Inspiring stories

Pediatric Critical Care Columnist · Mar 17, 2007

I'm going to echo what KellieNurse06 said. I've been the parent of a PICU frequent flyer and am in my 10th year of working in PICU. The new staff who recognize that they don't know everything are the ones I have to greatest respect for. I have a couple of pearls I pass on to my preceptees: 1) The only stupid question is the one you don't ask, and 2) take responsibility for your own education needs. Ask to help with difficult dressing change, ask to watch a new procedure a couple of times so you know what your role will be, ask to help with a challenging admission. You're there to learn how to be the best PICU nurse you can be, not to do somebody else's work; you can't allow yourself to be stuck in a rut with a million patient care tasks you're already proficient at when you could be soaking up new stuff. Use your resources... all of them: the other nurses, the clinical instructor, the physicians, the respiratory therapists, the pharmacist, the dietician, the nursing assistant, and most especially THE PARENTS!! They may not know much about critical care but they know that child! Involving them in care is also extremely important. There is always something a parent can do for their child, no matter how sick the child is, even if it's just washing face and hands a couple of times a shift.

You have the right attitude for a new PICU nurse and that will take you far. Please do keep us updated!

KellieNurse06 · Mar 17, 2007

Jan you are awesome! You are so right! 10 years, huh? Good for you!

When ever my daughter was inpatient ( only can go to PICU due to her vent regardless of what illness it is), I'd do tons of stuff that I could of just let the nurses do...I would suction her trach & mouth, change her briefs, wash up, do mouth care, do chest pt.....all of it ( & this was even before I went to nursing school)..except of course the obvious things no one but the nurse could do like meds,...unless of course they handed them to me & watched me give them........I really think they appreciated it when they were swamped.....and I'd even mark the time on a brief I changed, or tell them I flushed the feeding tube with xx amount of water..............and I always made sure they didn't mind first.......none of which did (I think) because they knew us so well....

How do you feel about parents doing those things???? Seeing you as well are on both sides of the coin??? I always wondered if they really minded but didn't want to offend me...... they seemed to be ok with it.......and I'm sure they would of said so if it wasn't ok.

I also never hounded the nurses with questions about every little thing they were doing....like some who can be a nightmare parent....maybe because I am so adapted to it after dealing with it for so long....I don't know......I would love to get into PICU nursing....that would be my ideal job right now...

AliRae · Mar 17, 2007

How do you feel about parents doing those things????

We have a large population that we call "our kids" ... frequent fliers for one reason or another, most trached, many vent dependent. One of the very first things I learned was to listen to their parents. I actually got in a fight with the attending on my first day off orientation because mom and I agreed that "something wasn't right." If you're the kind of PICU parent I think you are, we love you. We have some kiddos who would not be alive but for their parents. I've been taking care of one guy recently who's the oldest living case in the WORLD of the syndrome he has ... by about 5 or 6 years! And I'm firmly convinced that it's because his mother loves him and cares for him the way she does.

That being said, there are some parents who are not such pearls. I admitted one such family recently, and they were physically pushing me away from their baby as I tried to get the CPAP on. I would go into the room when he desatted to find that they had turned the O2 right down because "it would hurt his eyes." (NICU grads) We eventually had a l - o -n - g chat and they began to let me do what I needed to do. If you get to the point that you're constantly clashing with your nurse, take a step back and see what's going on. Otherwise, you're my dream parent. =)

Pediatric Critical Care Columnist · Mar 17, 2007

Kellie, you would have SO much to offer to PICU! Go for it! But be prepared for the inevitable "What would you do if your child is admitted?" question, because it will come up. You'll have to be definite in your professionalism when you respond. It's hard to separate the nurse from the mom (and the mom from the nurse!) sometimes. Resist the temptation to try to "organize" her care: we don't let other parents choose who will be their child's nurse and we shouldn't allow staff to make that decision either. (This situation has come up in our unit and it created a LOT of issues!!!!) Your coworkers will make every effort to be fair and reasonable. And make it clear that when she's in the unit, you are her mom, not a nurse... don't get into the trap of taking over. You're not going to be legally covered for any nursing tasks you do while in hospital so you need to stick to what you'd normally do.

How do I feel about letting parents do for their child? I encourage it. I've been heard saying, "You were changing his diapers before he got sick and you'll be changing them again when he's better. If I show you how to do it here so that he's safe and you're comfortable, then there's no reason why you can't do it here too." I have a sense of which parents really want to do things and which would rather let me do it all. I never push anyone to do something they aren't comfortable with, unless it's one of those new facts of life, like enoxaparin injections, trach care, ostomy care, GT feeds, you know what I mean. Then it's more a case of demonstrating and teaching today, getting them to do part of it tomorrow, talking them through it, then working on getting them competently doing it on their own.

