Offer for Peds Intermediate ICU

[procrastinator911, BSN, RN]

I got an offer from a children's hospital on the peds intermediate icu. I am extremely excited. I understand they require more frequent monitoring and care compared to the floor, but less than ICU. But I wanted to know how sick are these kids? How long do they usually stay on the unit (I meant to ask during the interview but I forgot).

I have seen many posts about NICU,PICU, HEM/ONC, etc, but I haven't seen anything about intermediate care. I just want to have an idea of what to expect. I just want to prepare so i can provide the best care for my patients

Thanks guys

[NotReady4PrimeTime, RN]

At my hospital we don't call our intermediate care area an ICU. It's called the intermediate care environment. Patients who are transferred to those beds are most often s/p cardiac repair of some sort, neurosurgery or transplant. These are the kids who still need fairly close monitoring for things like blood pressure or rhythm issues, ventricular assist device, ICP, external ventricular drain, epidural analgesia, anticoagulation, high-flow nasal oxygen, mechanical ventilation via tracheostomy, fluid shifts and other similar issues. The nurse:patient ratio is 1:2, with a nurse in the room at all times. They will have continuous cardiorespiratory monitoring and oximetry, hourly vitals and q4h head-to-toe assessments like they were getting in the ICU but not the helicopter nursing. For most of these kids their need for intermediate care is brief, a few days to a week. For others, their stay in the intermediate care room is months long. We have situations on our ICUs where the kid may have been on intermediate monitoring for many days already but are considered to sick or too busy for the intermediate room. Our liver transplants are a good example. The kiddo might have been in an intermediate assignment for a week or more in the ICU but policy states they're to be 1:1 for the first 24 hours on the ward. It's a busy and challenging job, but parents can be encouraged to provide as much care as they're comfortable with. Good wishes for a successful launch into your peds career.

[procrastinator911, BSN, RN]

Thank you very much for a such a detailed description of the intermediate unit. I appreciate it very much. Thank you!

[jamisaurus]

I don't have any advice to offer from a pediatric standpoint, but I did start in an adult ICU and it was terrifying. I now enjoy going to work every day. It will be a huge learning curve, but if you're drawn to it, follow your heart. Remember, every great thing starts out scary! You can do it!

[procrastinator911, BSN, RN]

Thank you. How long did it take you to really start to feel comfortable

[jamisaurus]

I would say at about 6 months in I was feeling more comfortable but still having occasional bad days. Now at 1 year I feel comfortable and confident. There's always something to learn though!

[procrastinator911, BSN, RN]

Yeah I know it will be such a huge learning curve, but I'm looking forward to it