Pros and Cons of Adult vs Pediatric Critical Care Nursing

dah doh, BSN, RN · Jan 31, 2013

Depends on what you like and if you have plans for advanced practice or not.

meraki86 · Jan 31, 2013

That's just it, I love all three and can see myself doing all of them. I definitely want to further my career with a Masters in Nursing and Education and become a clinical instructor.

llg, PhD, RN · Jan 31, 2013

If you want to be a clinical instructor ... then NICU would not be a good choice for you. Undergraduate schools don't hire faculty members to teach undergraduate NICU clinicals. They hire "pediatrics instructors" or "med-surg instructors" or "community health instructors" or "psych instructors" -- but not NICU instructors. I say this as someone who specialized in NICU and who has a PhD in nursing.

As a PICU nurse, you could get hired to teach pediatric rotations -- but without general care pediatrics experience, you would be at a disadvantage. Just because you are a good PICU nurse (providing care for 1 or 2 patients) doesn't mean you have much expertise with the general care inpatient peds population.

If getting a job as a clinical instructor is your goal, you will need to develop clinical expertise in a specialty where students go for full rotations on a regular basis -- not some sub-specialty that is not emphasized in nursing school. Think about the major rotations that most students do. Adult ICU would give you more teaching opportunities. (But adult med-surg and/or geriatrics would probably give you the most career options.)

The 3 types of ICU's you mention are so dramatically different from each other that I believe you really need to think a little more about your likes/dislikes and preferences before you committ yourself. Do you really want to work with peds patients: Can you handle it when they die? Do you want to work with trauma victims? Child abuse victims? Do you want to work with post-op patients or adult medicine patients? Do you want to work with neonates? Think about the family dynamics you will have to deal with in each type of unit, etc. Which appeals to you most?

umcRN, BSN, RN · Jan 31, 2013

You need to consider your feelings towards each age group. You can become a clinical instructor in any of the units though I would say more likely so from Adult icu or picu.

Having worked in both NICU and Peds CICU I can think of a few things to consider.

How are you with families? Family members are going to be a much bigger presence in peds & nicu, there is a lot of teaching them and a lot of learning from them. They are another member of the childs care team and we must work together to have the best outcome for the child.

Are you good with kids? Silly question maybe but this is an important part of working in a PICU, you have to be able to identify with all age groups, neonates, toddlers to teenagers and if its a cardiac unit then even adults with congenital heart issues. You have to be a little silly, willing to do an assessment on the floor and sometimes chart with a toddler on your lap (yes, even in the ICU). More so you need to understand developmental levels and how to approach painful/difficult tasks with each age group.

What's your patience like? Even in a level 3c NICU you will spend days trying to encourage an old preemie to eat, it's time consuming, frustrating and actually takes quite a bit of skill.

And then there's your own personal beliefs and ethical issues to consider. Every ICU has ethical issues. In the adult world it's the 92 year old with breast cancer and mets to every organ in the body but family refuses a DNR, in peds its the child abused right to the brink of brain death by moms boyfriend, mom won't press charges or leave said boyfriend and wants everything done for said child who, if he survives, will never walk/talk/see/hear again. In the NICU its saving the smaller and smaller babies. The "23" weekers who by the time they've been resuscitated really appear more like 22 or even less and now parents want everything done to keep essentially what was trying to be a miscarriage, alive.

Now picture yourself someday doing chest compressions, because in an ICU it will happen, what is the age of the person you are working on and does it seem like something you can handle? For me I could never do compressions on that 92 year old and feel ok about it. Sometimes I still don't feel ok about it with the kiddos, but when we have a good outcome, and many of them are, I feel satisfied that I've helped that child potentially have a meaningful life.

