Not sure if PICU is for me

Pediatric Critical Care Columnist · Jul 15, 2010

Christie, what you're feeling is NOT unusual at all. PICU nursing is one of the most morally-distressing occupations there is. I worked nights last night and everyone I talked to all night expressed exactly what you just did. The things we're seeing on our unit right now make it very hard to keep on keepin' on. If it were always like this, I think most of us would move on. But it's not always like this. We have had long stretches where everything goes right and the kids get well and go home. Our former patients get their transplants, do incredibly well and are out of hospital and living large. Then there are times like this where nearly every kid on the unit is not going to have a happy-ever-after and the ethical gray swamps every other aspect of our work. As with most things, it's cyclical and we know it's going to change again soon... if we can wait that long.

There is no shame in deciding that you aren't able to work in an environment and stay healthy yourself. There are times when you can't be an effective PICU nurse AND protect your own spirit. Your age may have more of an influence on your perceptions than you think. It's been my experience that we late-bloomers (I was 36 when I graduated) see more deeply into situations than the youngsters and feel distressed by things that they may not be even really aware of. I also find that working nights gives one a lot more time to ruminate on just these sorts of things.

What kind of person is your manager? Does she seem like someone you could talk to about this? She may be able to offer you some options you aren't aware you have. She may also be able to provide some support and relief from your emotional burden. Other people to turn to are the unit social worker or the chaplain. You don't need to be a "religious" person to benefit from talking to someone who is. If neither of those avenues appeals to you, maybe your employer provides an employee assistance program that could help. But in the end, you have to do what is best for you. Honoring the commitment you made to your unit will not be a good thing if you end up feeling like a sacrificial lamb. In that case, everyone loses. :hug:

christieb01 · Jul 15, 2010

Janfr- I think you are completely right about age being a factor. I work nights with many young people- and they seem to be able to brush off the emotional stuff. I've started to freak out at the littlest things with our son. He goes swimming and instaed of enjoying watching him swim, I freak out thinking about the drowning victim at the hospital.

I did my preceptorship in the outpatient surgery area- mostly healthy kids getting ear tubes, T&As, etc. I loved it!!!

I think you are right though- I need to sit down and talk to my manager. She's not really the approachable type though so I may go to our unit educator (more approachable) and ask her to help me decide if this is the route for me.

Thanks for listening!

Pediatric Critical Care Columnist · Jul 16, 2010

Usually that extreme reactivity relating to our own children passes fairly quickly. It's hard to cope with while you're experiencing it but it really does get easier. I'm sorry you rmanager isn't approachable (neither is mine), but you could find that she's developed a shell to protect her own feelings (not the case with mine). Your educator might be a great resource for you and may be able to facilitate a transfer for you to an area where you'll be happier, or run interference for you for awhile so you can ease into the gray stuff. At any rate, I'm always around so don't heisitate to bounce things this way.

SteelCity_RN · Jul 21, 2010

Christie,

I too am a new grad, finished college last May and immediately started in the PICU. I know exactly what you mean, I have been here a little over a year and am wondering, how much longer can I do this. The trach, g-tube zero quality of life kids really hits me hard that someone could be so cold to keep a practically brain dead child alive via artificial means to lay in a bed. I run that scenario through my head EVERY day at work and still haven't found a solid explanation. I often think its money, guilt (depending on the situation), lack of better options and not wanting to be responsible for "ending" their childs life. Granted, I have never been in that situation. But honestly, I can tell you 100% without a doubt I would not do that to my child if something awful like that happened. That is my personal opinion. I work in a 36 bed PICU and we get lots of drownings, traumas, non accidental injuries and transplants. It is physically and emotionally draining. You do not just deal with and treat the patient but with the stressed family as well. Im keeping at it for now, feel free to message me and share your stories/concerns. I know exactly how you feel.

christieb01 · Jul 22, 2010

An update- well at the urging of a fellow co-working I went to talk to my unit educator. I knew that I felt comfortable talking to her and that she might be able to help me through my feelings. Well, I broke down crying before I could even say a word! We sat down in the conference room, she asked me how I was doing, and out came the waterworks. She said she knew I was having a tough time of it and figured I would be coming to her soon. (I kind of wish she would have come to me first but I understand that she needed to wait for me to make the first move). I told her that I felt the job was emotionally and physically draining and that I just wasn't sure if it was "right" for me. She said that sometimes PICU isn't the right fit for everyone and asked if I would be interested in a different position in the hospital if one was available. She then got our unit manager- I'm guessing gave her the heads up as they walked to the conference room. Long story short- I have an interview tomorrow morning in the outpatient surgery clinic- which is where I did my preceptorship while I was in school. I am so excited/ nervous. In some ways I feel like I am abandoning my fellow co-workers, but I know this could be a very positive move for me. Another plus is that it's a day shift position- so much better than the night shift I am currently working!

To all the wonderful PICU nurses out there- God Bless You! I am so thankful that there are nurses out there who are able to take on this difficult position.

Thank you for listening to my ramblings, I will keep everyone updated.

Pediatric Critical Care Columnist · Jul 22, 2010

Well, that went pretty much as I expected. I'm glad for you! I predict that your interview will go well - they already know you there - and that you'll be transferring soon.

Don't feel bad about leaving your PICU coworkers in the lurch. They'll be fine. Someone will move into your position and they'll all survive.

christieb01 · Aug 1, 2010

Final Update- I got the job in Outpatient Surgery!! I start working there the end of August. I am so excited. Since this is a department I have "worked" in before, I know what to expect. The best part is that the schedule is days- with four call shifts per 4-8 weeks.

Thank you everyone who responded to support me. This way a difficult decision for me. I am so thankful that I had a supportive environment to vent to!

Thanks!

JERIKA13 · Aug 2, 2010

Just wanted to pipe in here with a different perspective for many of you. I am an "older" student-almost 36 and will be finishing my RN this May (2011). My daughter has a fatal genetic neuromuscular disease called Spinal Muscular Atrophy. She has had a g-tube since just turning 1. That was the first of many surgerie and many PICU stays for life threatening respiratory complications. A trach is also in her future IF there is no cure. Please remember that not all children that are trached and g-tube fed are vegetables. Her brain is completeley unaffected and she is happier than the majority of humanity-I don't say this lightly either. I will never forget the last PICU nurse that cared for us after her 8 hour spinal rod placement in Madison. That surgery literally was life threatening, but necessary. It was the scariest time ever for us and while not pleasant, her nurse Christen, will forever be in my heart and mind. I was so thankful for her confidence and understanding and all the explaining she did while also finding patience to handle my multiple questions and hesitancies. You may not realize what you are to families like us, but you are often our everything: our communicator with the docs, our advocate, our support, our educator, and most of all, when we know you are genuinely giving the best care for

christieb01 · Aug 3, 2010

Jerrika- thank you so much for posting your reply. You are so right- not every child that has a trach and g-tube is a "vegetable". I had the joy of caring for a couple of patients recently who reminded me of that. I did have the opportunity to make a difference in their stay at our hospital. I was thankful to have had the opportunity to care for these kids. I still believe that PICU is not the environment for me. However, I have learned so much in my short stay in the PICU. The best "teachers" I have had are the families. They have taught me the little "tricks" with their g-tubes and trachs. I will still have the opportunity to care for these precious children, I know that through these experiences I can handle whatever comes my way.

So I guess thank you to all of the parents who teach us every day!