Trying to get into the PICU. Better to start in general Peds, NICU, or adult ICU?

Pediatric Critical Care Columnist · Sep 10, 2017

Any of those routes would be helpful, for different reasons. General peds lets you become used to calculating medications based on weight and using smaller equipment and supplies. It will give you experience in teaching parents and siblings about your patient's illness, their care and their responses to treatment. It will also give you practice getting children to cooperate. (Let's face it, at some point prior to discharge, PICU patients are floor kids, otherwise they'd never leave!) NICU patients are somewhat different from PICU patients in that many of those babies are premature and have issues related to prematurity while PICU patients could be just larger NICU patients or they could be teenagers with more adult illnesses. The focus in NICU is somewhat different as well, but there are many skills you'd pick up there that would translate into PICU skills too. And adult ICU will give you great critical care skills that are modifiable to work with kids too. One thing that's common to all those is the necessity for learning how to interpret non-verbal behaviours to recognize when something isn't right with your patient. So having experience in any of those realms will make you attractive to a hiring manager. I did the neonatal-to-peds route, but I know lots of fantastic PICU nurses who came via general peds and adult ICU so I'd recommend going with the one that appeals to you most.

HiddencatBSN, BSN · Sep 19, 2017

I vote for NICU. You'll have pediatric-specific critical care experience and even though NICU is quite different from PICU experience, I think it would be the easiest transition in terms of skills and your appeal. NICU nurses who transfer to other Peds units have amazing IV skills which is a big selling point and you will have experience with some of the highest acuity, fragile patients available so your critical care skills will be strong provided you give yourself time to soak in as much as you can. I don't think you can go wrong with any of those options provided you are in a hospital that has a PICU, however I think your transition from adult ICU would be the hardest both knowledge-wise and from the perspective of needing to move in to pediatrics without pediatric experience.

lala87 · Sep 20, 2017

Awesome, thank you both so much for the input! I was already leaning toward the NICU out of everything I've experienced so far. I'll be lucky to get a job as a new grad in any of these departments, but I'm definitely going to be pushing hard for the NICU. Thanks again!

PICU-Murse · Sep 22, 2017

I'm honestly going to have to disagree with the other responses here. I believe NICU has some to offer, but honestly there is not all that much that transfers over. NICU is limiting in my honest opinion. Adult ICU would probably be your best bet because it offers an array of different disease processes that transfer very easily into Pediatric Intensive care.

- Depending on what PICU you eventually want to end up in, your previous experience will matter greatly. For example: NICU does not see trauma, TBI, DKA, Asthma, etc. You will see these things (or similar things) in an adult ICU,NOT in the NICU.

-The PICU I work in I can tell you with certainty, we scarcely hire nurses with NICU experience. On the flip side, we very, very often hire nurses with Adult ICU experience.

-As far as med-surg experience, I think we both know the answer to that.

llg, PhD, RN · Sep 22, 2017

You might want to check with the PICU where you particularly want to work. At my children's hospital, they like hiring nurses with experience from our general peds units. It's considered the "standard" way to get into the PICU -- work peds med/surg for 1-3 years, then transfer to the PICU.

They are suspicious of people coming from adult ICU's because they have been burned by such people seeking PICU jobs to get "a little" peds experience to bolster their CRNA applications. Such people are looking for a short term job only.

NICU -- the patients and the culture and way different -- not the usual or preferred route -- though it has been done successfully

Actually talk to the people involved in the PICU hiring and find out what their preferences are. That's your best bet.

PixieRN1 · Sep 26, 2017

Okay...my career trajectory was 7 years in a level IV NICU (ECMO, therapeutic hypothermia, peritoneal dialysis, vasoactive/sedative gtts). I did a year as a school nurse. I then did 2 years in PEDS float pool (11 floor children's hospital, including peds ER). I also simultaneously did 3 years in intensive peds home health PRN. Peds float pool actually got me my first experience in a PICU and a peds CVICU. From there I moved into a PICU/Peds CVICU/Transplants for over 5 years.

I'm now in Psych but that is how my career trajectory into PICU went about. In my experience, new PICU nurses came from NICU, peds, and adult ICU. Depending on the level of NICU experience, it's probably fine, as long as you get to deal with ART lines, Broviacs, vasopressive and paralytic/sedative drips.

NICU will give you experience with pedi doses and calculation, also working with peds specific drugs, which are different than adult drugs, which is a plus. Adult ICU will give you trauma and neuro experience, general ICU management, which is a plus. Adult cardio isn't a ton of use because pedi heart defects tend to be congenital, not obstructive, therefore the treatment is hella different, but I don't think anyone could consider it a negative, just not necessarily the most helpful.

And I worked at a level 1 trauma/transplant center, and they would admit an occasional new grad, so I don't think it's impossible to get into.

I would just pick what you like with the caveat that I probably wouldn't pick a Level II or III NICU, as it won't be the most helpful.

Good luck!

PeakRN · Oct 7, 2017

I would advise against the NICU, is a very different environment from the PICU both in patient age, conditions, treatments, and even how your day is generally scheduled. We very rarely hire NICU nurses into the PICU, and they tend to go back to the NICU after a short period of time.

The PICU in our hospital generally hires out of the Adult ICU, Peds floor, or the Peds ED. Each of these have different benefits but have all been the best for long term development.

Adult ICU will give you some similar conditions, similar medications, and similar pattern of your day but you will need to develop your pediatric experience.

The Peds floor gives you pediatric experience but does not teach critical care thinking.

The Peds ED gives you pediatric experience, VERY similar medications, the same conditions, and critical care thinking but is about the opposite when it comes to the way care is administered throughout the day.

The other benefit of the adult ICU is that if you ever change your desire and want to work somewhere else it is probably the best launching point for the most places.

vintage_RN, BSN, RN · Oct 20, 2017

I'm a NICU nurse and I wouldn't think much would transfer over to the PICU except maybe drug calculations, titrating drips and managing vents. our patient population is very specific and many of our treatments and things we do are very NICU specific. There is a lot more variety in the PICU and your knowledge would be generally limited to infants.

ChryssyD · Dec 19, 2017

General peds, definitely. There will be too many conditions and situations in both NICU and adult ICU that you will never see in PICU. If you want to be a PICU nurse, might as well start out with the kiddos! Good luck!