Trying to survive as a new PICU nurse..;(

NurseforPreggers · Sep 12, 2005

That does not sound like a safe situation at all. I would seriously consider changing your atmosphere. That is absolutely ridiculous that you have been there only a week and are expected to care for 16 patients at a time. That is too much for a nurse that has many years of experience. I would urge you to protect your license. Do not lose your license because of a poorly run facility. I think you should report this situation to some governing agency, whatever that may be where you are. Good luck to you!

ERNurse752, RN · Sep 12, 2005

Leave if you can...doesn't sound safe at all. I'm sorry your first experience is going so badly.

Editorial Team / Admin · Sep 12, 2005

Good day to Everyone,
I just graduated last year and after our oath taking, I took a three month training in an Adult Intensive Care Unit i in a tertiary, 800 plus bed capacity public hospital in our city...
After my training, I was hired by the Hospital..in my first month I was assigned in the Medical Adult Ward, it was difficult but manageable..
I was reassigned and became a permanent staff in the newly furnished Pediatric Intensive Care Unit...specifically in the septic (infectious)unit (since we have non-septic and septic PICU, which rooms are just adjacent)
Most of the staff are new and have a little or almost no job experience in dealing with sick children..including me..
I know sick children by the book, but i know experience matters A LOT. In PICU Septic Unit, we have 16 bed capacity. 6 for sick neonates [ if you wonder why they are not in the NICU, i'd probably say the NICU is full and we have to cater them..] 8 beds for sick children and 2 isolation rooms..
Our ratio is 2 nurses and one nursing attendant to 16 patients with different needs and health conditions...
I am mortified and terrified to death because there are times when my partner is scheduled 10am-6pm as i go 7-3 or 3-11 sked OR both newly exposed nurses are on duty...both badly inexperienced...
the thing is...i am absolutely terrified for our patients... I mean this IS PICU..intensive care unit...for very very ill kids...these are not dolls...we deal with 16 of them, almost 4 of these are intubated on continuous ambobagging ambobagged by one of the parent (because the PICU septic only have one mechanical ventialtor), 3 are candidate for intubation, preterm infants who would suddenly go into apnea....terrible...if i was a cry baby, i would have cried a long time...
i realized that children are more toxic than adults in ICU's. you need to keep close watch and monitoring on them, VS every Hour seems not enough because just after 15-30 minutes, one of the kid becomes cyanotic and tachycardic then bradycardic...When they go into arrest, they are difficult to revive..
I am new here, and I MUST cope fast with the fast forwarded procedures and interventions since the Doctors get mad, and i mean really mad at you when your resucitation is (as what the Doctors say) "slow"...
I was scolded once because the Doctor said I am wasting too much time giving epinephrine..but from what i understand in Advanced Cardiac Life Support after the first dose of epi, the second will be 3 min. after.. i mean there is pacing...the Doctor wanted to give first dose epi then after 10-15 seconds give another dose... i want to know if the ACLS in Adults is THAT different from the PALS?? was she right??
I was not even acquainted of what ET sizes for this child is, what OGT or NGT is for this child...it was only there that i heard of Continous Positive Airway Pressure for children..since in our hospital, what is familiar to me is PEEP..
Please help me. I have been here in PICU for only just a week and I cannot stand this situation. I feel very incompetent. I am still trying to get hold of PALS manual. I am browsing, surfing, reading my books on Pediatrics..refreshing and trying to update myself with the Pediatric world...
if you'll ask where our headnurse is, she is approachable but she is currently sick..another blow..where is our nurse supervisor? nowhere to be found. from what i observed, they come in our unit just to ask the census, who are intubated, who are toxic. and that is it. i mean that is it. I almost wanted to cry. the Chief Nurse? i can only shake my head in dismay...i don't know what to do..
can anyone tell me what are the apporpriate ET sizes for children in PICU? I know only of 3.5-4 for neonates and f.8 feeding tube.
I don't think I can ask the Doctors, i think they have a heavy heart towards us. I fear that i'll only get insults. which happened to some of us here...
please tell me what to do

Hello, Elicec,

I am moving your thread to the Critical Care forum, subforum for Pediatirc Intensive Care. I believe you will get better response here.

I am so very sorry that you are in this situation. I agree. It is VERY dangerous. I cringed when I read the part about parents ventilating their own child. MY GOSH!!!!!!

I cannot imagine working in that environment.

Staffing with inexperienced personnel is dangerous. And, your ratio is 8 VERY SICK children for each nurse????? I cannot fathom that.....

And, you are NOT a cry baby. You have valid concerns. Again, I am shocked that you are working in such a situation dealing with critical children.

As for the resuscitation efforts.........have you had a course in Pediatric Advanced Life Support? Is this offered where you are located? Do you have some type of pediatiric life support class that you can attend.....and, quickly? Taking this type of course will answer MANY questions regarding med dosages, Endo tube sizes, the different arrests, airway management, etc. You will get great info by taking a course like this.

To answer your question regarding epi..........yes, you wait 3-5 minutes between doses. You will have physicians who want to "stack" the doses, however, and this has been proven to cause more problems.......This physician was incorrect. Your PALS book (I reread your post and see you have this book.......THANK GOODNESS), will tell you what size tubes to use.

I cannot imagine putting myself in your shoes for even a second. I see you have serious issues here and would not blame you if you seek another position and very soon.

You are to be commended on your evaluation of the situation.

Please respond and keep us informed.

I/we care.

