What to look for in a PICU

Pediatric Critical Care Columnist · Feb 10, 2006

You want to work in a unit that values its staff. Ask about the type of assignments you can expect in your first year. Ask about how your skills and knowledge base will be built. Ask about nurse-patient ratios. 1:1 is the best you can hope for usually, but 1:2 can be doable with the right patient mix. 1:3 is, in my opinion, unsafe. Ask if staff are happy working there. How much sick time is being used? How many are on stress leave? How much overtime is worked? What is the turnover rate like? Is there a place close to the unit but not on the unit for staff to take breaks? Do staff GET their breaks? What is communication like? How is bullying dealt with? What are relations like between disciplines?

You should decide what your values are before you decide where to work, and let those values guide your decision. It's possible to compromise on some things but there are other things where you just cannot look the other way. Only you know what you're comfortable with. If your internal alarms are going off, then run!

at8588 · Feb 10, 2006

Thank You! I have interviews coming up and the information you provided will be a huge benefit!!! One of the PICU has a large turnover and that makes me really nervous. I also hear other nurses from other floors complain about PICU nurses. This hospital is far more advanced than the other one I'm thinking about. I'm not sure if the turnover alone or bad talk should scare me away. Thanks you for help!!!!!!

Pediatric Critical Care Columnist · Feb 10, 2006

I'd be nervous about high turnover too. Our unit is currently in crisis and people are leaving in droves. Our manager is a bully and she likes to have bullies in charge when she can't be there. So there's quite a reign of terror going on.

PICU nurses often have a reputation for being "superior". We do have about the broadest scope of practice possible and we have a lot of responsibility. Some of us like to flaunt that. I think we tend to forget that our knowledge and skills base is much broader than theirs and it's easy to look down on them when they don't know what we're talking about. I have a great deal of respect for nurses on the floors. They have a huge workload and need to be very organized just to get through their shifts. Transfers to or from PICU can be very stressful for everyone, and we should strive to remember that.

That said, PICU isn't for everyone. Many nurses think they'll love it and can't believe it when they don't. The smart ones realise that they're never going to love it and move along. If that's the reason for the turnover in the unit you're looking at, then I wouldn't be too worried. But if it's the experienced old war horses that are leaving, that's a sign to you! You could always ask in your interview, "What are the reasons most people give for leaving PICU?" Then watch the interviewer very closely to see how truthful you feel the answer is.

I wish you luck. If PICU is the place for you, you'll know it sooner rather than later.

RNNPICU, BSN, RN · Jun 8, 2006

I have recently accwepted a job in the PICU and I asked about the turnover rate for new grads - of the six that started last year four made it through the program - the PICU had a celebration for them. I asked the reasons the other two did not make it - one became very ill and had to stop working, and one needed to get her skills up and was made to transfer to a medical floor. One thing I also asked about was how the "old" PICU nurses treated the "new" PICU nurses - the manager answered very truthfully and said at first there was some resistence but now that seems to have sorted out.

Pediatric Critical Care Columnist · Jun 8, 2006

I'm glad you found a good unit that is accepting of new grads and provided them with useful feedback. Unfortunately there are a lot of units out there that don't. The turnover in my unit is largely the old war horses these days, for reasons I won't go into, but related to the way the staff are treated by management. The new nurses, especially new grads, have no measure for comparison and don't realize that things are as bad as they are. Morale is at an all-time low and there seems to be no end in sight. Good luck to you!

scnewgrad06 · Jul 15, 2006

Hi! I was wondering if you took that position on the PICU and how is it working out? I had a position on a PICU but ended up leaving the unit because it wasn't for me. I'm looking forward to hearing an update on your experience! :)

at8588 · Jul 17, 2006

I did accept a job in one of the PICU. I began orientation in June. Currently I am attending classes and have days on the floor but will not be on my own till June. At times I love being there and at other time I worry I made a horrible decision! I have spoken with my fellow new coworkers and they all express the same fears. I truly believe I will always enter the PICU with alittle fear. Gradually I hope I will feel more comfortable. I think the main issue is that I surrounded by brilliant people and that can be imitating at times but it also gives me inspiration for the future! I think this is an area I am going to love! Just wondering.. why did you leave the PICU??

scnewgrad06 · Jul 17, 2006

I left due to a mutual decision between myself and the unit manager. I wasn't happy with the orientation process. I believe that is because I had set high expectations. I visited several hospitals before accepting the position I did. While the hospital I accepted at is a wonderful hospital, the unit wasn't a fit for me and my needs. :nurse:

Good Luck on your unit and keep my posted!