How would you handle this? Applying for PICU after your own child has been ill.

Atlnurstudt · Sep 1, 2007

Just wanted you to know I will be in a similar situation. I'm graduating (BSN) in December and hope to hire into the PICU. My daughter has been hospitalized in this PICU twice and this children's hospital 5 other times not in PICU. All within her first 3 years of life (she's now 4). Long story short, she had an undiagnosed heart defect and was hospitalized 3 times before diagnosis, and 4 times after for the heart repair and then related respiratory stuff. So, I don't think it's up to them to decide your motives. Would there be anything wrong with you just wanting to work in PICU because of the experience with your son? I really don't think so; you know yourself and your emotional health better than anyone else and I think having an experience with you own child only makes you a better pediatric nurse, esp. in regards to dealing with parents (I would emphasize that in your interview). You have been there as a parent and that experience is priceless in so far as caring for the family. It isn't called family centered care for nothing...and I know I haven't actually gotten out there yet...I just know that when they ask me why I want to work in peds, I'm going to be 100% honest about what developed my interest. Oh, and I started nursing school before I knew there was anything wrong with my daughter and I already knew I would be a good fit for critical care, so I will also emphasize this in my interview. I will emphasize my strengths as a nurse (love for complexity, high acuity, lines, assessment, variety in patho, excellent critical thinking skills), and how my experience as a mom on the other side of the fence will just add to the total package.

Btw, I'm starting my preceptorship in this PICU this week, my preceptor asked me on the phone if I'd been to the hospital before:lol2:. I said yes, my child has been hospitalized there twice in the PICU and in the hospital 7 times. Very matter of fact like that, I only went into detail as far as to say she has a heart defect. I'll let her bring it back up if she would like to know more, I'm totally comfortable talking about it but there is still that balance of being professional but having your boss and coworkers know your background. In the end I feel like it's just part of who I am as a nurse, and quite frankly a person, I couldn't hide that if I tried to. Having a sick child changes you. Nothing like what you learn from nursing your own child...So...sorry for the ramble, I know that this may not have helped you much, but at least you know there is someone else who will be interviewing in a similar position.

Good Luck and let us know how it turns out!

Carrie

Pediatric Critical Care Columnist · Sep 1, 2007

My son spent the first six years of his life in and out of hospital, including a 7 week stay in PICU. My intention was always to work in PICU when I graduated, but back in thsoe days new grads were never hired right in an ICU, so I paid my dues working neonatal stepdown. I've worked in PICU now for 10 years and I like to think I'm a good PICU nurse. When it's appropriate I will talk about my personal experience, a situation that arises about 6 or 8 times a year.

One concern the hiring person may have is how you'll be if your child is admitted to PICU after you start working there. Will you be able to stand back and be Mom and not RN? If you can honestly answer that with a Yes, then there won't be any issues. Good luck!

FrootLoop · Sep 1, 2007

Thanks for your replies!

I'd like to think the last year has made me a better nurse and certainly has given me a renewed appreciation for family centered care and nurses who truly advocate for their patients. I think my biggest worry right now is that they are going to see in my HR info and be concerned that I've been on leave from work for nearly a year- just don't want them to think I'm going to be some kind of attendance problem. All of the HR paperwork shows why I've been on approved leave, but I'm just afraid they'll think I'm a staffing risk. Maybe I'm making something out of nothing- I just really want this job and I"m very nervous!!!

Janfrn- I've had a few discussion with the peds & PICU nurses about the whole mom vs. RN thing when we've been in the hospital over the last year (over 20 hospitalizations so we spent the majority of our year on the peds floor). The nurses would often ask me if it was hard to stop being RN and just be mom to our son through everything. I'm not sure how/if it was possible to completely seperate the two. I remember being incredibly thankful for my nursing background so I could be a better advocate for my child. While most of our nurses and medical staff were wonderful, there were times when they wanted to do something that I thought was a terrible idea and it was my nursing background that gave me the knowledge to explain why I was going to fight it (for example, one oncologist really pushed for a feeding tube at a time that I thought it was inappropriate and thankfully I advocated for my son at a time when the docs & nurses were going to go ahead with their plan, the feeding tube didn't happen, and two days later my son was eating normally). So I don't know if I can honestly say I would "just" be mom if he were in the PICU again as being a nurse is part of who I am and I can't turn that knowledge off. I think I know what you mean though- and I wouldn't interfere with the nurses doing their job unless I thought they were being unsafe in some way.

