Anyone else go from adult med-surg to PICU?

Pediatric Critical Care Columnist · Oct 31, 2018

You're finding out the hard way one of the most important things about pediatrics... kids aren't small adults and as you said, EVERYTHING is different. But before you throw in the towel, stop and take a deep breath. All the things that are new to you now are just different ways of doing what you've been doing for a year and a half already. The learning curve is steep, but it's not insurmountable. At this point in your orientation I would be alarmed if you were confident about anything, never mind everything! Your most recent assignment would have been difficult for any new-to-PICU nurse and your preceptor should have been more helpful. If I were you, I'd ask for a meeting with your clinical educator, your preceptor and your manager to address the way your orientation isn't working the way you'd like it to. Perhaps your preceptor doesn't realize how she's coming across, perhaps she's not the right person to precept you, perhaps your educator has some strategies to help you get on your feet. I know this sounds very intimidating, but leaving it much longer might push it into the region of beyond repair. PICU isn't for the faint-of-heart, and those kids' lives are too important to just hope for the best here. As my manager loves to say, if she doesn't know what's going on she can't fix it.

dreamerachiever, BSN, RN · Nov 20, 2018

Don't give up, just like you has to learn how to take care of adults on your Medical unit. You have to learn to take care of kids in the PICU. Nurses have done it before you, so it can be done. I would talk with the nurse manager about possibly paring you with another preceptor. Your preceptor attitude can make a world of difference in your experience.

Good luck, keep the faith, you will be a fantastic PICU nurse!

jennylee321 · Nov 27, 2018

YOU ARE LEARNING

You are not dumb !

Please recognise the difference, nurses are too hard on themselves when they enter a new area. If I was preceptong you and you didn't ask any of these questions I'd be very concerned that you thought you knew everything and weren't learning.

tachyallday, BSN · Jan 30, 2019

This was a HUGE jump for you. Adult m/s to peds m/s to eventually PICU, or Adult ICU to PICU *would* have been easier, however, you sound like an excellent conscientious nurse. So give yourself some credit, because you deserve it.

Pretend you are brand-new again nurse again (because you basically, are), and don't set too high of expectations for yourself to learn or learn to critically think faster than you are humanly able. In your off-time read up on what you have experienced on your orientations days.

If your preceptor is rude, ask that he/she treat you with respect. Explain that you are struggling, and his/her workplace incivility (WPI) is making it more difficult. Feel free to throw out there that WPI negatively affects morale, and negatively affects patient safety - because it does. This person has probably never been called on their BS before. You are an adult, so act like one, and speak up for yourself. If this fails, and your preceptor is still a jerk, ask your director for a new preceptor, and outline why.

And to repeat, give yourself some credit!

Dacatster, ADN · May 22, 2019

I went from working from a adult renal diabetic unit to Ped stem cell transplant/step down CV surg. It was considered a PICU at my hospital, we were specially trained Hem oc and CV plus the rest of the picu stuff. I am not going to lie, it was a rough year. But I did find my calling in peds. I absolutely never ever wanted to do peds until then. Basically, I was desperate to get out of my med surg unit, 17 patient to one RN, with one lpn under you. You had 9 pt they had 8 you had to do all assessment, IVP labs, blood, dr. calls. It sucked. So I went PICU were we had 1-2 pt at a shift. 20 years later with 18 years as a peds,picu, peds er nurse. Now getting ready to go into family med at a resident clinic with majority of pt peds.

Caroline you can do it. Don't beat yourself down, don't let her beat you down. Remind her your were med surg, not peds, not icu.

LexRNnFly, BSN · May 22, 2019

Three things:

1- you are not dumb, the fact that you feel like you know nothing is a humbling experience and one that many people can not/will not acknowledge, take pride in the fact you are able to admit you don’t know something, and ask all the questions you need!

2- your preceptor likely does NOT think you are stupid, some people are just not meant to be in the preceptor or teacher role. As nurses, especially ones who have been doing this a while, we get jaded and forget what it’s like to be new somewhere, try asking for feed back or things to work on and if you don’t feel like you are getting the support you need ask your manager for a change in preceptors (I had to do this in my first RN role) —after all this is your learning process, and patient safety is at stake!

3- you being able to take this personally inventory and self assessment says a lot about how much you want this job and how much you want to be great at it, so don’t let the HUGE LEARNING CURVE scare you away, because anyone who has done that transition knows it’s a VERY steep learning curve! Take a breath and know you’re on the right track!

schicharro, ASN, BSN, MSN, RN, NP · Dec 5, 2019

On 10/30/2018 at 1:51 PM, Caroline0322 said:
So I am just wondering if anyone out there started off in general adult med surg and went into pediatrics-more specifically, PICU nursing...
I graduated nursing school with my BSN in May of 2017, and my first job was a very difficult med surg floor. High patient to nurse ratios & high acuities. We had a lot of codes and a lot of ICU transfers (those dialysis patients really can get sick and sick fast).
I became comfortable on my floor despite the high stress and demanding nature of it. I felt confident as a nurse and even felt like a goody nurse. I got asked to precept new grads after only being a nurse for a year, so I felt like I had to be doing something right.
However, my passion was always peds. I wanted to go into picu nursing since the beginning of school, but was told to try general med surg for a year. So I did and as soon as my year was up, applied to my hospital's picu.
I got the job and was thrilled. I started about 2 weeks ago and am in orientation for 12 weeks. I have worked about 7 shifts now...and my confidence is SHATTERED!!
I feel like I know nothing. Everything is different. The way you give meds, the med calcs, the way you draw blood, the way you give blood, the tubing you use for meds is different than adults. It's literally a whole new world.
I knew it would be different-like being a new nurse all over again. That being said, I feel so STUPID. I feel like I'm a horrible nurse and my preceptor thinks I'm dumb.
I had had my first intubated pt yesterday on epi and all the regulars of versed, precedex, fentanyl paired with a trached pt on a home vent. I was so overwhelmed. I felt so stupid with everything and trying to learn all about the vents, the drips, appropriate MAPS, end tital CO2s, weaning your pt off epi, etc.
To make matters slightly worse, I think my preceptor thinks I am so dumb. She asked "didn't you do any of this in adult nursing?" No, we didn't. I wasn't in an ICU so we didn't get any of this stuff. Plus, everything in kids is different than adults-even general.
She gets annoyed when she has to repeat herself. If she tells me something once that was 5 days ago, and I don't remember, her response is: "I told you this already, remember?"
All is this has me left feeling discouraged and dumb. I don't know if I have what it takes to be a picu nurse. I don't know if I'm smart enough. I used to think I was a decently intelligent person. Always did well in school, graduated top of my class...but now I'm second guessing everything. And I'm literally scared of my preceptor because she acts like I'm an invalid.
Anyone else gone through this??

Feels like what you are going through is exactly what i went through. It feels like I am starting all over again. I was charge nurse before getting into peds. I literally am growing all over again in a different unit - peds. It has been 9 months now and I am starting to feel better, I am building my confidence over time and getting closer to my ped team.