NICU, PICU or Children's ER?? Need to choose for final practicum..

cjcsoon2bnp, MSN, RN, NP · Aug 27, 2010

I have this same dillemma so its interesting to see that someone else is thinking about going into the same areas. I actually work as a tech. in a Peds. ED so my manager and clinical educator have advised me to look into a different area for my last practicum (even though I really want to work in this same ED after I graduate) this is because they think I need to have a little bit more of a diverse experience so I can see other speciality areas and see if I like them. I am still trying to narrow it down between NICU or PICU and I'm not sure yet. I have been told that NICU is really a world of its own and once you work there you usually end up working there for the rest of your career because it is so highly specialized and NICU nurses are really devoted to their patients. I think if your looking at going into Pediatrics overall (either PICU or Peds ED when you graduate) you should probably choose between those two departments. I think that PICU might be a good place to start because you are taking care of only 1 or 2 very complicated, critical patients and it allows you to develop those highly technical skills and be able to take care of the whole patient. In the ED it can be very fast paced, busy, crazy and a rough place for a student to start if you have never worked in an ED. This is just one opinion.

!Chris :specs:

luvmyboys · Aug 27, 2010

Peds ICU or ER would probably give you more variety. You will get to care for infants all the way to teens. NICU is going to be more narrow as in just the newborn population (although some chronic kids stay on the unit until they are several months old they all start out there as newborns). I agree with the previous poster about NICU being a world of its own.

Just curious - what are the pros and cons you have already come up with?

Good luck!

Shanlee79 · Aug 27, 2010

I have this same dillemma so its interesting to see that someone else is thinking about going into the same areas. I actually work as a tech. in a Peds. ED so my manager and clinical educator have advised me to look into a different area for my last practicum (even though I really want to work in this same ED after I graduate) this is because they think I need to have a little bit more of a diverse experience so I can see other speciality areas and see if I like them. I am still trying to narrow it down between NICU or PICU and I'm not sure yet. I have been told that NICU is really a world of its own and once you work there you usually end up working there for the rest of your career because it is so highly specialized and NICU nurses are really devoted to their patients. I think if your looking at going into Pediatrics overall (either PICU or Peds ED when you graduate) you should probably choose between those two departments. I think that PICU might be a good place to start because you are taking care of only 1 or 2 very complicated, critical patients and it allows you to develop those highly technical skills and be able to take care of the whole patient. In the ED it can be very fast paced, busy, crazy and a rough place for a student to start if you have never worked in an ED. This is just one opinion.
!Chris

Thanks Chris...ya, it is good to know that I am not the only one in this boat. I've worked my way through school as a health care aide in adult emerg, so I am familiar with the flow of things, and it would be great to see/do alot with my pts but I think not being able to give more time/focus if I wanted would get to me too. I think that goes in hand with that devotion aspect you mentioned re: the ICU. I have sent a request to shadow in both the PICU and ER, hopefully it'll work out. I already had a chance to spend a day in NICU, and I can see what you mean about the limitations. Good luck to you too..let me know how it works out!

Bortaz, MSN, RN · Aug 27, 2010

I did my practicum in the NICU, because that's where I wanted to work from day 1. I was offered a job in that same unit, and have been there now almost a year, and hope to never have to do any other type of nursing...so, the devotion aspect is certainly true.

Having said that, I love my NICU, and am constantly trying to recruit my friends into my area.

Shanlee79 · Aug 27, 2010

I did my practicum in the NICU, because that's where I wanted to work from day 1. I was offered a job in that same unit, and have been there now almost a year, and hope to never have to do any other type of nursing...so, the devotion aspect is certainly true.
Having said that, I love my NICU, and am constantly trying to recruit my friends into my area.

Thanks Bortza..it is nice refreshing change to have passionate nurses like you, who are encouraging us students rather than eating em up. I certainly loved my day I shadowed in NICU, the nursery side wasn't overall exciting but nonetheless I loved the change in atmosphere from what I have mostly experienced as a student on adult floors and the really nice change from having to clean up 300lb complaining adult. Mostly loved when I got to follow the nurse who went to the OR for high-risk births and then back to the obs unit with the sick infant. Never seen such awesome teamwork! Naturally, I would not be able to start here though but in a way that makes it less intimidating too.

My question for you...do you know if it is still easy to transition into other areas from NICU after some time or examples of where NICU nurses have moved along too?

chloecatrn · Aug 27, 2010

I think you'd likely find that you'd be the most versatile out of the PICU. Having worked with bigger small people, you'd be able to go to work in the NICU, especially because you'd likely have seen some infants in the PICU -- just not neonates. Secondly, EDs like ICU experience, so if the ED is somewhere that you're interested in working in the future, the PICU would definitely be an advantage for you.

viral2010 · Aug 27, 2010

The largest persentage of nurses who start in the PICU are new grads. I would advise PICU also due to the extensive list of diagnoses that are seen. Very interesting!

Summer Breeze · Aug 27, 2010

It really depends on where you see yourself working in the future. I had my practicum in the PICU and I loved every second! I seriously was so sad on my last day, I didn't want to leave. The PICU sees a wide range of patients, so I have taken care of a 2 week old up to an 18 year old! (Some PICU's have patients older than 21 come in as well.) I honestly enjoyed the variety; no two days were the same! One minute you could be taking care of an 18 month old in respiratory distress, and the next moment a 12 year old with diabetic ketoacidosis could be getting admitted and they are starting to exhibit mental status changes.

