advice requested= track to PICU

[jopadeevra]

Hi all,

I am a nursing student about to enter my last semester :) !!! I feel a calling to work in peds, and I think specifically PICU. I'm looking for advice in which direction I should go initially after gradutaion to give me the best knowledge base to carry me into the PICU. I currently work in the Emergency Room Admitting Department at my local children's hospital. Sometimes I think that (ER) would be a good place to start , but other times I don't because of so many run of the mill (sore throats, minor lacs, ect.) cases. Maybe peds med/surg? Any input would be appreciated. Also, any words of wisdom from PICU nurses regarding not becoming too emotionally involved in cases is greatly appreciated. Does it get 'easier' over time? I am not an overly emotional person in the first place, but we recently had a patient at our hospital that was heart-breaking. I know the best gift a nurse can give is compassionate care, but how does it not chip away at your soul?

Sorry so solemn, but thanks!

Paula

[malenurse82]

I had 2 weird questions in an interview for a PICU job.

the first question was:

Give an example of an event or instance where you found that policy was inconvinient and you decided to not follow policy.

Ok, I get the essence of the question: I think its related to critical thinking and making autonomous/ patient specific decisions.

However, I couldnt really come up with anything specific to say, it really blocked me and I had to ask to skip it to come back to it. Perhaps this is because im fairly new to nursing (graduated last fall, started working 6 months ago). Us new grads we are always so adament to following policy and, in nursing like anything else in life, rules can be broken only after following them for some time.... no?

the second was:

Give an example of a time where you had to make a decision without consulting your nursing manager / charge nurse / facilitator...?

Ummm... I make most of my decisions in a day to day basis without consulting... I dont really know what the objective of this question was.

I dont think these were fair questions to ask a new grad (like me)...

any thoughts?

[sergel02, BSN]

3. In your interview they will ask you a few scenario-based questions. One of the questions I got in my interview for the job I'm in now was about an 8 year old who had been in a bike-vs-car MVC who was coming in with a suspected closed head injury. What would I do to get ready for the patient's arrival? What would my nursing care priorities be in the first hour after admission? What are some signs of increasing intracranial pressure? What are the safety issues around use of mannitol? Things like that. Another sure thing is that they'll be assessing your ability to prioritize. So they'll give you another scenario: you're temporarily in charge of the unit; the patient in Bed 3 has just been admitted following cardiac surgery and his blood pressure is falling. The patient is Bed 5 is having a seizure, has an airway and sats in the 90's. The infant in Bed 9 has just extubated herself with her toes and is blue and bradycardic. And the nurse caring for the patient in Bed 14 is looking for someone to check her choral hydrate dose. What do you do first?

I know this mighy be old, but im curious about the bed question. Would the correct order be bed 9, 5, 3, then bed 14 last?

[NotReady4PrimeTime, RN]

I'd go Bed 9, Bed 3, Bed 5 and Bed 14. The reason why I'd attend to bed 3 before Bed 5 is that post-op cardiac surgical patients often have hypotension shortly after admission and the usual measures (liver squeeze, stimulation, increasing pressor support) fail with some regularity. Even giving a fluid bolus to these kids can be dangerous, depending on their underlying cardiac anomalies (most of the ones you'll have challenges with are going to have multiple anomalies) and how stunned their myocardium is. They don't need to be severely hypotensive to arrest either. So this would be more critical than attending to a child with a secure airway and good saturations who is seizing.

[sergel02, BSN]

I'd go Bed 9, Bed 3, Bed 5 and Bed 14. The reason why I'd attend to bed 3 before Bed 5 is that post-op cardiac surgical patients often have hypotension shortly after admission and the usual measures (liver squeeze, stimulation, increasing pressor support) fail with some regularity. Even giving a fluid bolus to these kids can be dangerous, depending on their underlying cardiac anomalies (most of the ones you'll have challenges with are going to have multiple anomalies) and how stunned their myocardium is. They don't need to be severely hypotensive to arrest either. So this would be more critical than attending to a child with a secure airway and good saturations who is seizing.

Thanks for the insight. I was debating between 5 and 3, the other two I felt pretty sure about. I think it's partly because I don't really know the signs of seizures or how to treat them yet.

I feel like I'm learning so much from you!

[abaker6]

I been reading this post and it has defitnely answers some of my questions about picu. I am very devoted to kids and want to help in the process of getting them better! I love how all you nurses join as a team for one main cause. I have apply to Memorial Hermann and I will be applying to Texas children as well hopefully I can be a part of you guys team soon!