New Grad trying to get into PICU

**NICU Guy, BSN, RN** · Oct 24, 2014

Senior Capstone in a PICU and maybe PALS class

Pediatric Critical Care Columnist · Oct 25, 2014

Good advice, Don1984, RN. But I don't recommend PALS for new grads. There's too much that they haven't experienced and integrating what they learn in PALS just doesn't happen.

Why do you want to be a PICU nurse? If you can articulate that, you might find some clues as to what you can do to stand out. My unit hires new grads (more out of desperation than design), and some of them have been really outstanding. But more of them have been seriously unprepared and unable to grasp necessary concepts to develop the knowledge base to make them good PICU nurses. Don't put all your eggs in one basket. Having a couple of solid years of nursing experience, whether in peds or not, will make you a much more attractive candidate.

Nepenthe Sea · Oct 31, 2014

I went to school with the goal of working in NICU or PICU, but there were few jobs available, so I worked with adults, mostly in Med-Surg. I did that for almost two years before I decided to move on with my original plan, and applied for a job in PICU at a different hospital. The director that interviewed me (and hired me) told me that she PREFERS nurses with ADULT med-surg experience. All this is just to say that if it doesn't work out for you to start out in PICU (hopefully it will), the just get some experience SOMEWHERE. It will help you in the long run.

LoveMyBugs, BSN, CNA, RN · Nov 3, 2014

Network network network. Be willing to relocate. My hospital will hire new grads into the PICU, they have to go through the Versant New grad program

NicuRN628 · Nov 4, 2014

I am a new grad (August 2014) and I just interviewed for a PICU job today! It seems very promising :) The hiring manager told me neither he nor the lady from HR who interviewed me has any reservations about hiring me. He told me to let my references know that he will be contacting them this week! I am not sure what made me stand out, but I do have my BSN as well as a bachelors of science in biology, I was a part of state and national nursing student organizations, a nursing honor society, and now professional nursing organizations. I applied about two weeks ago to this position, was offered an interview last Thursday, interviewed today, and was told it will take 2 to 3 weeks to hear back. Good luck!

Annaiya, NP · Nov 10, 2014

I've seen many nursing students say they want to do PICU, because they enjoy it so much while they're there. There is a lot of "cool" stuff and tons of things to learn. You only have 1-2 patients to take care of, so it seems less overwhelming than the floor. You work closely with the NPs and MDs. But many of them, I knew would not do well in the environment. The PICU is stressful, physically and emotionally draining. I think to be a sucessful PICU nurse, you need to thrive off of being challenged, working hard and motivated to put in extra effort to learn as much as you can, even on your own time. So the things you want to convey to potential employers is intelligence, ambition and a strong work ethic. As well as demonstrating you understand the difficulties faced in the environment.

I've seen the students who are facinated with the work, but they have the comfort of being a student. They are not responsible for the care of the patient. When you are the only person monitoring and caring for someone's unstable child, it is a very different feeling. And I think most students don't appreciate that. I had days as a bedside nurse where I left work knowing that what I did that day was the reason the child was still alive. Not to downplay the rest of the team that is necessary to keep these incredibly sick kids alive. However, regardless of what the rest of the team does, it comes down to the bedside nurse being able to manage all of the therapies and status of the patient and interveve/notify when appropriate. It is an immense amount of responsability. So hiring managers are trying to find the nurses who will thrive in that environment. I'm not at all surprised that dalmatianmancer had good feedback from her interview. It sounds like she was able to convey leadership skills, ambition and intelligence. All good PICU nurse qualities:)

Pediatric Critical Care Columnist · Nov 10, 2014

I echo Annaiya's response. I've seen a lot of new grads come and go from our PICU and I think part of the reason for them leaving is that they're not getting an accurate view of the job they're taking on before they start. Some of them have said they wanted PICU because they'd been told they'd only have 1 patient or at most 2, and that most of the kids are sedated. So this suggests the workload is fairly low. There's nothing said about the enormous knowledge base they're going to need, the multi-tasking expected of them or the complexity of integrating what they see with what is required of them to do. Then they start orientation, where at least on our unit, they're really not allowed to do much for the first few weeks - they're not allowed to be the second signature on meds, they're not allowed to chart, they don't give report and they aren't allowed to cover someone else - even their preceptor - for break (right up to the very end of their buddy shifts!). So they still don't know what they've signed up for. Then when orientation is over and they're on their own for the first time, completely responsible for that patient (the most stable one on the unit), they are still looking for the level of support they were getting from their preceptor. It's a huge shock when they have to start making decisions based on their own limited experience and don't have a second pair of hands immediately available. And they're being expected to cross-cover breaks with someone else. With a really good orientation a strong new grad will do very well and thrive on the job. But there are no guarantees that's how it works out. Pair an inadequate orientation with an unhealthy work schedule and it's no wonder the new grad doesn't stay. Those who seek information here and from other sources about the true nature of the job are already ahead of the game.

