General Peds

I work in what's called med-surg but it's mostly kids right out of the NICU/PICU. About half the kids have trachs and are vented. We have 3-4 kids depending on staffing, most are babies. I get report in the morning, then check on the kids and make sure they have all their safety things like an ambu bag, suction is working, catheter kits, scissors, etc...then I check my meds, prioritize depending who has what. See each kid, give their meds, get vitals, assess, suction if their on a vent, etc...if they don't have an aid and their parents aren't doing their ADL care then I'll bathe and get their weight if needed. Morning rounds are around 9:30, so I talk to the docs/PA/NP and discuss my kids, their treatments, any issues. Sometimes PT/OT/speech works with them depending on their needs. There's a morning play group in the play room which child life handles, so I help get the kids who are going ready for that or get them out of bed. Suction and give meds all day long. Assessments are every 4 hours. CSM checks every 2 hours, safety checks are every hour. I also feed the little ones who don't have an aid and take a bottle, redrop NG tubes if one of the babies pulls theirs out, keep track of intake and output, hang g-tube and NG feeds, change trach ties, clean around the trachs, lots and lots of diapers, g-tube care, scoring NAS babies who are withdrawing from drug addiction. So many things! Huntning down vent alarms that are going off and fixing those, which is usually caused by the vent tubing popping off or a patient desatting. Lots of leads coming off the patients and troubleshooting the cardiac monitors. There's also a lot of parent teaching. It's a very busy floor but I absolutely love it. You say you may not have the skin for the PICU but just make sure that you can handle the craziness of a general pedi floor. You have more patients and they are very sick to begin with to be hospitalized these days, and they can turn in an instant. You need to be able to be prepared to send that patient the PICU, to help intubate on the spot, to monitor for worsening respiratory distress, to put up with lots of vomit. If you work in a Level I hospital with pedi, you'll see much sicker kids on the floor who don't necessarily get admitted directly to the ICU, such as those with sickle cell anemia, cancer, congenital anomalies, seizures. Don't forget about the parents either!

Well I currently work on a pediatric hematology/oncology floor but I originally started on a med/surg general peds floor. I always did nights so my typical night on a general peds floor consisted of taking about 4 to 5 patients some respiratory, GI, Diabetic, SCC, FTT, etc you name it. Ages range from a few days old all the way to 25yrs old. We got everything! Medications are a big thing and consist of my whole night but of course the assessment skills are always working throughout the night. My assessment skills are needed most at night b/c doctors aren't readily available in case of Emergency as they are in the day time. So I have to be on my Ps and Qs at all times. Delegating to our nursing assistants was another big thing, checking up on vital signs, delegating finger sticks for our diabetics. Coming on shift checking that emergency equipment is set up, especially for our RSV babies who need to be suctioned so frequently. Checkin in with respiratory therapy to make sure they are coming around as frequently as they need to be. And of course Documentation, documentation, documentation. Alot of what nurses do is behind a computer documenting assessments, etc.

Now I'm on an oncology unit and I do the same routine but the medication routine consists of giving various types of chemotherapy which can last all night depending on the drug. some need frequent vital signs some don't. On this floor I usually never have more than 4patients and having 4patients is kinda rare since these kids are sometimes quite complex.