There are those nurses who are very territorial about "their" patients. And they are often convinced that no one can do their job better than they can. It's almost an "I'm the nurse, I'll decide" mentality. Nothing is going to change them; parents who actually do know what they're doing scare them senseless, and they go on the defensive. It's just better that they not be assigned those kids.

Last night I came very close to decking a nurse with about 30 years of experience. We have a teenager who came in with severe asphyxia a month ago who is in a vegetative state and is very hypertonic and spastic. This nurse asked for my help to reposition the patient. We got the kid boosted up in bed, limbs supported and all that, then I looked across the bed and she's trying to force the kid's very rigid right arm into a bent-elbow orthosis. I had already applied the left hand resting splint with no trouble. But this nurse didn't seem to realize that when you touch a kid like this, they stiffen and posture, and that repeatedly trying to make them do something only makes it worse. I finally said to her, "May I show you how to make that easier to get on?" It's all about patience (she has none) and calmness (ditto); if you hold the limb firmly and don't move it around but just wait, the spasticity passes. Then you can gently and firmly position the limb the way you want it by sliding the orthosis onto the limb, not jamming the limb into the orthosis, and get the straps on before they've noticed what you've done. I had to repeat the lesson with the AFOs, because of course the second she grabbed the kid's foot, whoops, rigid plantar extension. "Here, try bending the knee and just holding the foot firmly and gently, see how it relaxes and you can slide it right in to the heel of the AFO? Isn't that easier than trying to force it?" I doubt the lesson will stick, but I had to try...

KellieNurse06 · Mar 18, 2007

(((Ali)))) awwww you are so sweet!!! Thanks!!!

Wow Jan...I can tell you really are awesome & one of those who "get it" lol. Speaking of those nurses you mention...who have the "I'm the nurse" mentality....omg..there is one on the unit my daughter goes to...who is exactly like that! I almost spit my coffee out because when I saw that, I saw her...lol! You know how patients are on precautions sometimes.....well one time my daughter was on precautions and this one nurse had her this time....now they never have me gown up because I am around her 24/7.... one of them told me it's more for the nurses/docs due to going patient to patient( unless they are mistaken) & cross contamination.....well you know..why am I telling you???....lol...She actually told me I was not not going in there until I gown/mask/glove up, and this was her coming onto 2nd shift, we were there all day,had gone to eat & came back up just as shift was changing (no gowning/gloving/masking all day)...and my mom was so taken aback..she said to her.."you know this is her mother, right?"..she actually said yes.......and still told me to put the garb on.......now all the other staff up there told me because I am around her 24/7 & not going around other patients that it was ok for me to not garb up...just wash my hands extra well etc.

She also is one that gets all paranoid & questions every stinking little thing I do.......& will stand there & watch me. & is very condescending when talking to me.....lol...one of my daughters home care nurses who even has encountered her up there said she probably needs to......well I won't go into details. but you probably know what I was going to say...lol!

And the nurses up there have been there as long as I can remember......so they know us very very well...and one like you mentioned about knowing the patients/ parents well....my daughter got a fracture while in there, not good; but thankfully happened in there...what a nightmare that would of been trying to explain... (she has very brittle bones, proven medically) she had argued with one of the docs to get an xray because she knew something just wasn't right, pain, restless & uncomfortable & no one could tell why.... and I practically kissed her feet....she argued for an xray because she new something just wasn't right......and lo & behold......fracture.......they figure it happened from turning her .......anyway, it's nurses like her that I trust my childs life with because because they know these kids so well after having them for so long........ and I can see you are one of those nurses........I have the utmost respect for those nurses....

If my daughter ever was admitted if I were to work there....I would never try to do anything but be the mom.....except of course if I thought something wasn't being done that should be.....other than that.....the plus is I could be working and see her....lol...... Maybe that's why they haven't called me....conflict of patient/employee??? oh well............ Anyways thanks for the insight!!! I learned alot of great info from "the inside" lol!

Pediatric Critical Care Columnist · Mar 18, 2007

If my daughter ever was admitted if I were to work there....I would never try to do anything but be the mom.....except of course if I thought something wasn't being done that should be.....other than that.....the plus is I could be working and see her....lol...... Maybe that's why they haven't called me....conflict of patient/employee???