pedsnurse22 · Jan 29, 2015

I am a new grad nurse working in the PICU. I like you was certain after my clinicals that PICU was for me. If I can give you one piece of advice that you probably do not want to hear and you can take it or leave it, do a year of med surg or general pediatrics before trying to get into the PICU. PICUS will hire new grads but honestly I wished I would have listened to people when they told me to do a year of gen peds first. I am trying to transfer now to gen peds from the PICU. Critical care is a highly stressful environment for anyone but especially a new grad and then you add the stress of it being kids on top of it. I have found that figuring out how to make the transition from student nurse to professional nurse is harder than I thought and the stress of the PICU is not helping. I think it's best to get some experience with non critically ill dying children, hone your skills and communication abilities before you tackle this immense undertaking. I wish you the best of luck in whatever you decide but please think about what myself and others have said to you. Good luck.

pedsnurse22 · Jan 29, 2015

So true

Annaiya, NP · Jan 30, 2015

I really think it depends when it comes to floor experience prior to the ICU. Honestly, pedsnurse22, it sounds like the PICU isn't a good fit for you. IMO, floor experience isn't going to make you feel more comfortable taking care of unstable kids. I did about a year and a half of floor nursing before transferring to the ICU and I found it made the transition a lot harder. I did 6 weeks in the PICU for my leadership clinical in school and 5 weeks as a nurse resident. By the end of my residency time in the PICU I was able to manage a ventilated child on dopamine with almost no help from my preceptor. I felt very confident in my ability to work in the PICU. I ended up placed on the floor because the residency program I did placed you where they needed staff. When I was able to transfer to the PICU, I felt like I had lost all of my ICU skills after being on the floor so long. It made the transition much harder. I think going to the ICU right out of school is better, because you learn to think like an ICU nurse, not a floor nurse. They are two different things. And I was on a high acuity floor, and it still didn't help me. Sure I was more comfortable with doing a thorough exam and more familiar with basic medications, but that it's a reason to advocate for floor experience.

LadyFree28, BSN, LPN, RN · Jan 30, 2015

It really depends on the person; I think having some form of working with medically complex children does help; whether on a specialty Peds floor or private duty home health.

I went from PD HH and a medical daycare and the curve was HUGE; I also had 7 years experience of being a LPN where I was very comfortable with high tech kids; The PICU chose me, probably because they have a high turnover in nurses and I much as I enjoyed it, I was not ready, though I worked and tried to make that first year curve of being an RN.

The most important thing is to self study; especially in a Critical Care Environment; I used to look up while I worked, and after I worked, especially on my days off; learning how to do a good Pedi assessment is key as well. Absorb as much information and find out what books that are needed; especially Critical Care books; studying doesn't stop after school.

I think a good transition program can make an excellent nurse; I did not have such an experience so after a break from the critical care environment with stints as a LTC supervisor-you'd be surprised how learning how to identify people in an non-monitored environment can prepare you to identify abnormal and escalate a situation can prepare one for critical care! - and in pedi post acute care setting with complex kids, central lines, vents wounds, very complex treatments and conditions that are part of the critical care setting, I am about to start a Level 1 Trauma Pedi ER.

I find myself with another health system that has a much better process in place, and starting a new position. I am currently self studying and put it to good use while I was working at my current position. But what also changed was ME. As soon as I got the new position, which was an unexpected event, I started studying ER books and book marking important aspects like assessment, vitals, how to prioritize and identify better to strengthen my already competent assessment skills and am looking at my pharmacology cards to get familiarized with sedation and resuscitation meds. I suggest PharmPhlash cards from the success series.

As long as you have a plan in place, ask questions, and be a sponge to the information and are consistent in wanting to build a good practice you will build one and you may have to go a few places to build one before stepping into that setting, as long as you are active in your orientation process and a good program is in place, the can be success. :yes:

Best wishes! :up: