What to choose, NICU vs PICU?

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Hi everyone! I have been a pool nurse for a little over a year, working about 36hrs a week at a small community hospital. I mainly work on medical surgical units that are telemetry, but I've also worked on the observation unit, bariatric, stroke, psych, and rehab units. I usually have a 6 patient assignment, and have had 7 patients at least 3 times in the past year. We are constantly understaffed ( in every department, not just nursing) so the morale is really low. I think my job is very task oriented, and do not feel like I am learning much. I do not feel valued because I am constantly pulled during shifts and tend to have the highest acuity, most confused, and most needy patients. I am ready to move on to an area of nursing where I can grow and not have to literally give myself a pep talk before I walk in the door because I know I'm going to be taken advantage of.

I just applied to CHOP & have received a call back 😁. I applied to both the NICU and PICU. I understand that the NICU has patients that are 0-6 months and congential anomalies are commonly what brings them there. PICU seems to be more diverse as the ages range from 6months to 18 years. I was asked to figure out which ICU I'd prefer to work in, but I cannot decide. I would love to work with babies, but I am nervous that I won't feel competent. I felt the same way when I first became a med/surg nurse, but now I am comfortable. I'm hoping I'd feel the same way after orientation and knowing that I have the necessary resources in case I have questions.... because I ask alot!

Can any of you both PICU and NICU nurses please describe some

common diagnoses you see, what you love about your job, what makes your job difficult or hard to cope with? I really just want some insight before I blindly choose one! Thank you!!

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Specializes in Pediatrics, NICU.

I work in a level 3 NICU and here are some of our common diagnoses:

-prematurity (obviously!) ranging from 22/23 weeks gestational age upward

-respiratory distress syndrome

-chorioamnionitis/sepsis/meningitis (can be premature or full-term)

-hypoglycemia related to prematurity, underlying illness, or a diabetic mother

-cardiac issues such as VSD, coarctation of the aorta, ASD, etc.

-meconium aspiration syndrome

-hypoxia-ischemic encephalopathy (we use a cooling blanket to try to reduce potential brain damage)

-omphalocele and gastroschisis (intestines and potentially other organs in the umbilical cord or through the abdominal wall, respectively)

-congenital diaphragmatic hernia (diaphragm doesn't form properly and intestines take up some of the lungs' space)

-necrotizing enterocolitis (serious intestinal infection, can lead to perf)

-drug withdrawal (can be from prescribed methadone/subutex or illicit drugs)

Some common pieces of equipment we use:

-conventional ventilator

-oscillating or jet ventilator

-inhaled nitric oxide

-CPAP/SiPAP

-high flow nasal cannula

-whole body cooling

-isolettes including the Giraffe

-chest tubes

-arterial lines, including peripheral and umbilical lines

-PICC lines

I love watching our babies get better and bigger to eventually go home with their families. My favorite is taking care of a very sick baby and seeing them improve, whether it's on my shift or days/weeks later. Least favorite is when we are unable to save a baby or they have a very poor outcome/prognosis.

I hope this helps! Let me know if you have more questions :)

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I second everything NICUNurseEliz said.

Another thing that's unique to NICU that you might not find anywhere else in the hospital is the continuity of care. With adults, as their status changes, patients move to different units. For instance, a traumatic brain injury MVA patient might go to the ED, then Trauma ICU, then step-down, then a neuro/rehab unit. When you take care of a sick ED/ICU patient, you probably will never know what happens to them. In NICU, we take care of our kids from the minute they're born in the delivery room until we walk the patients and their parents out the door. You may take care of the same baby from the time they're 1 lb and vented until they're big enough to take a whole bottle themselves. It's incredibly rewarding to watch them get big and strong, and to celebrate as they achieve their milestones (i.e. coming off the vent, coming off oxygen, coming out of the incubator, etc.) You may or may not get that continuity of care in your PICU, depending on whether it's integrated into your Peds unit or if it's its own unit with separate staff.

In NICU we have moments of joy, which I believe is uncommon in acute care. Helping parents do skin to skin, putting a baby to breast for the first time, giggling when a pooping baby makes a goofy smile. I absolutely love it.

To be honest I don't know if anybody feels competent when they start in NICU, but you'll learn. The same can probably be said for PICU! I actually think adjusting to PICU would be much harder because the norms are so different at various developmental stages. I am in awe of the PICU nurses who know a normal/abnormal assessment findings in a 17 year old as well as they know them in a 1 year old. My hats are off to them!

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Go CHOP! You can't go wrong with either unit there. I hope I can get in at CHOP sometime in my adulthood. What a great opportunity!

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Specializes in Peds, GI, Home Health, Risk Mgmt.

Dear Soon To Be Peds Nurse,

A dedicated national children's hospital like CHOP is going to have very high acuity patients, especially when compared to less urban community hospitals. CHOP is also going to have many very unique diagnosis patients, lots of congenital abnormalities and trauma patients. Besides the difference between NICU and PICU patients in general, you should also consider the respective size of the two units and what sort of specialty care they do. Will you have to work with burn patients or heart transplant patients in the PICU? Do you have children of your own; if so, you may find it more difficult with with patients of the same age as you own. The NICU patients usually stay in that unit until they go home, while the PICU patients get transferred to other floors as they improve.

You should ask for a tour of each unit and the opportunity to speak to some of the staff RNs to find out more about what they like about their units.

Good Luck to You!

HollyVK RN, BSN, JD

former NICU & PICU nurse

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Thank you all sooo much for taking the time to reply! It seems that you all love being NICU nurses, and all I really want is to be able to say that I love what I do! I told the recruiter that I choose the NICU and I have an interview and shadow experience on Dec 11th :) .. keeping my fingers crossed!

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Hi novicenurse123,

thanks for your post, I was wondering the same thing about which unit would be better for me. Did you hear back about your interview and shadow day?! I recently shadowed in CHOP's NICU and I am interviewing in a little over a week. I was interested to see how it went for you!

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This has been a few years past now, but wondering how your NICU vs PICU experiences went and how you are enjoying being a specialized RN. I'm at a similar crossroads. ? Thanks!

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Specializes in NICU.
22 hours ago, GrenIedGal said:

This has been a few years past now, but wondering how your NICU vs PICU experiences went and how you are enjoying being a specialized RN. I'm at a similar crossroads. ? Thanks!

The OP has not been on here since Dec 10, 2015.

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26 minutes ago, NICU Guy said:

The OP has not been on here since Dec 10, 2015.

Thanks, NICU Guy. I realized but thought I'd stir up some action from anyone that was on here before and how the decision went. I'm pretty certain NICU is my calling, and know this is a personal decision for everyone, but figured I'd ask how it went. ?

PS- I like your profile pic/message!

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