Starting PICU Job...nervous!

[skatingrn]

Hi fellow nurses! I'm starting a PICU job in a couple weeks and I'm very excited but slightly nervous. I've worked with kids that are chronically vented and trached for the last few years in a home with several kids requiring 24/7 nursing. We will run a respiratory code on these kids about once a week on average and do not have docs or RT's on site. The manager of the PICU I'm starting on is excited to have me because of my background with peds vents. What makes me a bit nervous is that this is a contract/travel position so the orientation will be limited to only a shift on each of the floors that I will potentially float to (NICU and peds) in addition to the PICU before I'm flying solo and I'm wondering if that's going to be enough 'brush up' time on some of the ICU critical care aspects that haven't been part of my practice in the last few years. I want to do well of course from the very beginning. Any suggestions on how to refresh, what to read, videos to watch, etc. would be most welcome!

[NotReady4PrimeTime, RN]

That's really hard to answer. So much depends on the acuity of their average patient. If they're a Level 1 trauma center, or do cardiac surgery +/- ECMO or transplants, the answers will be different. In general, you won't be wasting any time if you review invasive hemodynamic monitoring - most kids will have an arterial line and a transduced central line. That leads into pediatric shock states and both fluid resuscitation and vasoactive drugs. You've got a good grasp of the airway and ventilator stuff, but you might need to brush up on blood gas analysis and fluid-electrolyte balance. Blood product administration will be part of the job so have a gander at transfusion reaction assessment and treatment. Brush up on your med calculations. Don't be afraid to ask questions! It'll all come together.

[skatingrn]

NotReady4PrimeTime:

Thank you! That's very much along the lines that I was thinking. ECMO and ICP are the two things that are making me a bit anxious. I've heard good things about Pearls Reviews so I plan to put in a lot of time there over the next couple of weeks. Do you have a good reference text or phone app recommendation for use in the ICU?

As a new user I've seen some of your other posts; you're a fountain of knowledge! Do you teach?

[NotReady4PrimeTime, RN]

ICP isn't really that huge of a hurdle for the less-experienced PICU nurse. On our unit it's considered to be a Phase 1 skill, so our new grad new hires are being assigned to these kiddos. ECMO patients aren't usually assigned to nurses with no experience in monitoring them so you're likely to be safe, at least for your first couple of travel placements.

AACN has some pocket card-type apps you can put on your phone that will help out with hemodynamics, dose calculations, resus drugs and doses and an assortment of other things. I relied heavily on my Core Curriculum for Pediatric Critical Care Nurses when I was preparing for my certification exam. It's very good, but not portable and very detailed.

No, I don't teach. I'm not qualified to teach as far as my employer is concerned. I applied for a CNE position after being on the unit for 12 years and didn't even rate an interview. But thank you for your kind words.