As long as you can just be her mom and do the things you'd have done anyway, anywhere, that should be fine. (Like pointing out those little things that sometimes get overlooked, or suggesting an easier way to do something that you'd done a gazillion times!) You might find that management will ask you to take family sick time if your girl is admitted. That way no one will be able to point fingers or talk about you behind your back. It will happen, trust me.

I would guess that you have some kind of relationship with the management there already, since your girl has been there frequently. Maybe you could ask for a meeting where you can express your understanding of professional boundaries, your willingness to revert to Mom-mode when she's there and your desire to help other families in the way that yours has been helped. They might see that positively and give you a second look for hire. It certainly can't hurt! As I always say to my daughter, "What's the worst that can happen?" You still don't get the job? Nothing ventured, nothing gained. Good luck! I'm rooting for you.

8great · May 12, 2007

Good luck! Hope you have some solid way of taking care of yourself. These are all great stories, soon you'll have your own. I worked in the OKC bombing, in the PICU...............as much as that was in the news, it might have seemed easy to forget that those kind of patients/ miracles/heart breaks happen everyday in the PICU. It's an amazing place to be.

AliRae · May 12, 2007

I have another one to add!

Over the summer, while we were on strike, a kid came in following a horrific MVA. Thankfully the only really sick kid that needed to be admitted while we were out, and there were enough HNs to take care of him properly until we came back. He was a train wreck. Quickly got trached, vent dependent and we pretty much wrote him off. He went to a rehab hospital where they actually weaned him to trach collar. Unfortunately, he went into respiratory arrest there, coded, and came back. What little he had been able to do was totally gone. We stabilized him, dealt with some pressing issues and sent him to another rehab hospital, where we figured he would stay for a l o n g time.

Just the other day, he wheeled his motorized chair onto the unit, followed by his beaming mother. His smile was enormous as he explained to us that he didn't remember any of us, but he wanted to thank us for saving his life. That's right- he's awake, smiling, decannulated and talking, walking with parallel bars and they have hopes that he still might make it out of the chair some day. We paged everyone we could think of, and the hall was packed with people coming to see him and hug his mother. Not a dry eye in the place, and none of us could stop smiling for the rest of the day.

Goes to show ... you really have to give those TBIs their full year before you start thinking they're not going to get better!

DoubleblessedRN, ADN, RN, EMT-B, EMT-P · May 15, 2007

I'd like to tell a story of my own. I'm not a nurse (yet) but I'm a paramedic and I have some very basic knowledge of critical care. (Not so much peds, though.) When my daughter was 7 weeks old she went into septic shock. She was born at 34 weeks gestation, so she was really only a one week old full term. She was admitted to the PICU in the early afternoon and intubated. Towards evening, her HR and O2 sat would decrease when she was being touched or handled. A couple hours, later, her BP dropped, and I heard the Dr (who was a fellow at that time) order dopamine. That's when it really sunk in and I exclaimed "Oh my God, she's going to die!" The look on the nurse's face was priceless. She didn't say anything but looked like she wanted to say "I don't know what to tell you 'cuz you're probably right." In the very early morning hours she stabilized, but ended up with an embolus from the central line, which had to be surgically removed later that day. Nearly 48 hours later, she was extubated, but took a couple of steps back and was intubated again. A day later they tried again with success. She was then sent to the med surg floor and was hospitalized for 14 days. They wanted her to have a 14 day course of IV antibiotics because of the severity of her condition. All she had left were scalp veins, the were unable to locate venous access for a PICC line. 13 months later, we took her to the hospital out patient for a vascular follow up. I went to the PICU and saw one of the nurses AND the Dr. He was soooo happy to see her and to know that she was fine. And I'm glad I saw him when I did because his fellowship was ending in a couple of weeks and he found an attending position at a hospital an hour away.

Kellie, you are so right when you tell others not to judge, especially by how often or not so often the parent(s) visit. When my daughter was transferred to the med/surg unit, the nurse asked if I could stay (basically at all hours) with my daughter. As much as I wanted to, I couldn't always be there because I had to take care of her twin brother, and only one visitor was allowed overnight. My husband had just returned to work from a 4 week FMLA, and our parents don't live nearby. When I stated I couldn't, she didn't say anything but gave somewhat of a disapproving look.

To all of you PICU nurses out here, I have the utmost respect for you all...I could work critical care, but not peds or neonates. I'm not ashamed to admit they scare me. They're definitely an entity of their own, and they're smarter than we think. They have built in s*** detectors! :lol2: