO critical patients on a regular peds floor. The closest I came to a good answer was an 18 month old baby who had nephrotic syndrome (which i actually said he had "nephritis"...holy heck was i nervous, i couldnt remember anything), and was losing lots of protein, was on all sorts of medications, including high dose steroids, and was s/p renal & liver bx. I did tell the NR that, although this patient wasn't considered "critical", i told her that i felt it was important to monitor his status closely because (based on his labs and history) had a lot going on. My plan of care was exactly that...to monitor him closely for changes, keep precise I&Os, and follow up on his labs. Perhaps i wouldnt have hired myself at that point, but she may not have been listening very closely...either way, i was invited to take the pediatric pharmacology exam and was told to expect to be called for the panel interview.

The sad part of it all was that i have had the incredible opportunity to be involved in several pediatric emergencies. I have worked as an MA for the last 5 years at a pediatric cardiology practice, and witnessed kids having tet spells, post pericardiotomy syndrome, cardiac failure, respiratory distress, etc...i had one kid was on the verge of death. BUT, this is a good indicator as to how nervous i was...i did not think to draw on ANY of my experiences, because the way she asked the question related to my experience in nursing school. I'm sure i could have had an excellent answer. But i blanked.

Their peds pharm exam had TONS of drugs in it, and my way of preparing for it was to try to memorize as much as i could. Atropine, epinephrine, bicarb, lidocaine, and verapamil where on the list, so i'm pretty comfortable with them.

The thought of this next interview makes me so nervous. But i want to be prepared. THIS is exactly what i have wanted to do.

Why do i want to be PICU nurse? I think of this very often, especially while driving, for some reason...i'm going to think it through (i know in my heart that this is what i want to do, but i need to convert that into words), and come back to answer that. Perhaps you can tell me if you'd hire me...

thanks again!

[NotReady4PrimeTime, RN]

Kids with nephrotic syndrome can become critical in the blink of an eye. I'm sure you could be forgiven for calling it nephritis. Their high-dose steroids can cause some interesting changes in their lab work, like hyperglycemia. Knowing that has saved many of my patients who are getting hydrocortisone for hypotension from ending up on an insulin infusion. The bxs are also something important to consider, because of the potential for significant bleeding. If the kid had hematuria, how would you know which was causing it, the nephrotic syndrome or the bx? Then there's the fluid retention they experience. They need frequent position changes and scrupulous skin care. They can have respiratory symptoms because of it too, due to increased intraabdominal pressure. Lots of things to consider and monitor.

It's too bad you weren't able to slip in anything about your out-of-school experience at that first interview, but you have a second chance now. Develop a script in your head for the interview, practicing describing a couple of memorable situations that will put you in the best light possible. Talk about what happened, what you did and what you would do now that you'd be in a more responsible role. You can practice it on me if you want.

If you give good answers to the clinical content on the interview and have a stand-out reason for wanting to work in PICU you can't lose. Puleeze! Don't fall back on cliches, like "I really want to help people" or "I love kids and can't think of anything more rewarding than looking after sick ones." My answer usually falls along the lines of "pediatric intensive care being an extremely challenging job with a lot of stakeholders, and providing the best care possible to a family in crisis is a very important part of it. There's a wide variety of problems seen in the population served and I like to be challenged to learn and grow my skills." That sort of thing.

Let us know how it goes.

[Canadian_Nurse]

Hi all!

I received a call just before suppertime today from the nurse manager in PICU...you were right Jan...I was offered the job! Of course, I accepted the offer! I do have to meet with her in the next couple of weeks after her vacation and go over some fine details, but it sounds like we're both excited about things. I know I am! Thanks for all the support and encouragement. I'm sure I'll be here lots as I go through my orientation and preceptorship periods, asking tons of questions.

Gotta run, back to work in the morning!

TTFN!!