PICU versus Peds CVICU?

[mpier]

I've recently changed jobs from an adult MICU to a pediatric CVICU. I've always wanted to work in peds, but now I'm seriously questioning my move. I just finished my 2nd week of orientation and I just don't know if I like it. I feel like the doctors have such tight control over their patients that I don't get to make a move without their permission. I had a provider call me three times asking about a low potassium that I had already replaced and was going to recheck in 15 minutes. Its been frustrating for me.

I guess what I'm asking is: Is this experience unique to the CVICU or just pediatrics in general? Or is this just my unit? Obviously I've never worked in peds before, so I just want to see if I'm in the right place. Should I think about moving to the PICU instead of the CVICU? Or am I just judging things too soon?

Feel free to tell me that I'm being stupid :-)

[NotReady4PrimeTime, RN]

I think you're judging things too soon. When I started my current job in a joint PICU/PCICU I brought 5 years of PICU experience with me, including code team and charge. But I was expected to prove myself, not only to the physicians but to my peers as well. There is less autonomy in peds critical care than in adults, mostly because children are less predictable than adults and will turn turtle on you when you least expect it for the reason you'd least expect. The surgeries pediatric cardiac patients undergo are, generally speaking, much more complicated than those of adults and there are no two identical defects. Adults will have one or more coronary artery bypasses, valve repairs or replacements and aortic repairs. Children may have all of those, plus septal defect repairs, multiple extracardiac shunts, patches, grafts, baffles and a multitude of other tweaks to their hearts. For that reason we never say, "Just an ASD" - there's no such thing. Kids also have paradoxical reactions to drugs, a huge range of acceptable vital signs and may have other anomalies. They tend to have a much more malignant response to low electrolytes (K+, MG++ and Ca++ especially). So peds intensivists tend to like a little more control over what happens to their patients. But once you've gained their trust, you'll have more autonomy.