Texas Children's PICU New Grad

Pediatric Critical Care Columnist · Apr 2, 2017

Congratulations on your new job! I hope you love it. I'm happy to know you'll be given some time on the acute care units to develop your time management, prioritization and assessment skills before you plunge into the PICU. That's setting you up to succeed. It'll also give you some time to learn the most effective ways of communicating with both your patients and their families before you're up to your axillae in alligators.

One thing I've noticed over the years is that new nurses working in critical care settings are hungry for the fast-paced, hectic, epinephrine-inducing sicker-than-sick patient care experiences long before they're ready for them.We seasoned nurses are trying to avoid those situations at all cost! I've lost count of how many relatively inexperienced PICU nurses have complained about being bored while they're responsible for those stable, almost-ready-for-transfer patients. That's a sign they're not truly engaged in what they're doing. Instead of sitting at their computer terminals bemoaning the fact they're looking after a kiddo with RSV bronchiolitis on high flow oxygen, they could be reading about what RSV does to an infant's lungs, or how high-flow oxygen has really changed how we're caring for those kids. Or they could be offering their hands and brains to the nurse with the sicker-than-sick patient who has a gazillion things to do and only 12 hours to do them in. So there's my first piece of advice. View EVERY patient you are assigned to care for as someone worthy of your care, and as a potential learning opportunity. Trust me, you're NEVER going to know everything there is to know about sick children.

I'm sure you're aware that not all stories have happy endings. There will be children who die. There will be children who suffer catastrophic - but not fatal - complications. There will be children whose injuries or illnesses were inflicted upon them. There will be children whose parents demand their lives be saved at all cost, without understanding what that means. There will be children whose faces you never forget. Don't turn off those feelings, but rather, find a way to channel them. Know who you can talk to, who will offer you their support unconditionally. That's vital to remaining emotionally strong. Use what I call my 5 A's of psychological health. Acknowledge your feelings. Analyze them objectively. Address them and their affect on you. Accept them for what they teach you. And absorb them into your heart. Every emotion has value and can teach us something about who we are. It's also important to know what we can change and what we can't.

Always remember that the child's parent knows that child far better than you ever will and they're part of the team too. If a parent says somethings wrong, trust their instincts. Listen to their reasons, assess their child thoroughly and intervene appropriately. Sometimes there's a good explanation for what the parent is concerned about and sometimes, there really is something wrong. The only way to distinguish between the two is to check it out. For those children who have been medically complex their whole life, the parent is the one who has been there for everything. They're the ones with the history and the ones with the integral knowledge of what works for their child and what doesn't. It does no one any good to ignore a parent's recommendations, substituting "by-the-book" responses, only to discover later that Mom was right. And remember that no matter how poor the quality of life a child (or any one, for that matter) lives may seem to you, that child has people who love her exactly the way she is and want what everybody else wants - good care and compassion.

Perhaps the most important message I have for you is to ask for help when you need it. If you don't know how to do something, ask someone to show you. If you don't know what you should do about a situation, ask someone to brainstorm with you. If you see a change in the child's condition, behaviour or vital signs, tell somebody. Looking after critically-ill children is a team sport. Their well-being is everyone's responsibility so don't ever feel like you have to go it alone. Because you don't. Now go out there and get your hands dirty!

dmorenoRN · Apr 2, 2017

Thank you so much for your advice, it is very helpful. My sister has epilepsy and used to have 8-9 hour critical grand mal seizures- the best nurses I've met do exactly what you said- they listened to our parents. Thanks for being one of them. I will be one too. They are most certainly one of the most important people on the care team, and some of the time they are an expert on their child's illness if it chronic and they have been dealing with it for years.

I will never stop asking questions, learning, or viewing every opportunity to care for a child as an opportunity to deepen my knowledge and experience. To be honest, right now I feel no where ready for the adrenaline inducing cases. I have so much to learn and I realize that something as simple as a medication administration error can kill a medically unstable kiddo. I want to make sure I have dotted all my i's and crossed all my t's so I can truly care for my patients in the most caring, compassionate ways. I don't want to be a hindrance, but an asset and advocate. I look forward to embracing my emotions of it all and learning from every day. Thanks again!!

alex1987 · Apr 7, 2017

May I ask you how was the interview?

I'm not a new grad but only have 10 months experience (telemetry - and adults!) and I've been out of work for 2 years. Today I got a call for a PICU interview at Texas Children's west campus and I'm super nervous. Any advice?

penny reverential, ADN, BSN · Apr 16, 2017

I'll be starting at TCH's PCU in July. While not as intense as PICU, still rather busy and still caring for fragile patients. I'll be watching this thread, too.

GGarryy · Apr 17, 2017

They use the STAR format for interviews they have a panel of people asking prefabricated questions "give us a specific example of a time when you had to correct a coworker who had performed a task incorrectly and how you handled it" they want you to answer it "Situation" "Task" "Action" "Result" "S-my coworker did not have a proper seal on the ambu bag during the code,T-They need to be re-educated without being insulted, A- I pulled them aside in private and educated him on the C-E clamp, R- Their PALS skills improved and our report strengthened"

They are going to ask about customer service, ethics, team dynamics, times when you were counseled by leadership, and delegation they want specific incidences and they want it in this format. Don't act like you were expecting it, but have some ideas ready so you don't have too much awkward silence making you nervous. It can be an amazing place to work, you just have to play a lot of corporate games since it is such a large institution.

nsummer, BSN · May 22, 2017

I'll be starting at TCH's PCU in July. While not as intense as PICU, still rather busy and still caring for fragile patients. I'll be watching this thread, too.

Good luck in the PCU! It can be a very stressful unit. Do forget to ask for help when you need it and there are plenty of nurses to give advice or assistance. I oriented there for a brief period :)

nsummer, BSN · May 22, 2017

Thank you so much for your advice, it is very helpful. My sister has epilepsy and used to have 8-9 hour critical grand mal seizures- the best nurses I've met do exactly what you said- they listened to our parents. Thanks for being one of them. I will be one too. They are most certainly one of the most important people on the care team, and some of the time they are an expert on their child's illness if it chronic and they have been dealing with it for years.
I will never stop asking questions, learning, or viewing every opportunity to care for a child as an opportunity to deepen my knowledge and experience. To be honest, right now I feel no where ready for the adrenaline inducing cases. I have so much to learn and I realize that something as simple as a medication administration error can kill a medically unstable kiddo. I want to make sure I have dotted all my i's and crossed all my t's so I can truly care for my patients in the most caring, compassionate ways. I don't want to be a hindrance, but an asset and advocate. I look forward to embracing my emotions of it all and learning from every day. Thanks again!!

Be deligent and ask questions regarding meds if you have them. Ask questions about anything g you need clarifying. I recently started in the PICU after working with adults and it is quite different. I sometimes feel like a nuisance, but ultimately it's about the patient. I haven't had one experience at TCH where a nurse hasn't been willing to help or provide valuable information. Even the more experienced nurses have questions. No one knows everything! You'll learn a lot. Good luck :)