Siri

Moderator Allnurses.com

Pediatric Intensive Care Forum

Corrin1RN · Sep 12, 2005

OK, I am a new nurse (grad in december) and if I was in your situation I don't think I would go back even once, parents bagging patients because there aren't evough ventelators!! I am as I said a new nurse, but this sounds like something out of a tv show about a hospital in the jungle out of a third world country, i work on a high acuity floor with only occasional peds patients and our patient ratio is 4/1, 2/1 in the icu, and 5-6/1(total care, not team nnursing) on the surgical and medical floor, and i thought that that was bad. I sometimes feel very stressed and my biggest problem is when we don't have a tech/unit asistant, or when a lpn or less experienced nurse than me is floated to us and I have to be charge nurse. but there is always an experienced rn or supervisor somewhere on a different floor near by. I am a christian and I pray before every shift for God to protect me and my patients, to keep them stable, and guide my actions, and He has never let me down, I have had some rough nights, but I always make it through. If you don't want to quit and go to a hospital or floor that will nurture you and all that you are facing, and learning as a new nurse, then i would at least go to administration and insist that this dangerous situation not go on for even another shift, and fill out an incident report about the situation for potential danger, you are a patient advocate, and you owe it to those precious little souls to speak for them. sorry this was so long, it just fired me up reading your message, Good luck and I will be praying for you.

Pediatric Critical Care Columnist · Sep 12, 2005

I cannot imagine trying to work in an environment like that. Your story makes me ashamed for complaining about having to care for two PICU patients in a resource-rich unit. I'm appalled that a hospital would open an intensive care unit... any intensive care unit never mind peds, with only ONE mechanical ventilator. That's malpractice in my book. If you feel compelled to stay in that job, you need to educate yourself in a hurry; your PALS manual will be very useful in that. The website below is another good source of information; I use it all the time. Make sure you take good care of yourself when you're not at work, and try not to place blame on yourself for the disastrous events you're continually exposed to. You've been placed in a very unsafe situation by people who should know better.

http://pedsccm.wustl.edu/

Editorial Team / Admin · Sep 12, 2005

The website below is another good source of information; I use it all the time.
http://pedsccm.wustl.edu/

Excellent website, janfrn. Thank you!!

rach_nc_03 · Sep 19, 2005

I am so sorry you're in this situation! It does sound terribly dangerous. I work with several nurses from the Phillipines, and they've described similar situations in some of the hospitals there. I hope you have the option of moving to a safer environment.

Not that it would help the safety situation in your unit, but a good resource to have is the Manual of Pediatric Critical Care by Mary Fran Hazinski. i think it's available on amazon.com. At a minimum, it can give you some reference info on things like ET tubes and the like...certainly no substitute for a safe environment, but it has far more pertinent information on peds critical care than the average pediatric nursing textbook.

overall, though, i agree with the other posters- get out! i'm not sure what the regulatory situation is in the phillipines, but it sounds like this level of danger shouldn't be legal. like another poster said, i'm a new grad working in a picu in the states, in a wonderful research hospital with boundless resources, and i feel totally overwhelmed...i can't imagine how difficult your situation must be! please keep us informed, and do what you can to get yourself in a safer situation.

i'll be thinking of you.

Elicec · Sep 20, 2005

from my last post i have been coming in and out in the forum..unfortunately i don't have any good news to share.. :crying2: , the situation is all the same..true enough, most if not all public hospitals in our country has this problem..very unsafe indeed..we are understaffed, in a week we work 5-6 days( only 1-2 days off), with not enough equipment to support critically ill children...this is most of the public tertiary hospitals deal with for the longest time..its like a chronic disease that doesn't have a chance for recovery at all..

Our unit is trying to make the most of what it has, whew.. what is evident is that critically ill children has slow progress ( since most family here are poor,due medications are missed because they can't buy it, very sad), so what i do is, i take out a drug from our stock and share it those who have same prescribed drug and give the prescribed dosages..like if 7 kids were to receive Pen-G, i'll get one 5 M unit dilute it, calculate the desired dose for each kid and administer it, that will last for a couple of days only since our unit get short of meds, which is so not good..medications are supposed to be continous especially antibiotics right?

one worst thing i just encountered and realized as i became staff in PICU is that the Doctors are toxic.. ..very hot headed..they are like ticking bombs that will blow at you in no time.. most doctors are females and they would raise their voice at you roll their eyes and slam charts, and scolds the parents of the patient for not complying with the treatment regimen and some other things..whew..I don't know what the situation is in some hospitals here, but as i observed, We've got a feudal system in our nurse-doctor working relationship. Nurses are not recognized as equal health care partners here...very sad isn't it?...

should i quit? if yes where will i go and practice? private hospitals are not hiring as of now..in another public hospital?with the same situation?...i actually wanted to quit, but where will i practice?Im so confused.. :/

as of this time, i am continuously reading materials regarding critical care in pedia..trying to figure out how to take care of my patients with so little that we have...so much for an intensive care unit...

Elicec · Sep 20, 2005

and yes, i am so terried for my license...i actually want to disappear whenever i go on duty..and every single day i pray to God for my little patients..and i almost always wanted to cry at the end of days work..

indigosoul329 · Sep 21, 2005

i am so sorry to read about your situation i know nothing about the philippines but i would venture a guess that there are many places in the world that need nurses and would treat them with mre respect than what you are experiencing right now. best of luck to you- if you have an opportunity to get out of your current situation, i would recommend it - there are many nurses in the US from the philippines, have you considered traveling to a new country?