PICU Nursing: How long would you....

studentLVN · Jul 18, 2016

What additional training is beneficial for me to take to be pediatric patient, where could I obtain this training and is it available for me as a vocational nurse

**NICU Guy, BSN, RN** · Jul 18, 2016

How long would you suggest waiting before making the big switch to PICU nursing? I currently work in an adult ICU, and have been there for six months. It is my first job as a nurse. I love my job and am so grateful for it, but would love to eventually make my way into a children's ICU. I feel that that is where I would ultimately like to be. I feel I have so much to learn where I'm at, but it's easy for me to wish for the days when I will be in a pediatric setting and was wondering how long y'all would suggest someone is a nurse before moving into such an acute setting with such critical children.
Also, do you have any advice for a nurse aspiring to someday move into pediatric critical care? What is one thing you wish you had known?

The only way to guarantee that you won't get a PICU job is to not apply. They may want 1-2 yrs experience but there is no harm applying. I would start now.

meanmaryjean, DNP, RN · Jul 18, 2016

I would recommend getting a year or two of adult ICU under your belt before making the switch. You will become proficient in that time period, and develop a deeper understanding of critical care and the nuances thereof. PICU is the most difficult specialty I practiced in my career (39 years adult/ neo/ and peds ICUs) and a good foundation in critical care can only serve you well.

Most of the adult ICU nurses who came to PICU did very well, not so much the NICU transfers.

ThePrincessBride, MSN, RN, NP · Jul 18, 2016

Most of the adult ICU nurses who came to PICU did very well, not so much the NICU transfers.

Curious...why do you think that is the case?

Pediatric Critical Care Columnist · Jul 19, 2016

There are only a small number of typical patient problems seen in NICUs. Their patients are all very small, their focus is much narrower and they're even more OCD than most ICU nurses. That's only my observation; my PICU recovers neonates post cardiac surgery and once they're stable we send them back to NICU so I have a bit of background there. I've also worked in both areas. For example, a while back we took a babe from our NICU who was critically ill and was likely going to require ECMO. The baby was slightly premature and slightly LBW. We had a limited number of options as to which bed we admitted the baby to due to the potential for needing to have room for an ECMO circuit, probably a CRRT circuit, ventilator, 20+ IV pumps, 2 staff members and all the rest of the accoutrements this baby was likely to need. The NICU staff were appalled with where the baby was situated on the unit because we weren't going to be able to provide developmentally-supportive care (minimal handling, dark environment, minimal noise, flexed and supported position etc). Our concern was keeping the baby alive. We failed.

Most PICU patients have more in common with adult ICU patients than they do with NICU patients. We use a lot of the same drugs (although doses are very different), we see a lot of the same reasons for admission, we have a lot of the same equipment and our focus is always life over limb. Between peds and adults, critical care is critical care. So nurses who have experience in adult critical care come with a lot of very essential skills; their knowledge gaps are straight-forward - norms for vital signs, typical drug doses, growth-and-development and family-centered care. NICU is a very specific and relatively narrow specialty. PICU nurses have the broadest scope of practice of any nurse out there; I wouldn't hesitate to say it's broader even than ED nursing. That's what informs my opinion.

BeenThere2012, ASN, RN · Jul 19, 2016

I agree with another who said a good.foundation of adult ICU will serve you well. It really is different though in a lot of ways. Practice drug calculations and getting used to standard dosing by kg. Also, take a PALS course. You will learn a bit more about the types of codes and causes as well as the protocols and algorithms.

Also, you will have a lot more interaction with parents of the patient's and their wishes/opinions on how to work with their child. Sometimes you spend as much time with them as you do the patient. As opposed to explaining what you are doing with the patient, you are explaining.to.the parent and often the patient as well. You will need to understand stages of development and ways to effectively communicate with children of different ages. This is what I thought of off the top of my head.

The most important thing you should.do is to find a great place to work that will give you a comprehensive orientation.

