Switch from adult to pediatric ICU?

RNNPICU, BSN, RN · Apr 30, 2007

CamilleL: I have only done Peds ICU, but I know that one BIG difference is that in Peds, everything is mg/kg, mcg/kg, etc. Everything is weight based. Weight is the big thing, it is important to know the weight of the patient. Also, knowing the age, because of the developmental stages, if they are not delayed, is important. The kids are not little adults. If you go to an all childrens hopsital, you will have everything customised to children. But if I can leave you with one thing, knowing the weight, and how to calculate safe ranges for the meds is the most imiportant, in my opinion.

Clg03280 · May 2, 2007

I worked in an adult SICU for 4 years and then did PICU and never wanted to go back to adults. I love PICU. It is either for you or not for you.

nursenpnk, RN · May 11, 2007

I am getting ready to change from an adult MSICU to a PICU and I know the one thing I have already been warned about, at least in my particular area, is the difference in autonomy that nurses have in the adult world as opposed to the peds world. For the safety of children, the amount of interventions and med titrating that can be done without a doctor's order is more restricted.

Pediatric Critical Care Columnist · May 11, 2007

True to a point. Where I work we have a fair degree of autonomy, after we've proved we can handle it! :uhoh21: But you're right that kids are a different kettle of fish and even small misjudgments can be huge problems. One needs to understand the effects, both intended and incidental, of what they propose to do, and that takes time and experience. I've been around long enough to know what I can do without consulting the physician and what I can't. Most of the time I get the doc to write me orders to cover a number of potentials, so that I don't have to track them down when the expected arises, and then I just do my job. This is especially the case on nights. The residents aren't always keen on doing it, but our fellows and attendings don't hesitate.

RNNPICU, BSN, RN · May 15, 2007

At the PICU were I work, we have a lot of autonomy. We can titrate our sedation meds by our protocol, wothout having a new MD order we need to go up, also the drips such as Dopa, epi, norepi, vasopressin, etc, we have ranges for the goal, and we titrate accordingly. There is a lot of autonomy. Of course, we know that everything is mg or mcg/kg. The weight is important.

CarpeDiemRN · May 18, 2007

i have not personally made the switch from adult to picu, but have spoken to several nurses on our unit who have done this- successfully, and unsuccessfully. those who didn't like it, came to the picu pretty much expecting to do the same job just with smaller patients. those who made it, recognized and embraced the higher level of checks/double checks/protocols as a nice safety net when you are working with such tiny little patients. in the picu there isn't just one "adult dose" (excluding the larger adolescents)- each patient has their own dose based on their weight... calculations are more prevalent, checks and double checks are in place everywhere. i think if you equate a higher level of detail with "lack of autonomy", then the switch can be difficult. i think those that stick around long enough to see how quickly a child can crash, or how a small variation in a med can affect them, come to understand why things are the way they are in the picu.

to know if you will like the transition, i think it would be important to look at your motivation for the move. once you begin to master the technical/detailed nature of nursing in the picu and become comfortable dealing with the heightened emotional level of families, etc. it is a very rewarding place to work. good luck!

JennieJenRN · May 23, 2007

i did it!! and have loved every minute of it. i worked adults for years and my friend finally got through to me and i switched. i had an adult patient the other day and can not believe i did not make the switch sooner:lol2: !!