Want to come back to PICU

[Damien201]

I have worked in the PICU (first nursing job) for a little over 9 months. Unfortunately, I had to leave my job because my wife is getting her PhD. The area that I'm moving to does not seem to have PICU jobs open for people with less than 2 years of experience. I was offered a job in an ER which has a pediatric beds and another job in a NICU.

The ER is interested in me because of my peds experience, but I'm worried about the unit. They are not a trauma center and there are a couple other peds trauma centers within a reasonable distance. They have just expanded their peds side but it is not established in the community yet. They "expect" in the coming year, they will be expanding rapidly. I was told they'd get kids like the chronic patients with acute-type of problems because, once again, they are not a trauma center and it doesn't look like they'll be heading that direction soon.

The NICU is a level III. They're a well-established NICU and are a great training ground. Not much else to say.

Which one do I take if I want to get back into the PICU after about 1-2 years of working at one of these hospitals? I was told that NICU and other critical care areas are 2 totally different worlds and an ER might keep me primed for the PICU, but if the patients aren't very acute...will it really?

My wife is getting annoyed with me about this and wants me to pick one soon..."happy wife, happy life," right?

[NotReady4PrimeTime, RN]

Did you apply to the PICU or are you just going on what you've heard? If you haven't applied, I would do that right away. Having 9 months of PICU experience will still set you apart from applicants with even adult ICU experience. If you have applied and were fobbed off, then either of your options would be reasonable. Although NICU is quite different from any of the adult ICUs, it's a lot more similar to PICU than it's different. The ER job would still give you an opportunity to utilize the skills you've already developed even without the trauma. Sometimes those chronic kids that so many people sneer at come in VERY ill and in need of highly skilled care. Respiratory failure, aspiration pneumonia and septic shock are actually fairly common in that population, and kids with VP shunts can develop shunt malfunction leading to critically increased ICP or meningitis from translocated peritoneal bacterial contaminants. Status epilepticus is another potential admitting diagnosis you would see, and then there are the bowel perfs and sepsis that can follow fecal impaction. Some of the sickest kids I've ever looked after have been "chronics". I don't know what it's like where you are, but here ambulances are routinely routed to the closest ER when carrying an unstable patient and even our rural ERs see a number of very critically ill children each year.

[Damien201]

Thank you janfrn. That definitely helps. I did apply to all of the PICUs in the area, but was turned down due to "lack of adequate experience."

The other thing about the pedi ED is that I'll be asked to come over to the adult side if there are not any kids on my side. I'm not completely against working with adults, but I'd really rather not. Part of the reason I went with peds is so that I don't have to deal with whiny adults...just being honest....

But what I'm gathering from what you're saying is that it doesn't really make a difference and one won't be better than the other?

[meanmaryjean, DNP, RN]

I agree with janfrn - NICU is more like PICU than anything else. And if I am a hiring manager looking to fill a PICU job, I'm picking a NICU person over an ER person (almost all ERs have pediatric beds). Our PICU here in Indianapolis has a LARGE population of open-heart kids from the NICU at any given time.

[NotReady4PrimeTime, RN]

Since you're already leaning toward NICU, and there's so much overlap between NICU and PICU, then there's your answer! As marycarney says, PICU sees a lot of neonates post-cardiac surgery and we also see a significant number of very young infants with respiratory illnesses who might have gone to NICU except that they'd been home and so weren't eligible for NICU admission. The equipment ill be the same, the overall routine will be similar, although I think most NICUs have their own particular foibles. When we get a kid from NICU post-op we toss their Kardex and start over. When we transfer them back they change ALL of our infusions because we mix them differently. But really, it's not that big a difference.

[meanmaryjean, DNP, RN]

OH - and when I float due to low census - I float to NICU and they float to us. A good way to get 'known' to the PICU while you are gaining experience.