PICU interview

Always rule number one in pediatrics: Airway, airway, airway! Something else I learned quickly was, always listen to the parents--if a parent says, "He/she just doesn't look/isn't acting right," prepare for an immediate intervention or call to the doctor--mom and dad are rarely wrong about that.

I don't know about pedi cardiac ICU in particular-I did general peds, sub-acute (vents, trachs, and G-tubes, mostly), and PICU for 13 or 14 years (I've lost count!). I remember being asked, when interviewing for a position in a major university hospital's pedi unit, Tell us about a situation in which you wish you had done something differently(I wished I had been more aggressive and proactive in pushing for earlier interventions, like intubation and vasopressors, for a toddler with meningococcemia, instead of waiting until she crashed), as well as, Tell us about a situation you think you handled badly, why, and what you would do differently today (In my first year of nursing, I had a father worrying that his infant son was breathing funny--I went in, looked at the baby, assessed him, and told Dad, "He's fine," which didn't quell his fears and led him to complain to my boss, especially after the next nurse handled it so much better {She basically said, Well, yes, he is breathing a little unevenly-maybe if you reposition him he'll be able to breathe more comfortably; Dad did just that and was happy with the results}. Lesson learned-never dismiss a parent's fears and always, if you possibly can, give the parent something positive to do--it keeps them from feeling helpless, which parents usually can't stand.)

Which brings me to teaching, which is so important in pediatrics-you need to be prepared to teach your patient and the family, who are almost always present. The monitors and equipment of any ICU are especially stress-producing for some parents, and you may have to spend a lot of time explaining what everything is, what the alarms mean, and, again, what parents can do to help. Parents may wish to hold their children, or climb in bed with them, and this is usually encouraged and facilitated (if the child's condition is reasonably stable) rather than denied as it would be in an adult unit; an applicant who understood the importance of teaching, the role of the family, and the fact that pediatric nursing is really family nursing would stand out for me if I were interviewing candidates for a PICU position.

Something to keep in mind, too, is how your experience will translate to pediatrics. Several years of med-surg gives you a nice, broad, and thorough background in nursing-you've probably seen all kinds of things and done all kinds of procedures; you've had to handle emergencies and interpersonal conflicts (difficult patients or family members) and care for patients of all different ages (teenagers to the elderly). Pediatrics can cover ages birth to 21, in some areas, so you're accustomed to that; and difficult people show up everywhere--because the family is so ever-present and so important in pediatrics, you need to be able to handle problem people and defuse tense situations. Pediatric emergencies can be especially harrowing for some people--the key is to prevent them from happening in the first place. Cardiac ICU may be a little different, but kids in general don't look and feel fine one minute and fall out in V-fib the next--you can usually see a kiddie crash coming , you just need to learn the signs; look at trends, rather than any isolated number, and always--airway, airway, airway!

Best of luck to you, and hope some of that helps!

That was absolutely wonderful. Thank you so much for the response.