Differences between Floor and PICU nursing?

~PedsRN~, BSN, RN · Apr 25, 2015

I think it will depend on what time of floor and hospital you are in. My floor takes progressive patients as well as general admission patients, and at times it feels like I work in the ICU stepdown. But there are things that I immediately will send to PICU. A kid who is about to crump and I can see the respiratory failure looming needs to go... because we don't intubate up here. Anything that requires a titrated drip goes to PICU. I feel like anything that is Q1h anything should be in PICU but the docs don't agree with me on that... LOL.... We don't sedate kids on the floor, we have open visiting hours, we get a lot of drama. But I'm not coding kids every night either (THANK GOD). My floor is in no way a cake walk. I have only ever felt like a babysitter the days that we are keeping a child waiting on foster placement. :) Otherwise, we are busy and we take care of super sick kids.

But when they turn that corner and become super duper sick, we send them downstairs. :)

I will tell you that if I code, I have a list of PICU nurses that I want to show up. They are awesome!!! Nothing but respect.

Pediatric Critical Care Columnist · Apr 26, 2015

I agree with ~PedsRN~ that kids on the floors are sicker than ever before. The same can be said for kids on the unit. And as ~PedsRN~ said, so much depends on what kind of hospital you work for. I work on a combined PICU/PCICU in a teaching hospital in a city of ~1 million people. Our kids range from knocking persistently on Heaven's door to chronically critical to waiting for a floor bed and very routine. I've cared for an intubated and ventilated kid with a ventricular assist device, 18 infusions, multiple antibiotics, and also on (manual) peritoneal dialysis. That patient was considered to be 1:1 when there really should have been a second nurse. I've also cared for a toddler awaiting a transplant who was as close to a regular toddler as one can be and still be on the unit. We played with Pla-Doh, read stories, sang songs to each other and had food fights. I've had a patient come in from a rural hospital go from sitting up and crying on the stretcher to cannulated for ECMO in less than 2 hours. I've also had a newly diagnosed diabetic patient that I took to the staff bathroom every couple of hours because she really didn't want to use the bedpan. So it truly is a soup-to-nuts scenario.

sergel02, BSN · Apr 26, 2015

Thanks for the help you two! I know I won't know until I learn more critical care material next semester, and actually have my rotations in the pediatric floor and PICU the semester after. There are 3 PICU's in the area here, and I know they generally keep intubated patients and once they're off they send them down to the floor.

Gotta wait around a year now to see how I enjoy it. I know some students and nurses who felt like in adult med surg they were just passing meds and charting, but I haven't heard the same from the pediatric perspective as much. I think variety is probably one of the biggest things I know I want in wherever I end up. There is going to be some routine and monotony no matter what, and that is nice sometimes, but having some variety is important.

sergel02, BSN · May 19, 2015

I learned last week that I was sort of wrong about the amount of PICU's in the area. There are like 2.5 and not 3. The third one just sends the critically ill kids to their ICU. I found that a bit odd, since I don't think the ICU nurses are used to dealing with critically ill kids.

One hospital focuses on trauma while the other focuses on cardiac (though funnily enough that trauma hospital has a PCICU). The trauma center is much more accommodating to PICU families than it is for the general peds floor families (nicer rooms and amenities, both parents can sleep overnight, less restrictions on guests). I guess it's because they are sicker, not quite sure.

I know it's different at every hospital, but have you ever noticed a difference between the ages of the units? Like younger kids more often than older in the PICU or vice versa. It seems concentrated to the pre-school age and younger from what I heard, but that makes sense given issues like asthma and such.

Pediatric Critical Care Columnist · May 20, 2015

Many of the patients on a PCICU will be infants or toddlers. Most repairs are done early in life. Although there are the older kids who come in occasionally for valve repair/replacement or who have developed cardiomyopathy. On a general PICU there's usually a mix of ages, with definite seasonal variations. Fall and winter in northern states and all of Canada brings an increase in very small children with RSV, influenza, enterorhinovirus or pertussis. Spring will bring the odd drowning as bodies of water melt. The first long weekend of the summer brings teenaged traumas; drowning for all age groups is an ever-present threat in summer as is heat stroke. Fall may bring asthma exacerbations. Easter, Hallowe'en and Christmas are significant for diabetic ketoacidosis, generally in the pre-school through teenaged set. And Christmas is a bad time for house fires with associated smoke inhalation and burns, for children of any age. There's no real way to know what the mix will be on any given day.

sergel02, BSN · May 20, 2015

Many of the patients on a PCICU will be infants or toddlers. Most repairs are done early in life. Although there are the older kids who come in occasionally for valve repair/replacement or who have developed cardiomyopathy. On a general PICU there's usually a mix of ages, with definite seasonal variations. Fall and winter in northern states and all of Canada brings an increase in very small children with RSV, influenza, enterorhinovirus or pertussis. Spring will bring the odd drowning as bodies of water melt. The first long weekend of the summer brings teenaged traumas; drowning for all age groups is an ever-present threat in summer as is heat stroke. Fall may bring asthma exacerbations. Easter, Hallowe'en and Christmas are significant for diabetic ketoacidosis, generally in the pre-school through teenaged set. And Christmas is a bad time for house fires with associated smoke inhalation and burns, for children of any age. There's no real way to know what the mix will be on any given day.

Thanks again for your input.

All the seasonal correlations is interesting. It's something I never really thought of, but there is that correlation between the seasons and certain diagnoses, even with adults (near-drownings in summer come to mind).