New to the PICU world...so many ?'s!!!

tryingtohaveitall · Dec 6, 2008

Sorry it's taken so long to get this response off to you. I'll try to give you my best answers.

Most common dx? Well, in the winter I'd have to say respiratory illnesses of a wide variety. It used to be that we were inundated with RSV babies, but thanks to synagis, not nearly as many these days. Other seasons, it really is a huge variety of issues, which definitely keeps it interesting!

What % graduate? Most of them? LOL, how's that for an uninformed answer. We can go weeks without a death, and then we'll have three in a week. It just varies greatly. I'm sure most ICUs will agree that it seems like you'll have a bad patch where you lose several, and then it isn't so bad. The thing I love about working in a PICU is how resilient children are. They frequently survive illnesses that would put under any adult.

What makes me a born PICU nurse? Funny thing is that I never planned to be an ICU nurse. I started out on a Peds Cardiopulmonary stepdown unit and got a taste of the adrenaline. When I moved after a year, I went for the PICU and have never looked back. I think my ability to keep a cool head in a crisis, my attention to detail and ability to prioritize are very helpful.

I'm not sure what you're asking in the last question. To me, the safety is part of everything I do, every single day. I wouldn't dream of skipping safety steps, such as checking arm bands, MARs, following up on things that need orders, etc etc.

Hope this helps! The PICU can be a very difficult place to work but it can also be extremely rewarding.

Pediatric Critical Care Columnist · Dec 6, 2008

I had planned to respond to this thread on Wednesday but my wireless router packed it in and I had no Internet access until last night. By then I'd forgotten. But I digress.

I hope you find PICU as interesting, challenging, exciting and rewarding as I do. I've been at this since September 1997 and although there are days when I hate my job, I never could hate my work. If you know what I mean.

On our unit the #1 diagnosis is congenital heart disease. We're a referral centre for a very large catchment for pediatric hearts; we have a pediatric transport team and a very busy pediatric extracorporeal life support (ECLS) team. In the winter we see a lot of respiratory illnesses, even though Synagis has been availalbe for years now. Many of our patients are from remote areas where health care availability is spotty; many kids who would qualify for Synagis don't get it because their primary care provider isn't up-to-date on the "new" stuff. Then we also see a lot of traumas, particularly in May when the last of the snow is gone and the ATVs are brought back out and in the fall when the weather is starting to turn and people try to squeeze just a few more rides in. Our unit also is a transplant centre; we do hearts, livers, kidneys and lungs. Right now we have 2 heart recipients, one liver and one double lung and we have 2 kids waiting for hearts.

Our mortality rate is quite low, about 2.5%, but our morbidity is starting to creep up. The reasons for that have more to do with medical and surgical decisions rather than nursing care deficiencies. Our cardiac surgeons will do complex surgeries on patients other centres have turned away and they do transplants on people who are extraordinarily poor candidates. We also use ECLS a lot more than we used to and some of those kids are doomed to a very poor quality of life. But then there are the ones who defy the odds... go to http://www.canada.com/globaltv/edmonton/features/healthmatters/index.html and look for "Unsung Heroes" from Dec 2, 2008. Kids like this are what keeps us going.

Great PICU nurses are born, as you say, and not made. We're part mother hen, part mother tiger... we protect our patients in whatever manner is needed at the time. We're part hands-on comforter and part technical wizard... we use touch and soothing voice to provide comfort and manage a dozen or more high-tech gadgets all at the same time. We're part student and part teacher... we are continually learning about new illnesses, new treatments, new drugs and new technologies and we teach parents and siblings about the problems faced by our patients so they can understand and deal with it all. These qualities are all wrapped up with a passion to provide our patients with the best possible care, the most worthwhile life and when necessary, the most peaceful passing.

Safety precautions are built into our practice. We utilize restraints when needed, we double-check every medication we give, we verify dosages before giving medications for the first time, we ensure that someone has eyes on the kids at all times. Our monitors alarms are tightly set so that any aberration is noted immediately. We also use anti-entanglement devices on IV tubing for chidren at risk. It's all just part of our culture.

Don't expect to interact all that much with your patients. They're usually sedated in PICU for most of their stay. Your experience with asthmatics will be useful though. Some children with severe asthma will need to be admitted to PICU for back-to-back albuterol nebs and other more complex interventions (we've had one youngster who has been on ECLS twice!) or medications that need close obs.

Please check back and let us know how you're liking it, won't you?

MelodyButlerRN · Dec 6, 2008

I am also tranferring this week to the PICU from a busy med/surg floor. I worked with adults for almost two years and I know my calling is with children. I start this Tuesday and I am so excited and I have never been more sure of where I want to be. I'm so glad I found this forum, I can tell you all are so willing to give great advice, I look forward to talking to you all!

RN from NY

LittleWing21, RN · Dec 12, 2008

Good luck DelicateMElody! I'm still working on my med/surg floor and I'll interview in PICU and NICU as soon as there are vacancies. Thanks for all the helpful info!!

kessadawn, BSN, RN · Dec 15, 2008

1) What is the most common type of diagnosis? My PICU sees a lot of cardiac surgeries, DKA, rare genetic stuff, oncology, respiratory infections, we don't do ECMO or transplant, however

2) How often do your pt's "graduate" and get well?Most go home, acute events solved. Chronic kiddos have frequent trips to us, but they get back home as well. Kids are incredibly resilient. The kids that don't make it, well, it's rare, and can go in spurts for various chroninc and acute reasons.

