NICU to PICU

kastas, BSN, RN · Aug 6, 2005

Do you reckon this transition would be hard for me? I'm paeds trained but haven't done any PICU.

I don't think you'll have a problem, especially if you are peds trained. You'll give different meds and the concentrations will be stronger. Just always look up what you don't know, you'll be fine. Good luck!

suzanne4, RN · Aug 7, 2005

The basics will be the same but you will probably be using more ionotropic drugs in the PICU. Also, you can get patients that are actually larger than you!

misschelei · Aug 7, 2005

I think you will be fine. You will be continually learning. You will see all kinds of things you haven't encountered before. I've seen 30 year veteran nurses look at a patient chart and say they've never heard of that particular syndrome, etc.

Tomskatt · Aug 13, 2005

I am sorry to doublepost but I originally posted on Peds, when I meant this for PICU.....now I see there is a current discussion, so here goes.

Okay gang.... here's one you may have dealt with before, but I would love to get your expertise and opinions. I have been a NICU nurse for almost 11 years (YIKES! How did that happen?). Most of that time was as P/T or per diem. I am now going to go back to work F/T and am thinking about making the jump to another specialty... most likely to PICU. I love what I do, but to be honest it is very limiting and I really can't see myself as a staff nurse for the next 20 years. Have any of you made the switch to/from any specialties and how did you find the experience. Is it overwhelming? Rewarding? Impossible? Please, don't hold back! I really believe Peds nurses are some of the most well rounded nurses in the hospital. Dealing with a paient anywhere from newborn to young adult really gives you some great experience. What do you all think?

nurseiam · Aug 25, 2005

:smokin:

Last year I went from NICU to Float pool at a childrens hospital. WOW! My first orientation was heck! It was the ER. I think they expected me to have more basic ped knowlegde. That was rough. Next I did IVT which only took 4 days. We did our own in the NICU. Then I did med-surg, that was great! I had done it on-call for a year. Short stay was also an easy transition. I just finished my PICU orientation. I loved it. It has been the most challanging with a similar environment to NICU. There are soooo many dx! soooo many different meds. At this point in my like my kids are 7 and 13 so I am not ready to make the emotional commitment. I will love doing it as needed!

Good Luck! The initial jump is the hardest!

Pediatric Critical Care Columnist · Sep 12, 2005

I made the jump from neonatal (level 2) to PICU 8 years ago and have never for a moment regretted it. Like tomskatt, I found neonatal very restrictive... there are essentially the Big Three or Four diagnoses in neonatal, the patients are all roughly the same size, and most shifts look very much like the ones before. In PICU every single day is different, even when you have the same assignment several shifts in a row. I feel that PICU nurses are the most-well rounded nurses, with the broadest scope of practice there is. In our unit we have had kiddies who were only several hours old (diaphragmatic hernias mostly) right on up to the 20 year old who had a cardiac cath that went horribly wrong and no adult ICU bed to send him to. From caring for a fresh post-op Norwood infant, to admitting a school-aged kidney transplant recipient, to caring for an adolescent with full thickness burns and on to teenager who attempted suicide, work in PICU is never dull or routine. In many ways, neonatal experience transfers well to PICU because you're already trained to calculate your meds based on the patient's weight, and you're already trained to understand the differences in anatomy and physiology between little people and big people. And you've been dealing with distraught parents and siblings as well, so that all makes the transition easier. Having kids of your own helps with the inevitable developmentally appropriate behaviours... you know what I mean! But a good understanding of growth and development is a good substitute for personal experience. Kids are incredibly resilient and we all can learn a lot from them.

Tomskatt · Sep 13, 2005

I made the jump from neonatal (level 2) to PICU 8 years ago and have never for a moment regretted it. Like tomskatt, I found neonatal very restrictive... there are essentially the Big Three or Four diagnoses in neonatal, the patients are all roughly the same size, and most shifts look very much like the ones before. In PICU every single day is different, even when you have the same assignment several shifts in a row. I feel that PICU nurses are the most-well rounded nurses, with the broadest scope of practice there is. In our unit we have had kiddies who were only several hours old (diaphragmatic hernias mostly) right on up to the 20 year old who had a cardiac cath that went horribly wrong and no adult ICU bed to send him to. From caring for a fresh post-op Norwood infant, to admitting a school-aged kidney transplant recipient, to caring for an adolescent with full thickness burns and on to teenager who attempted suicide, work in PICU is never dull or routine. In many ways, neonatal experience transfers well to PICU because you're already trained to calculate your meds based on the patient's weight, and you're already trained to understand the differences in anatomy and physiology between little people and big people. And you've been dealing with distraught parents and siblings as well, so that all makes the transition easier. Having kids of your own helps with the inevitable developmentally appropriate behaviours... you know what I mean! But a good understanding of growth and development is a good substitute for personal experience. Kids are incredibly resilient and we all can learn a lot from them.

