PICU or Pediatric Oncology

toomanypants · Apr 6, 2016

Hi! While I do not have RN experience in the pediatric heme/onc unit, I was a nursing assistant.

What I know for sure about parents is that 99% of the time, our kids have a family member present 24/7. I know you are asking about comparisons to the PICU, but compared to the other med-surg floors, onc parents are involved and dedicated. They really made my job easy, emotionally and physically. But it really depends on your hospital demographics and who you serve.

Maybe some RNs can chime in and add to this thread. I've always been interested in both of these settings, as many onc kids get sent back and forth from PICU.

Pediatric Critical Care Columnist · Apr 6, 2016

It's been quite a few years since I worked peds oncology, but as toomanypants, BSN, RN said in the previous post, oncology parents are about the most educated and involved of any parent group I've ever come across. They're totally in the know when it comes to protocols, timing of treatments and follow-ups, side effects and how to interact with their child. For some nurses that's like a gift, for others it can be more of a curse. It depends on your nursing style.

In PICU there will be a proportion of parents who are also very educated and experienced in caring for their children with chronic health conditions - they're actually experts in that particular child. You'll run into parents who want to know and understand everything about the both clinical condition and care of their child, and others who are happy only to know the high points. Some parents will be very willing to help with personal care and some who run in the other direction. On both units there will be some parents who aren't present much of the time and others who never seem to leave. There will be those parents who scrutinize your every move and correct you if you're not doing whatever it is the way they're used to it being done.

The risk of radiation exposure in PICU is real, but it's mitigated by the use of lead aprons and neck protection (these days... not when I first started in PICU, which may be a contributing factor to my current situation...). Cytotoxic medications and bodily wastes of persons receiving them must be handled carefully and with appropriate PPE, but there's no reason to be terrified of them. With proper training you'll be very safe.

There will be children who die on both units, fortunately not that many. But there will be some. Deaths on the oncology unit tend to be a little gentler and the families somewhat better prepared than those in PICU. The pace can also be different. You may have more patients on the oncology unit but be less busy than in PICU... if that makes sense. I've had PICU shifts where I don't sit down for even a few minutes and do my charting on my feet, when I look at the clock and am shocked to find there's only half an hour left in the shift - with a single patient. Other times it's more of an intensive monitoring situation than an intensive caring situation. But no two days are ever exactly alike, even with the same assignment. That's something you may want to consider.

Best wishes with whatever you choose.

cwazycupcakes · Apr 7, 2016

Thanks for your insight.

Is oncology generally the same? Or is there enough variety with different protocols and stages in the disease. I really like central line care and figuring out IV compatibilities. And it sounds like the team environment is stronger in oncology. And the partnership with the parents sound great. According to the staff I spoke to, a lot of their patients come back to the unit once healthy. On my current unit I do enjoy the patients who are long-term.

That being said I also like variety and like it when my assignments get switched up so I can learn different things. I am leaning towards PICU. At first I was worried about not having interactive patients but the staff told me they get about 75/25 mix of intubated/ventilated and non-ventilated patients.

I guess I am trying to figure out what I would like more. What were your favorite parts of oncology and PICU and what were your least favorite parts? Or to anticipate the negatives to both ahead of time in order to make an informed decision.

Pediatric Critical Care Columnist · Apr 7, 2016

Teamwork is essential in both disciplines. I think it's a little less visible in oncology; the physicians round and write orders and then sort of fade away. Social work, child life and chaplaincy tend to be active but aren't directly involved with nursing. When things go sideways on the oncology floor, it's PICU that provides support and intervention. Our rapid response team is called to our oncology floor fairly regularly. In PICU there is typically a very visible physician around most of the time, especially in a teaching hospital. Social work, child life and chaplaincy seek out feedback from nursing on what's needed for the family and will often share their conversations with parents to help the nurse provide more holistic care. And when the feces meets with the oscillating ventilation device, everyone turns out to help.