Overall, I loved how the PICU (or any ICU for that matter) allows you to really know the patient and their families. I'm very detail oriented and I love how I can provide so much care for one patient. =) The ER would allow you to provide important care as well, but it isn't for a long period of time and I feel as though you take care of their immediate problem and then transfer them elsewhere or discharge them. So for me, I know that forming a relationship and really getting to know the patient was what I wanted to do and why I chose PICU over Peds ER.

With PICU experience, I know in the hospital where I had my practicum and the hospital where I have interviewed for *I'm keeping my fingers crossed that I get a call back* sometimes require the nurses to float to other units (general peds floor, pediatric step-down, or NICU.) I know that jobs for NICU sometimes say PICU or NICU experience preferred, whereas PICU is usually going to just ask for PICU experience.

But you know what is best for you! I absolutely loved NICU as well, but PICU is where my full heart is set on! Good luck to you and please let us know what you decided to do! I'm sure you would love any of them, PICU, NICU, or Peds ER. They are all interesting and I found that I loved anything related to pediatrics. So good luck!!!

Shanlee79 · Aug 30, 2010

Just curious - what are the pros and cons you have already come up with?
quote]
Hi there, well I am merely basing pros and cons a lot on my hunches of what each area may bring. I hope to do more shadowing soon to confirm these beliefs hopefully. Basically, like you mentioned...the ER or PICU would have the variety aspect, which I feel I would enjoy. As much as I love acuity, I think not being able to give the focused attention that you may be able to in an ICU setting would get to me after awhile. However, the ICU setting really intimidates me, partially b/c I am not familiar as it, as I am emerg. Other reasons, simply involve the actual units themselves regarding staffing/mgmt issues I have learned. I have basically tried to match my personality to pick the best place but find that I am kind of in the middle of the road and could adapt to either or.

Shanlee79 · Aug 30, 2010

I think you'd likely find that you'd be the most versatile out of the PICU. Having worked with bigger small people, you'd be able to go to work in the NICU, especially because you'd likely have seen some infants in the PICU -- just not neonates. Secondly, EDs like ICU experience, so if the ED is somewhere that you're interested in working in the future, the PICU would definitely be an advantage for you.

Thanks for the reply! I guess that was also part of my question...which one is best to start with in order to gain experience that can be transferable to another unit? It is kinda the what comes first, the chicken or the egg question. Some have told me that I need to have ER experience before I could get into an ICU and then I have heard the opposite. I guess in the end it's all linear and probably doesn't matter which is done first, as I haven't seen restrictions in postings in my city.

Shanlee79 · Aug 30, 2010

It really depends on where you see yourself working in the future. I had my practicum in the PICU and I loved every second! I seriously was so sad on my last day, I didn't want to leave. The PICU sees a wide range of patients, so I have taken care of a 2 week old up to an 18 year old! (Some PICU's have patients older than 21 come in as well.) I honestly enjoyed the variety; no two days were the same! One minute you could be taking care of an 18 month old in respiratory distress, and the next moment a 12 year old with diabetic ketoacidosis could be getting admitted and they are starting to exhibit mental status changes.
Overall, I loved how the PICU (or any ICU for that matter) allows you to really know the patient and their families. I'm very detail oriented and I love how I can provide so much care for one patient. =) The ER would allow you to provide important care as well, but it isn't for a long period of time and I feel as though you take care of their immediate problem and then transfer them elsewhere or discharge them. So for me, I know that forming a relationship and really getting to know the patient was what I wanted to do and why I chose PICU over Peds ER.
With PICU experience, I know in the hospital where I had my practicum and the hospital where I have interviewed for *I'm keeping my fingers crossed that I get a call back* sometimes require the nurses to float to other units (general peds floor, pediatric step-down, or NICU.) I know that jobs for NICU sometimes say PICU or NICU experience preferred, whereas PICU is usually going to just ask for PICU experience.
But you know what is best for you! I absolutely loved NICU as well, but PICU is where my full heart is set on! Good luck to you and please let us know what you decided to do! I'm sure you would love any of them, PICU, NICU, or Peds ER. They are all interesting and I found that I loved anything related to pediatrics. So good luck!!!

Thanks...You know, you made a good point about the family involvement. I know what you mean, and as a health care aide in emerg I am reminded that the main focus is patch em up and on they go. Though, I see all sorts of neat stuff and by no means is it boring but last week I saw a perfect example when a teenage mom miscarried and rather giving her time to grieve or speak to pastoral care or what have you, she was pushed out the door with her script, clearly still shaken up. I understand that is the way it is and the beds are needed..and most times the turnover doesn't effect me, but certain times I think it would. I to am detail oriented, love to be in the know-how. In fact, the only thing I liked about being a student was having you 1-2 pts who I researched the heck out of and was on top of them b/c I had the time. I loved pathophysiology in school and love knowing the why to what was going on. Sure, some families can be a pain, but in reality the only bad examples I had was when I had no answers to give the anxious bunch b/c I was waiting on the docs to come around.

I will make some follow-up calls this week in regards to getting some shadowing done to help make my decision..I will keep you posted. Good luck to you too, I hope you get that call you're waiting for!!