PICU or ED

[LaxNP, DNP]

So, I interview for the ER and PICU at a large 700 bed hospital. I was offered both jobs and need to make a choice. My main concern is that PICU is a narrow specialty and the hospital that I interviewed at is the only childrens hospital in hours. The ER is great...organized, new...the whole package with grea pay and a good rep. My question is, does PICU experience prepare you for adult ICU experince as well. I am 24 years old and I may want to change to adults later on. So I am a bit torn.

Kenny

[NotReady4PrimeTime, RN]

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.

[LaxNP, DNP]

Thanks for the reply. I have worked with peds on a med/surg adults/peds floor. The hospital has a NICU, PICU and peds floor that they require training on all and mostly on PICU as that would be my unit. I see it as a great opportunity. Both positions are great. I think I will be more fulfilled with the peds job. although I see it as more challenging. Basically, I am wondering if working in a PICU will equal the skill set needed to make a time appropriate change to adult ICU with a relative easy orientation. I want to tavel in a couple of years as well as gain good skills.

[NotReady4PrimeTime, RN]

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.

[kimmie518]

Hey, I was in the same position. Large 700 bed hospital Trauma 1 center with the choice of the PICU or ED. I opted for the PICU and I LOVE IT!

BTW, what hospital are you taking about?

[Redneckmedic63]

PICU and ER experience both lend so much to your practice in the other. I was an old-goat medic who went to nursing school with every intention of being an ER nurse, but took a job in PICU on a whim and have loved it ever since. The cool thing is that I now also work a little part-time on the side at an ER across town, and between the two, find the experience invaluable. It's cool, because I find myself being seen as a resource at both places. In the PICU, often for bigger patients and trauma, and in the ER for the Peds patients. In my humble opinion - grab the PICU first, get yourself well settled there with a year or so under your belt, and then try some ER on the side. It'll make you a better nurse all the way around.

You might also find the same as many of us have - we'd rather be around kids than adults ANY day LOL!!!

Good luck!

Joe