PICU vs. PEDS

cherryames31 · Mar 19, 2008

I like PICU because it still includes the peds...with extra and interesting challanges :)

Out of school, I worked for 2 1/2 years on pediatric med/surg floors in Children's hospitals, 6 months of that I was travel RN. In the beginning, I felt like I was learning a ton every day, there was a lot of variety, interation with the kids and families, etc. My first two years, we had the luxury of talking amongst ourselves and picking our patient assignments (I see how rare that is now). I found myself actually picking the sickest and most involved of the patients on top of my other busy assignments...because I really enjoyed the intellectual stimulation. This may sound morbid to anyone but a PICU nurse, but I actually enjoyed being the nurse who helped that kid who was starting to go downhill that day on the floor...nobody else really wanted to.

While there's always something new to learn, I found myself getting really bored on the floors, even being a travel RN. I ended up moving and alas, no med/surg position...but tons of PICU. I couldn't believe it! I had found my niche, and didn't even know it would be. (I had interviewed for PICU as a new grad and the manager scared me to death...never thought I'd give it a try after that)

I love the chaos, the highly increased learning curve, the invasive procedures, helping families in times of intense stress, actually finding that the docs find the nurses' opinions and thoughts imperative to patient care in the PICU. When children die or are close to the brink, you're the one the families can lean on in their suffering. Or you're the instrument that helped save that child's life. I've got a very one-track mind, I enjoy being able to focus all my energies on one patient, one family...instead of the multitudes.

Just one of the disadvantages is that the PICU can take it's toll on you emotionally. I guess I wasn't prepared for some of the social situations that you'll encounter. I knew that in peds you not only take care of a patient, you take care of the whole family. In PICU, you can take care of families who are severely stressed, financially in ruins, slightly neurotic, potentially abusers or negligent, agressive, and on and on. In PICU, you can't just come in do your patient care. Sometimes I spend a lot of my shift talking on phone to families, smoothing things over with them because I can't get a single doctor with a second to talk with them, teaching, supporting... I leave some days with my emotions completely tapped out. It's rewarding, but exhausting at times.

Anyway, I think it's really helpful to know your skills, your likes and dislikes, what kind of nurse you are before venturing into the PICU. You might potentially consider shadowing a nurse for a day in the PICU to get a good perspective. Good luck to you as you search out the possibilities.

Pediatric Critical Care Columnist · Mar 19, 2008

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!