nicu to picu transition

meanmaryjean, DNP, RN · Aug 9, 2016

Brutal honesty here: Sometimes, some former NICU nurses express an air of superiority regarding their practice. As in "We would NEVER do (fill in the blank) in NICU!" they tsk-tsk at you.

And that is understandable as you deal in NICU with a very, very narrow patient population and fairly narrow range of conditions.

Understand that things are done differently in PICU. Not wrong- just different. Be open to that difference and you'll do well.

I have experience with adult ICU, NICU and PICU - and let me tell you PICU is that hardest, most challenging position I have had in nearly 40 years of practice.

Pedsnurse292 · Aug 9, 2016

I appreciate the honesty! Good to know so I can make a conscious effort NOT to do those things :)

Pediatric Critical Care Columnist · Aug 10, 2016

What meanmaryjean said is all too true. There are some NICU nurses who truly do feel they're quite superior. In my experience, NICUs tend to have a significantly better funding arrangement than their affiliated PICUs. After all, who doesn't want to help save those poor, tiny, helpless babies? So they tend to have bright, shiny new equipment while the children and staff in the PICU make do with whatever they can scrounge. So the nurses in the PICU may see you as a potential nursing "snob". At my hospital PICU recovers all the cardiac surgical patients, no matter how old they are, and once the neonates are on minimal inotropic support and have their intracardiac lines out, we send them back to NICU... across the hall. The nurses there look at our infusions with disgust and we know the second we're out the door they're switching them all over to their own mixtures. This may be a common experience. We've also been expected to float to NICU because we do look after "their" patients, but they've never been required to return the favour, because we can't guarantee them a neonate. They do everything differently there, even their charting. Forewarned is forearmed, so now you know these things you can ensure you're not THAT nurse.

Many of the other challenges relate to scale. The patients are bigger, their drug doses are bigger, their poops are bigger... and they're stronger than you'd ever believe to look at them. Parents have had them to themselves a lot longer and will have certain routines and habits that you might never see in NICU. Oh, and those kids have minds of their own. Along with opinions that they might not hesitate to share. Those are some of the things that might give you transitional hiccups. But don't let them stop you from being a fabulous PICU nurse!

meanmaryjean, DNP, RN · Aug 10, 2016

NotReady4PrimeTime is so right. At our hospital, I could take care of a NICU patient having an open heart procedure, care for them on ECMO, get them off their drips and send them back (about a month's time) - then float over to NICU the next night and be told that the same patient I had in PICU the night before was 'too critical' for my skill set and "Here- you can have all the NAS babies. BUT you can't do your own assessments, you can't give meds and you certainly can't chart!"

^^ True story: I was told this by a sweet young thing who was born a full decade AFTER I worked on the drug trials for PGE1 (alprostadil).

Pedsnurse292 · Aug 10, 2016

Thank you both for the advice, it's good to know the possibility of that dynamic before I start!