New Grad- PICU or Gen Peds?

[busby]

Hello,

I am a new grad who is interested in pediatrics (I am sure of that)... I have interviewed and been offered a position at a hospital, and they are letting me choose between the PICU or general peds unit, since they have open spots in both. I am leaning toward the PICU because I feel like it will be great clinical experience, I will have a little more time to get deep into the conditions my patient's have because I will have fewer, and I felt a better fit with that nurse manager. My question is if other people started out in the PICU and felt like that was do-able/ they weren't too overwhelmed? I know it will be challenging where ever I am to be a new nurse, and I am ready to work hard for that, I just want to make sure I will survive going straight to the PICU!

Lastly, the hospital is offering about 6-10$ less per hour than I was expecting! I have been getting very few other offers from hospitals as I am only looking for a pediatric position. Is is worth taking the position for less money to get my foot in the door and to get the experience, or should i hold out for a higher paying position? The salary they are offering I can make work, its just a little discouraging because it is a lot less than I had planned on (this is also my second career, so its hard to start back at square one after having worked for years).

Thanks for all the advice!

-busby

[Ruby Vee, BSN]

Regarding the money -- $6 - 10 is a lot of it. Is it possible that you're expecting a city salary but this hospital is in a more rural area? Is it possible that the cost of living is significantly lower where the hospital is located and that you based your salary expectations on someplace where it's more costly to live?

As for the floor vs. the ICU question, I've always believed that nurses would do well to learn the basics on the floor and then transfer to critical care after a year or two. I know my opinion is unpopular these days, and some new grads feel they do well in ICU. But there is so much to learn, I think one has better career satisfaction and longevity if they take the time to learn the basics -- how to clean up poop, how to talk to patients, families, physicians, consulting services, X-ray and the lab, how to do a quick and thorough assessment and chart it, how to drop an NG, place a Foley, stick a recalcitrant vein and draw blood, normal lab values and when to call for abnormal ones, drug uses doses and how to pronounce them, etc. THEN go to ICU and learn how to read and interpret rhythms, how to understand hemodynamic monitoring and relate the numbers you see to what's going on with the patient, how to use all that equipment you see in those ICU rooms and more importantly what all those numbers are telling you. You'll still need all of those basic skills you've been learning, plus you'll build upon them.

[RNNPICU, BSN, RN]

I think if you are interested in Critical Care then you should go for it. I was a new grad in the PICU and although I felt overwhelmed at times, I learned really good assessment skills, I learned to pick up on the small details that can make a difference. I learned a tone of other skills such as wound care, trach care, foley insertion, lab results ( your patients will have daily even hourly labs), medication calculations, lots of medication administration. Most of the time your patient is intubated, so learning all about respiratory management, Blood gasses. Since most of your patients are intubated you will learn how to communicate with family members. You will do A LOT of teaching, especially regarding medications, plans of care, importance of changes in the plan of care.

I really wanted the ICU, so although it was hard, I had a good orientation program, had tons of reading, and still did reading after orientation. It is fast paced becuase your patient is really that sick, you have to understand why your patient needs all of that equipment to keep them alive, how does it keep them alive, and how their diagnosis relates to all of it.

You will have to put in your effort to learn, and not just ask your preceptor all the time for questions, you should look up first and then ask questions based on what you have learned.