Don't go after something because of what you think you might want to do someday because that can always change once you've spent time being a nurse. Think about the present and what appeals to you right now. Also what is available to you. It's much easier to move around in nursing after getting that initial experience and you may find what you thought you wanted to be completely different in a few years.

llg is also right in saying that there are few ICU focused clinicals to teach. I do have a friend of mine though who works in the peds cardiac icu and she teaches a clinical elsewhere in our children's hospital, but she's in school to be a peds NP therefore has done her own work and additional clinicals outside of the ICU setting

dah doh, BSN, RN · Jan 31, 2013

It breaks my heart when my kids are sick, so there is no way I could do sick babies or kids. But I admire the ones who are strong enough to do it. Needless to say, I do adults (ICU). Yes, ethical issues do arise, but at the same time, in my mind a 92 yr old has "lived" and the baby or child really hasn't. Family issues always arise and you come to realize that there are a lot of messed up people out there and a lot of dysfunctional families, but some nice ones too. You just need to figure out what you like more and try for that because each nurse needs to figure out their niche. Sometimes it takes a few tries to figure it out though. Good Luck!

meanmaryjean, DNP, RN · Jan 31, 2013

I have worked adult ICU, PICU and NICU and the most difficult - in my experience - is PICU. You have the incredible range of developmental differences (birth to 18 year olds who are parents themselves), you have a much more clinically diverse population (cancer, congenital heart defects, accidental poisonings, victims of child abuse and neglect and on and on and on...)

Our PICU does a lot of heart surgery, and its a challenge keeping up with the thousand-and-one ways you can be born with a jacked up heart. (I mean, we had a patient who had Transposition, dextrocardia AND heterotaxy - makes your head swim!) :)

Having said that - I like PICU the best of all three.

umcRN, BSN, RN · Feb 1, 2013

Our PICU does a lot of heart surgery, and its a challenge keeping up with the thousand-and-one ways you can be born with a jacked up heart. (I mean, we had a patient who had Transposition, dextrocardia AND heterotaxy - makes your head swim!) :)
Having said that - I like PICU the best of all three.

I LOVE my pedi cardiac ICU but you know when the doctor stops to say, wait...where does their blood flow again? It's almost never good. It really is amazing the ways the body puts itself together sometimes, and then figures out even more ways to compensate for it! I took care of a 52 year old a year ago who was an unrepaired hypoplastic right heart. Doctors had sent her home with her parents to die and man her body worked something out (bluest person I've ever met but married twice, three adopted children and made a living, pretty impressive).

meanmaryjean, DNP, RN · Feb 1, 2013

Not to get off-topic too badly but here goes: How do you even stay alive with a CONTINUAL O2 sat of 70%? I never fail to be amazed by the adaptations the human body can make.

meraki86 · Feb 1, 2013

Wow you guys are awesome and offer some wise words that I will definitely take into consideration.

I do have a lot to think about.. I really appreciate the feedback!

umcRN, BSN, RN · Feb 2, 2013

Not to get off-topic too badly but here goes: How do you even stay alive with a CONTINUAL O2 sat of 70%? I never fail to be amazed by the adaptations the human body can make.

haha I wondered the same thing :-) but these kids do and some do it well! The 52 year old I mentioned sated low 70's her whole life and had Eisenmengers syndrome which is the result of that. One of the things included in that and how the body adapts is having a hematocrit in the 50's, in fact when hers dropped from 58 to 52 (she was coughing up blood) we transfused. The body adapts and sometimes amazingly so and others never adapt. However even with good adaption as she had there are a lot of complications and every organ system is affected, renal issues, gi issues, pulmonary issues, you name it.

Interestingly enough this woman lived longer than any fontan I know which is the type of repair she would have had done if she were born today.

meanmaryjean, DNP, RN · Feb 2, 2013

I have a homecare kid who completed her Fontan several months ago. She's four and has clubbing already, and likes (no demands) to go barefoot. We call her Madame Blueberry because her little clubbed toenails are so blue.

Mom recently had another baby (who has all four chambers in his NORMAL heart!!) and she says baby brother is 'kinda boring' - what with no home vent, oximeter, trach, g-tube etc. :)