PICU or ED

PICU is NOT a narrow specialty. It's actually the broadest scope pf practice there is. We deal with everything from sick neonates all the way to adult bodies ruled by teenaged brains. We deal with respiratory illnesses, trauma, oncology, surgery of all sorts (including transplants), cardiovascular disease, metabolic and genetic disorders, sepsis, burns, post stroke and cardiac arrest care... you name it and we do it. The pediatric patient is actually more challenging than the adult because you're also dealing with a language barrier (kids aren't easy to reason with!), their compensatory mechanisms have more stamina but when they're overwhelmed the kid goes south in the blink of an eye, and they react to drugs differently from adults so each dose is individualized to the patient. The basics of critical care are the same wherever you work. Drawing an arterial blood gas from a child is the same as drawing one from an adult, leveling an external ventricular drain is the same, cardiorespiratory monitoring and hemodynamic monitoring are the same except the parameters are different and so on. I have friends who have gone from PICU to the adult ICU and they've found it pretty easy, but the ones who have done the reverse really struggle with the huge body of knowledge they're expected to develop and the interpersonal interactions they're unfamiliar with. You would be surprised at how much some of us PICU nurses know and what we can do. Don't look down on us until you've tried it.

You'll acquire skills in PICU that you'll probably never need in an adult ICU... like placing scalp IVs (:chuckle )for one. And if you can calm down a terrified three year old, there aren't too many adults you won't be able to do the same with. Of course there will be things that you own't learn in PICU: we don't see any IABPs, and our unit has only had one PA catheter in the 5 1/2 years I've worked here. But so much of what we do has a similar adult component, and if you have a good foundation of critical care education, you'll be just fine in an adult unit with an appropriate orientation.

I have no liking for hospitals that mix their peds patients in with their adults. The kids lose out on so much that way. And hospitals who have access to a tertiary care PICU albeit perhaps at some distance who choose instead to keep a small child in their adult ICU for several days, until the child is so messed up they can't be saved before transferring them really should lose their accreditation. In the last six months or so we've seen three such cases, babies who might have lived and been just fine had they been referred to a PICU sooner. They all came from the same hospital, they all had the same admitting physician and they all died. It's awful.