3) What do you think makes you a born PICU nurse? Type A personality, completely anal retentive, and I think a little OCD:D

4) Do you feel you have the time in your day to take the extra safety precautions that are needed in the pediatric population? I can only compare to adult LTC care, but I never think about if there's time, I just do it

Hope that helped, good luck!

Smiler3 · Jan 28, 2009

hey here is an english view on things.....

1) what is the most common type of diagnosis? the majority or our patients are cardiac, in the winter respiratory patients, summer months we see more road traffic accidents ect

2) how often do your pt's "graduate" and get well? the majority of our patients "graduate", you can go weeks without a death, but then you can have 3 or more in one week, children cope very well and it is amazing how stong they are!

3) what do you think makes you a born picu nurse? i'm not sure, i amways wanted to go into emergency department nursing, but the lack of jobs ment i had to go for picu, it took me a while to settle and grasp the way we work but now i enjoy it, you have to be strong some people can't cope with the way the children look, with the wires and et tube and some of our cardiac pt's come back with their chest open which some people struggle with!

4) do you feel you have the time in your day to take the extra safety precautions that are needed in the pediatric population? our saftey precautions are built in to our daily routine, paeds nurses have all drugs double checked (which i think is a good thing!) we check our infusions as part of our start of shift and have hourly observations, and 1:1 nursing.

hope it helps x

gal220RN, BSN, RN · Feb 3, 2009

You are obviously thinking seriously about this transition and I congratulate you on that. Best wishes as you enter the PICU world. I will give you a few of my personal thoughts on your questions:

1. In a general PICU, respiratory issues are some of the most common reasons for admission to the PICU, especially during RSV season. However, if you are a Level 3/4 Trauma center, you will see lots of accidents (MVA's, falls, head injuries and non-accidental trauma). Additionally, if you within a major pediatric center, you will also get sick heme/onc kids (either newly dx or septic); a large percent of the population are your chronic, technology-dependent kids who have flares of their underlying illnesses (seizures, pneumonias, etc.)

2. The kids who graduate are the ones who are usually admitted acutely ill and get better quickly. Sometimes, you just return kids to baseline.

3. There are no "born" PICU nurses- you just evolve. Naturally nurturing individuals usually have to develop good coping mechanisms to survive, otherwise they burn out emotionally. If you are a flexible, yet competent clincian (this takes study and time) who loves kids, you can succeed as a PICU nurse.

4. Safety becomes part of your personal culture- especially when it comes to high-alert drugs, clincial distinctions within PICU, and just plain common sense. It is learned with time and experience. You will get there- be patient!

Passion is everything. You seem to have it in spades!

MaritimeNurse · Feb 24, 2009

I am also new to the world of kidos! I have been nursing for almost 3 yrs most of it in adult cardiac. I have recently started in a PICU and so far am seeing so much varity. I am loving working with older kids and the babies but am overwhelmed with questions!

I was wondering if any other PICU nurse out there uses a good pocket guide with formulas and quick reference info that you could reccomend? I would like one to keep on me while I'm at work.

Also I was wondering if other nurses who have recently made the change from the adult world of nursing to peds are feeling like a new grad all over again, because I am?!

Can wait for all the great things I'm gonna learn in the future....

Pediatric Critical Care Columnist · Feb 24, 2009

Do you have a Palm Pilot or an iPhone? There are a couple of good programmes for them that I use fairly frequently. One of them is Rapid Pediatric Emergency Care (RapidPEC). RNFastFacts has a good selection of peds topics, and there's one that has the current PALS algorithms at the touch of a button. AACN has some quick-references that come as pocket cards that are quite good too and are available online at aacn.org. I haven't updated my peds collection lately... I'm waiting for the exchange rate to improve.

picuRN0430 · Mar 11, 2009

1) what is the most common type of diagnosis? typically in our picu, we see a little bit of everything. a lot of trauma, as i work in a major city, and a lot of respiratory illnesses. also included: rsv, hem/onc, brain tumors, dka, cardiomyopathy, sepsis, esrd pts. on dialysis, hus, ingestion, cv surgical pts, unforunately abuse.. its quiet the variety

2) how often do your pt's "graduate" and get well? i would say 85% of the time, our patients get better and are transferred out of the icu. the other 15% of the time, they are transferred to boston or chop, or they pass away, and very very rarely go home form the icu.

3) what do you think makes you a born picu nurse? (i'm sure its almost impossible to describe but worth a shot!) i think that a born picu nurse loves taking care of very sick children and making a difference in their life. you must pay great attention to detail, be caring, passionate, extremely patient, be very organized, be able to prioritize, and still love the adrenaline rush when things go haywire.

4) do you feel you have the time in your day to take the extra safety precautions that are needed in the pediatric population? safety is the number one concern in a picu. not only do you have a multitude of equipment, but there are families around, who sometimes, may not understand the significance of not laying on top of ventilator tubing, etc. siderails are always up, bed is locked in the lowest position, pt. is restrained if necessary, and pt. is frequently checked by the rn.