I'd say that although there's a significant variety of types of oncologic disease and a wide variety of treatment options, there's also an element of routine with it. Kids are admitted for some types of treatment and have others as out-patients. Some of them will have long-term tunneled central lines, others will have implanted ports and yet others will have only peripheral access. When my son was an oncology patient he never had a central line... 3 1/2 years of oral and peripheral chemo plus radiation, all of it as an out-patient. His only admissions were for infections. Kids with brain tumors may have external ventricular drains but typically those aren't pressure-monitored outside the PICU, they're only for draining CSF. I have a lot of trouble with emesis - when they're doing it I have a hard time not joining them. So that was one factor that led me away from pursuing oncology in the long term.

PICU gets a broad range of illness and injury. Virtually all of the patients I've cared for over 20 years of PICU nursing have had short-term central lines, most have arterial lines and possibly PICCs as well, depending on why they're there. That's where IV compatibilities gets really challenging. When you're running epinephrine, norepinephrine, potassium, TPN, morphine, midazolam and dexmedetomidine then you're told to add sodium phosphate and you only have two lumens, some creative thinking has to be employed. If you're interested in learning skills, PICU will always come out on top.

One of the best parts of working in peds in general is seeing the kids when they come back for follow-up and they've grown, gone back to school and are flourishing. One of our long-stay patients (double lung transplant) comes by several times a year to see us and bring us food. When we think about how close to death this child was, then see the evidence of our good work in a healthy, smiling kiddo walking onto the unit, it's pretty awesome. On the other hand there are some parents who come back to see us on the anniversary of their child's death on our unit. Those occasions are very special too.

One thing that's difficult about both areas surrounds the ethical concerns we sometimes face. There are times when we do things we're not sure are the right things. (See the articles on moral distress elsewhere on the site.) I'd guess there's not much difference in the frequency of morally-distressing situations between areas, but they may be managed better after the fact in oncology, at least where I work. My view is a little jaundiced since we have both a PICU and PCICU; there are more gray-area situations on the cardiac unit, especially when it comes to extraordinary measures.

I think if you're leaning toward PICU then you should give it a shot.

klm21 · Apr 7, 2016

Hi, My name is Kiera and I am hoping to go into pediatric nursing as I further my education. I am attending a community college in NC and we're working on a project in my English class where we have to interview someone who is working in our career field. If you are interested please let me know. We can exchange questions up here or through e-mail. Just would like to know your education process, daily duties, and fun facts & stories you might have. Thanks.

KelRN215, BSN, RN · Apr 8, 2016

OP, it kind of sounds like you have already made your decision. For me I like the relationships you build with patients/families in pediatric oncology. I like that I can walk into a patient's room and not have to introduce myself every shift, because they know me and have known me throughout the whole process. I like being there at diagnosis and then getting to give the kid their last dose of chemo a year or two later. I've felt very privileged in my career to have been able to follow kids throughout the entirety of their cancer journey. Not saying that doesn't happen in the PICU and there are certainly patients who are regulars there (all vents, including chronic vents, at my hospital go to the ICU). I've never worked PICU. We do have a few oncology kids who go to the ICU for all of their treatment- kids with brain tumors and diabetes insipidus mostly, who need vasopressin drips while on chemo.

kelseykelsey4 · Apr 8, 2016

I don't work in either but have an interest in both. Someone told me if you want the parents to remember you work in the PICU. If you want the kids and parents to remember you, work in oncology. Pedi oncology is nice because you get to interact with the kids and have fun with them when they have good days. But the exposure to chemotherapy is a real thing!

cwazycupcakes · Apr 11, 2016

OP, it kind of sounds like you have already made your decision..

I actually haven't decided yet! I think I like both equally. They aren't being very patient with me. I have to let them know by the end of the business day tomorrow (1 week from the offer). I don't know how to decide which would be a better fit.

guest769224 · Apr 11, 2016

I don't know how to decide which would be a better fit.

You will likely get some cancer patients in the pediatric ICU. Therefore, you'd have both patient populations. If I were you, I'd go with PICU. More neat stuff to learn in there.

sergel02, BSN · Apr 19, 2016

Kind of curious, what did you end up deciding on OP?

alpal2021 · Jun 30, 2021

Hey @cwazycupcakes did you ever decide? I have been offered a peds ICU and a peds oncology position and am currently In your shoes. Do you have any advice for me based on your position?

Thanks