PICU / NICU: do you need thick skin?

[texaszeus]

Hullo,

First post, so please be kind. I am just wondering how NICU and PICU nurses do it - maintain calmness and professionalism, that is. As someone that will be starting their nursing education soon (2-year BN after degree), I am trying to envision my future, and I am feeling SO drawn to working with either babies or children. I already teach infant massage and work in a holistic center that specializes in maternal care.

My biggest fear, though, is that I won't be able to remove myself emotionally enough from the "sick kid" aspect of it to be a good PICU / NICU nurse. Do you have to be thick-skinned to work on sick kid units?? Is there a level of detachment that must take place?

This is going to sound bizarre, but I have been watching YouTube videos of stillbirth experiences and eulogies for dead kids, trying to determine if I have the *METTLE* to go into this field of nursing. And so far, I have been bawling my eyes out!!! Is that a bad sign?

Can you imagine, as a parent, talking to me, the nurse, and all of a sudden, the nurse starts bawling her eyes out because she can't remove herself enough from the situation!! Yikes, that would not be very reassuring at all!! That is my biggest fear! How do you keep these emotions in check at times when the situation is stressful or the news is really bad or the kid in the bed reminds you of your own kid, etc...

I welcome your thoughts on this, if anyone is willing to share...

[NotReady4PrimeTime, RN]

Hmm. How to answer that... I've worked neonatal and PICU my whole career. I don't have any problems maintaining my cool at all, but then my personality is such that I can be calm and rational in even the most emergent of situations. I often tell parents about all the nuisance alarms we see in our work, and that if I don't look worried or upset by an alarm then they shouldn't be worried or upset. But I don't tell them that they're not likely to EVER see me worried or upset because I can keep it hidden. That's not to say that I haven't shed a tear at work, because I definitely have. There's nothing wrong with feeling, as long as your feelings aren't the main focus. Your mention of watching the YouTube videos is not a good reflection of how you would cope in a stressful resuscitation situation, only how you react when a child is already dead.

I have been a PICU parent; it was a long time ago now, but there are some parts of that experience that I remember as if it were yesterday. My child survived but with severe sequelae; there will never be a day when this child (in an adult's body) will not need help with every aspect of daily life, but I have nothing but the deepest love in my heart. Having siad that, there has only been one time in my career that I've ever "seen" my own child in the bed. It was a very sad day fr me already beause my patient had been determined to be unsalvageable; the young person in the next bed had had life-sustaining therapies withdrawn and this was the first look at an unobstructed face that I'd gotten of this child. Suddenly I could see my own child; the facial similarities were very strong, at least on brief glance. I choked up and had to leave the unit. My charge nurse was very understanding and just let me go. But you know, I didn't cry. I just needed to breathe and to think. Then I was okay and I finished the shift.

Every person handles these kinds of stressors in their own way. Before you decide that you're not going to be able to handle it, maybe you should ask if you can tour a PICU to get a feel for the environment. And you should bear in mind that most PICUs have a very good track record. Our unit has only about a 3% mortality rate, and the vast majority of our patients get better, go home and never look back. That's what keeps us doing what we do.

[beckibritt]

I can only speak for myself, but when I'm working with a preemie or sick infant, my emotions are the last thing evident. I'm concentrating on what needs to be done and in what order, processing the orders (if someone is there giving them.) Sometimes, after all is said and done, I might have strong emotions, but only after my work is done. While I'm working, I'm working.

You might surprise yourself. While I'm the first to admit that I'm very emotional in other areas of my life, it's just not the same at work.

[texaszeus]

Well, I'm hoping some practical experience might sort me out and enlighten me as to how I might make out on these units. I really hope to gain some clinical time during my studies in these areas and go from there.

I agree that I might feel different when I am actually doing the work. Thanks for the advice.

Hopefully, I have what it takes!!