Edited to ask Janfrn- if you are so inclined, would you mind telling me a little more about what you mean about standing back and just being mom and not RN? Maybe I'm interpreting it wrong and I think it would be good food for thought for me before I embark on the interview. Thanks!

Pediatric Critical Care Columnist · Sep 1, 2007

Jen, I think you were on the right track... Your nursing knowledge is a great advantage to you in advocating for your child. Parents are the ultimate experts in their own child, and having that extra insight is very useful. Your example of the feeding tube is a perfect one... you knew he just needed a bit more time, you presented your arguments, you were heard and your child was saved the experience of an NG insertion. Good for you and for him! But there are also pitfalls. Because you know what you know and are who you are, you might not get the same level of information on intended treatments... the staff may assume you already know "everything", when in some cases you really don't because it's never come up before. They might also expect you to take on a lot of responsibilities that should belong to the nurse who is assigned care of your son that they would never expect any other child's parent to take on... without really asking you if it's alright. As his parent, you're not legally covered for the nursing responsibilities you'd be taking on, and the nurse who expected it wouldn't be either. At home you're used to doing all those things for your son and the natural inclination would be to just continue on with them in hospital; if you're okay with that, and the bedside nurse is okay with that, you should make sure that it's all approved by the unit management so that there's no fall out later. I'm one of the worst offenders in this category... the last time my son was in hospital, there were a few things I didn't wait for the assigned nurse to come an do... resetting the volume to be infused on the pump, dressing changes and things like that. And when the doc came in and told me I could take him home, I had the IV out and his clothes on before the staff had been told. That was a lot of years ago and I've had lots of time to rethink those actions. I surely would not do that today. (Although his dentist routinely asks me if I'd like to put in his IV... my reply is "When you pay me the big bucks I will!")

Having said all that... we currently have a child in our PICU who has been with us for more than 6 months. The kiddie is chronically critically ill and there are a number of psychosocial and ethical issues with the parents that are very distressing for staff. The mom is a public health nurse and has a great deal of knowledge, but she isn't a critical care nurse. Some of the things she insists upon are not in her child's best interests (such as withholding pain meds because the child is "too sleepy" or refusing to allow a 24 hour urine collection for metabolic assessment because it would mean a Foley), but she has the medical director's support, so the nurses are powerless. She can be very intimidating and they both act as if their child is the only patient in our 650 bed hospital. It's causing a huge amount of friction and the likelihood of the child being transferred from the unit any time soon is very remote.

Now, having said all THAT... If I were interviewing you, I would be wondering about the LOA, so being up front and honest about your intentions will be a very good start. Go into the interview with all of the obvious arguments against hiring you already examined... why you want to work there, what your contingency plan is for the times when your child is ill, your ability to separate your work from what's happening at home (focus), how your personal experience will be an advantage with families because you know where they're coming from, and suggest the interviewer speak with your son's oncologist about your emotional readiness. (I would hire you.) Does that help?

FrootLoop · Sep 2, 2007

Thank you- that's exactly the feedback I needed! Gives me some things to think about for sure. I appreciate it!

Pediatric Critical Care Columnist · Sep 2, 2007

Hey, that's what we're here for, to help each other out. (I think my daughter's finally come to recognize that it's easier on the ego to learn for someone else's blunders that to make them herself!) Please let me know how the interview goes and then fill me in on your orientation and how much like an old shoe PICU feels after you've been there awhile!