Sicu to picu? Help!

Your thread has been moved to our PICU forum to generate more responses.

Hello fellow nurses

i am looking for some advice. I have about two years experience in a sicu and absolutely love it. I was recently offered a job on a picu with an amazing manager and staff (something my current job lacks) and in a huge level 1 trauma center (actually named best in the state). As a fairly new nurse I know the experience will be an amazing one however I've never worked with peds and don't know if dealing with parents and coding children is quite my forte. Has anyone made this transition before or have any advice for me? I'm petrified to make the jump mostly because I'm leaving a place of comfort to fall into an area unknown. Any advice would be great. Thanks!

You're going to be a real asset to your PICU. You have some solid ICU skills and instincts that will be very valuable. You already understand cardiorespiratory and invasive pressure monitoring, ventilation (mechanical and physiologic), you know how a lot of commonly-used ICU drugs work and which ones to use in different scenarios and you have already learned to cope with difficult psychosocial situations. Dealing with parents isn't all that different from dealing with adult children who have their own agendas about the patient's care. The main difference is that we can't really do anything without parental consent.

Coding children is a bit different, simply because the precipitating events are different. Codes tend to go on a lot longer than adult codes do; most kids have healthy hearts, their rhythm abnormalities tend to be less malignant, they compensate better for longer and most are hypoxic in origin - bring up their oxygenation and they're usually recoverable. Kids' brains are more plastic, so they recover better than adults; part of that is that they don't know their limitations. As long as it's not suggested to them that they can't do something, they're going to do whatever is possible.

I think your biggest hurdles will be grasping normal vital signs by age, administering meds by weight and knowing which meds kids respond differently to than adults do. Some they need much smaller doses to get the same effect. Lasix is one of them. If you give a kid 0.5 mg/kg, they'll pee like there's no tomorrow. Others they require much larger doses to get a similar effect. Aminoglycoside doses in children under 10 are higher than for older children and adults. Phenytoin is another where the doses will seem larger than you're used to. Sedation and analgesia are often jacked up a lot higher than for adults too.

Your other big hurdle will be an ethical one. Not really different from the ethical considerations you see in SICU but perhaps a little harder to manage. You might want to read through the articles on moral distress found in this forum to prepare your mind and heart. I hope you find PICU to be a good fit; we need strong, capable and competent PICU nurses all the time!

You're welcome. It seems like I answer this question or one very similar to it at least a few times a year. If you spend a bit of time looking through the threads in the PICU forum, you'll find lots of helpful posts.