CICU and PICU How does your unit cater to nurses?

Pediatric Critical Care Columnist · Aug 5, 2009

There's quite a division among our docs. Some of them are very aware of how valuable smart, skilled nurses are and others see us as underworked, overpaid whiny children. Lately there's been a bit of a shift toward valuing us a bit more. Our consultants are slow to trust new staff, and I think that's justified on our unit. We've had a significant number of less-than-stellar hires lately and a lot of bad things have happened due to the lack of attention to detail that some of these nurses apply to their work.

And in tandem with that, our orientation process has really deteriorated due to a lack of leadership at the mid and upper management levels. I don't feel that new grads or less-experienced nurses get a good grounding in critical care before they're cut loose and they don't realize it until the fertilizer has hit the oscillatory ventilator. Some of us oldsters have asked a number of times to have our new hires go through the critical care course run by the community college like ALL the other ICUs in the region do, and we've been told that we're not considered a critical care area! (We do ECLS, complex CV surgeries, physicianless transports, transplants, the gamut, but we're "not a critical care area".)

I've been involved with a number of PICUs across the country and I've always felt that PICU is treated like a red-headed step-child. "Oh, yeah. You." We're understaffed, underequipped, pushed to the wall and left hanging. We get the leftovers, the hand-me-downs. The adult CV program just moved into a shiny new building with state-of-the-art ORS, walls of windows, marble floors and busts of famous doctors on pedestals in the entrance. The inpatient wards of our children's hospital-within-a-hospital are bright, cheerful, family-friendly and flooded with natural light. Our unit used to be the NICU; before it was NICU it was the adult ICU. The only concession to peds is the ancient borders (Vincent van Gogh's Starry Night) they put up around the tops of all the walls. We have no natural light, our windows look out over the cafeteria three floors down. We often cram 20 kids into a unit built for 15. We climb over equipment and furniture all the time and have to move the pump tree to reach the monitor. We were told we could have more room once the new cardiac sciences building was opened, and then we were told there's no money for renovations or even new equipment so guess what!! We'll just have to make do. As usual.

What do I love about my job? The kids and their families. I love that I play a key role in getting them home and healthy. I love my coworkers who work their behinds off to make sure the kids are safe. I love the variety of problems that bring kids to our door and the skill and knowledge needed to give them the care they need. I work alternating days and nights; there are those like me and then there are the day group and the night group. There are good and bad things about each. There is no supervision on nights so they tend to attract the less-than-stellars so they can fly under the radar. Days are crazy and if my personal circumstances were different I'd be working permanent nights.

Mexarican · Aug 5, 2009

I imagine your not describing a PICU in a children's hospital...because our PICU is so not like this!

Mex

Pediatric Critical Care Columnist · Aug 5, 2009

I guess it depends how you define a "children's hospital". We're a hospital-within-a-hospital, sharing physical space and some resources of a university hospital. Our administration and management structure are separate from the university and our staff is a dedicated pediatric staff. We're listed separately on the regional career-search website. Our ICUs occupy part of the 3rd floor of the university hospital, the ORs are on the 1st floor and are pediatric-specific, we have a separate emergency room and the wards, the child life department, the classrooms and peds rehab are all found on the 4th floor. We share the diagnostic imaging and endoscopy/day ward facilities with the university hospital. The only inpatient area that is shared between adults and children is the burn unit (critical burns go to PICU first). Would anything be different if we were free-standing? I don't know, but I doubt it. The free-standing children's hospital PICUs I've been in have had similar problems.