So much of what you say Jan is true, but I am terrified of the change! Did you get adequate training and orientation to your new position or was it learn as you go? How were your first 6 months? Sorry for the drill, just trying to know what to expect.

Pediatric Critical Care Columnist · Sep 13, 2005

My first orientation to PICU was four weeks: two 8 hour days were in the classroom, then two 12 hour buddied shifts were on the unit putting what I'd learned into practice. The unit I started out on didn't handle quite the same degree of acuity as the unit I now find myself on, so there were a number of "single-system" kids for me to cut my teeth on. After I'd been there about 15 months I had two days in the classroom with the clinical educator to give me some more advanced theory. The team leader I had on that unit was a strong advocate of staff development and was able to let me advance at a reasonable pace. She gave me challenges when there was extra staff available to back me up and within two years I was taking charge.

My second orientation, to the unit I moved to three years ago was a week of classes that all orientees receive, regardless of their previous experience. I then got four 12 hour buddied shifts then was given a post-op cardiac admission. Oops... that wasn't supposed to happen, but my preceptor decided I was ready. Three weeks after that I got my Phase Two orientation to cardiac defects and repair, continuous renal replacement therapy, code team responsibilities and extracorporeal life support. For me that was the right amount of orientation. I can handle anything that comes thorough the door.

For new-to-peds and/or new-to-critical care, the orientation program is much different; it has been rejigged in the time I've been here and is now a three phase process. The longest period that I've seen someone preceptored at Phase One has been 17 weeks (a new grad). The preceptorship is tailored to the individual; someone with NICU experience might get the classroom, then 4-6 weeks of buddied shifts. Someone from general peds might get 8-10 weeks of buddied shifts. Phase Two is usually entered once someone has been on the unit at least a year, depending on their level of function. It's strictly the cardiac defects and repair portion now. Until one has Phase Two, there are no assignments to any patient who has had cardiac surgery within the last 48 hours, or who remains unstable. Then Phase Three comes about two to two and a half years after starting on the unit. This too depends on the individual. We have some people who started the same day as I did who haven't had Phase Two yet, and others who have been on the unit less than a year who are doing their Phase Three.

The prudent manager will ensure that new staff has the opportunity to become comfortable looking after a single system patient before pushing them along. I strongly feel that with your NICU experience... eleven years is a long time... that you will be fine. During your buddied shifts make it your mission to move out of your comfort zone and look after big kids. Also I suggest that you request the type of assignment you would be likely to be responsible for once you're on your won. That way you'll be able to develop your assessment skills appropriately without feeling like you're drowning. Keep away from the infants, because you already know what to do with them, and you'll be getting them a lot initially while you're growing in place. RSV season is soon upon us after all! Best of luck... let me know how it goes.

Tomskatt · Sep 13, 2005

Jan, thank you, thank you, thank you! I can only hope that I will be able to get the same orientation that you were given. Heck I'd be satisfied with 1/4 of that! I am not sure what to expect as I am relocating to a new area and am not familiar with their hospital systems yet. Anyone out there from the Charlotte, NC area?

Jolie, BSN · Sep 13, 2005

Jan, thank you, thank you, thank you! I can only hope that I will be able to get the same orientation that you were given. Heck I'd be satisfied with 1/4 of that! I am not sure what to expect as I am relocating to a new area and am not familiar with their hospital systems yet. Anyone out there from the Charlotte, NC area?

I left Charlotte a long time ago so my information is not current, but I would guess that Carolina's Medical Center and possibly Presbyterian would be the facilities with PICU's.

My personal advice is to avoid Piedmont Medical Center.

Tomskatt · Sep 13, 2005

My personal advice is to avoid Piedmont Medical Center.

Hmmm, this seems to be the popular concensus. I was wondering why they have a ton of job openings posted all over.