PICU vs. PEDS

I'm a late comer to nursing, graduating at 36 from a diploma program. My goal in nursing school was always to work in PICU. My youngest child spent seven weeks in one when he was five, and the experience taught me so much about so many things, including myself. Until that time, I had thought I'd want to work in NICU. No more, never!

PICU is a rapidly changing world on most days. There is no predicting any of the things that happen, so it's vital that everyone on the team is prepared for anything. Assessment, planning and organization are the keystones of PICU care. (I can't stress the organization angle enough!) No two shifts in PICU are ever exactly the same even with the same patient, so it's a good place for people who don't need routine to succeed. The patients range in age from hours old all the way to the cusp of adulthood, and the variety of problems that bring them to hospital would fill a football field, so there's a lot to learn and adaptability is a must.

With the rotation I work, I almost never get the same patient two shifts in a row, so I've gotten really good at establishing a rapport with the parents in the first hour or so of the shift. They can be your best resources, and your best allies, but they can also be very difficult to work with if they've had too many "adverse events" occur. By this I don't mean a crashing child so much as betrayal of trust, feeling excluded or being ignored, getting fifteen different answers to one question, and so on. They need to feel like they're part of the team, and they are after all going to have to take this child home and care for them when we're not around any more, so they should be included and educated. If you can find ways to have them involved in the care of their child (mouth care is a good place to start!) they'll remember it forever.

I also like the marriage of technology with the more traditional hands-on care we provide. With advances in surgical technique, monitoring and delivery systems, critical care is on the cutting edge of health care and we're restoring health and happiness to children now who would have died even five years ago. The specialty is in constant evolution; it's really still in its infancy. The first PICUs were developed only about 30 years ago and as we learn, we grow, pushing back the boundaries and blazing new trails. It's exciting to be involved with something like that.

Another big facet is the autonomy. I make a multitude of independent decisions every time I work, based on my clinical knowledge, my understanding of the child's needs, the standards we apply to our work and sometimes on my intuition. I titrate drug infusions to effect without having to seek a physician's input, I decide how frequently I need to assess and intervene, I don't need an order to decide how often to monitor blood gases, for example, and I choose which interventions I feel comfortable delegating to someone else. (There are just some things I prefer not to let anyone else do!)

If you're the kind of person who likes to play or chat with your patients, PICU isn't going to provide much of that. But if you like to provide superlative care in a rapidly changing, noisy, confusing, hectic, fulfilling environment, then come on down!