BeenThere2012, ASN, RN · Jul 19, 2016

There are only a small number of typical patient problems seen in NICUs. Their patients are all very small, their focus is much narrower and they're even more OCD than most ICU nurses. That's only my observation; my PICU recovers neonates post cardiac surgery and once they're stable we send them back to NICU so I have a bit of background there. I've also worked in both areas. For example, a while back we took a babe from our NICU who was critically ill and was likely going to require ECMO. The baby was slightly premature and slightly LBW. We had a limited number of options as to which bed we admitted the baby to due to the potential for needing to have room for an ECMO circuit, probably a CRRT circuit, ventilator, 20+ IV pumps, 2 staff members and all the rest of the accoutrements this baby was likely to need. The NICU staff were appalled with where the baby was situated on the unit because we weren't going to be able to provide developmentally-supportive care (minimal handling, dark environment, minimal noise, flexed and supported position etc). Our concern was keeping the baby alive. We failed.
Most PICU patients have more in common with adult ICU patients than they do with NICU patients. We use a lot of the same drugs (although doses are very different), we see a lot of the same reasons for admission, we have a lot of the same equipment and our focus is always life over limb. Between peds and adults, critical care is critical care. So nurses who have experience in adult critical care come with a lot of very essential skills; their knowledge gaps are straight-forward - norms for vital signs, typical drug doses, growth-and-development and family-centered care. NICU is a very specific and relatively narrow specialty. PICU nurses have the broadest scope of practice of any nurse out there; I wouldn't hesitate to say it's broader even than ED nursing. That's what informs my opinion.

As a PICU nurse with some NICU experience, I feel you described it well and agree with your answer. OP can trust this advice.

llg, PhD, RN · Jul 19, 2016

I read somewhere that "there is more physiological difference between a 25 weeker and a full term baby than there is between a 3-year-old and an adult." I believe it.

NICU nurses are preemie experts and can also take care of full term infants having problems with the transition to extra-uterine life. But they are not experts in the care of older babies/children. PICU nurses are experts in the care of children (including full term babies with problems not directly related to transition).

Also, the historical development of NICU's and PICU's are totally different -- with PICU's following more or less the same pathways as adult ICU's and NICU's being different. (NICU's were established by nurses over 100 years ago to provide nursing care back in the days when doctors had little to offer preemies. They were nursing focused. Doctors were not even allowed to enter some NICUs. Parents weren't either.)

I agree with the posters above.

llg -- old, former NICU nurse with a special interest in nursing history and culture

offlabel · Jul 19, 2016

I did it as a new grad BSN with several other people and everyone did extremely well. Exceptional unit with excellent preceptorship.

HazelLPN, LPN · Jul 19, 2016

I worked in adult ICU for 30 years before becoming a PICU nurse. If I would have had to do it all over again I would have done peds from the start. Both my body and my morale were burnt out from years in the MICU. Adult ICU is very hard on your body, and you don't think of that when you are young. When you are in your 40s-50s it comes to get you. My knee, in particular, had to be replaced from dealing with such large patients, many of them obese/morbidly obese with chronic conditions where they will never recover. In the end, I felt like I was prolonging the lives of the suffering while destroying my own body in the process.

When I started working in PICU and phasing out working in the MICU, I found a whole new love for nursing that I had lost. Kids are tougher than adults, and it amazed me how quickly and more completely they recover than most adults. It was also easier on my aging body....I was pushing 60 at the time (oh to be 60 again....oh to be 70 again....)

I did NICU too and it was a nice change of pace from time to time. I was comfortable with two stable vents or three feeder/growers. The micropremies and the complex chronics needed a real NICU nurse...not an adventurous PICU nurse picking up extra hours. I certainly wouldn't have wanted to work over there full time because I enjoy the great variety of patients that you see in the PICU.

My advise? Apply tomorrow. Your mind and body will thank you!

Best to you,

Mrs H.

ThePrincessBride, MSN, RN, NP · Jul 19, 2016

I definitely agree that NICU is very narrow and I know some NICU-only nurses who've gone to school for fnp but have had a hard time getting jobs because they lack adult experience.

PICU is definitely a unique place with the most variety possible.