What's it like to be a PICU nurse?

Double-Helix, BSN, RN · Sep 19, 2011

I've only been a PICU nurse for three months, but I have gained a huge perspective in that time! Being a PICU nurse is exciting, heart-breaking, frustrating, scary, and wonderful all at the same time.

Imagine taking care of a child on ten seperate medication drips who is on a ventilator, has three central lines, arterial line, a CVP and a foley. You're drawing hourly blood gases and blood glucose levels, counting all of your I&O's hourly, monitoring the ventilator settings, constantly alert for any changes in vital signs, making sure your syringes of pressors don't run out, hanging so many medications that you are running out of lines to use. You're giving updates to the docs and making adjustments to your drip rates based on their orders. You need to turn your patient every two hours, which requires two other nurses to help move the patient and keep the breathing tube in place. To top it all off, you have angry family members scrutinizing everything you do and demanding that certain non-essential things be done immediately.

Being a PICU nurse is never boring. There is always something new, something that needs to be done. I've taken care of kids with so many different diagnoses that I couldn't possibly list them all. Our unit is a 19 bed PICU that takes all different kinds of kids. Our hospital has a pediatric cardiac surgery program, so we always have at least a few cardiac patients with various congenital cardiac defects. Depending on the season, we usually have a couple kids with viral illnesses, particularly RSV in the winter months, one or two babies on observation for apnea, asthma exacerbations, ex-preemies with chronic medical issues and heme-onc patient. Most of the pediatric surgical cases bypass the PACU and we receive them directly from the OR. So we get tonsillectomies, thoracotomies, traumas, amputations, appys, cardiac cath's, neuro surgeries, etc, etc. Our general peds floor does not have monitoring systems, so any patient that requires continous monitoring of any kind (HR, rhythm, O2 sats, respiratory) comes to PICU.

Skills:

Solid assessment skills are crucial. Kids can't tell you when something is wrong. You have to know what's normal and what isn't and be alert for any changes that might indicate the child is deteriorating.

Critical thinking: why is this patient presenting like this and what does it mean? What am I going to do if this kid goes south? What do I need to have on hand in the room in case of an emergency?

Prioritization and time management: You've got a lot to do. You need vital signs on all your kids at noon time and you also have three IV meds to hang, several po/GT meds, one kid needs an enteral feed and the other needs labs drawn and another has an infiltrated IV. What's most important? What can you get done early?

Communication: With docs, with parents, with the kids. Parents of sick kids are nervous wrecks. They have a lot of questions. You need to be able to explain what is happening in terms that they can understand. You need to explain things to the child. You need to convince a sick and scared child to swollow their medications. You need to explain to the doctor why you think one of your kids needs a different type of treatment. A big part of your job is communicating. And don't forget giving and receiving report.

My day begins at 6:45am and on a good day I leave at 8pm. Most days I eat lunch at the nurses station in five minutes so I am never far away from my patients. If I use the bathroom once I am lucky. But these are "my" kids, as I refer to them. They are my responsibility and whether I've taken care of them for an hour or three shifts, I love them. There is no other specialty like PICU, and there is no other place I would rather be working.

Jdjmj · Sep 19, 2011

Ashley, thank you for the great response! I now have a better idea of what PICU nursing is really like. I have a PICU interview coming up and am hoping I can demonstrate I have the skills you mentioned.

Double-Helix, BSN, RN · Sep 19, 2011

Good luck on your interview!! What state are you in, if you don't mind my asking?

anon456, BSN, RN · Sep 19, 2011

Im starting day four in a couple of hours and I cant agree more with Ashley! I really love the close teamwork of the staff that is needed to keep these kids safe! Just remember how important that teamwork is because in the PICU you need that network of support and different abilites and experiences.

The patient that Ashley describes is a more complex one and you often have a two to one ratio on those pts. I am new and have so far cared for a New TBI, a post op neuro, a vent pt with pneumonia, and a baby with bronchiolitis who was only on minimal meds but lots of oxygen support and suctioning. These are the "beginner" patients. Each one is so different and has so much to teach me. Last night I saw a baby smile for the very first time after finally feeling better. I didnt tell mom as I want her to be the first to "discover" it for herself. It was one of those great moments for me. I have also learned that some of the best parents are those who are very young, limited education and resources, yet very educated about their kid.

The whole thing has just been very rewarding.

BeachsideRN, ASN · Mar 24, 2015

I know this is an old post but I love reading these stories.. I am career changing into nursing and PICU is one of my big interests. I am really into oncology - since I did hem/onc research prior to going to nursing school and I think I want to work with the pedi population. I am even considering going on to become an NP or CNS. I can't wait until we get to the peds floor in school!

sergel02, BSN · May 23, 2015

It seems great to be able to see a kid get better from when they came in.

Just curious, but what do you prefer about PICU over floor?

Pediatric Critical Care Columnist · May 24, 2015

For me there are lots of aspects of PICU that drew me in. I like the complexity of care, the variety and the pace. I also like getting to know families and help them understand their child's illness, what we're doing about it and what to expect next. I'm not saying that doesn't happen on the floors too, but I think the scope is different. I enjoy the autonomy of PICU - we make a lot more decisions and are a lot more involved in planning and executing care than nurses on the floor. We provide treatments that aren't available outside the ICU, such as continuous renal replacement therapy; exchange transfusions; infusions of certain blood products; establishment of high-flow oxygen, biphasic positive airway pressure and continuous positive airway pressure and - of course - extracorporeal life support. Every day is a challenge on one level or another. What we do is usually the difference between living and dying.

nurse-samie · Jul 17, 2015

NotReady4PrimeTime said:
For me there are lots of aspects of PICU that drew me in. I like the complexity of care, the variety and the pace. I also like getting to know families and help them understand their child's illness, what we're doing about it and what to expect next. I'm not saying that doesn't happen on the floors too, but I think the scope is different. I enjoy the autonomy of PICU - we make a lot more decisions and are a lot more involved in planning and executing care than nurses on the floor. We provide treatments that aren't available outside the ICU, such as continuous renal replacement therapy; exchange transfusions; infusions of certain blood products; establishment of high-flow oxygen, biphasic positive airway pressure and continuous positive airway pressure and - of course - extracorporeal life support. Every day is a challenge on one level or another. What we do is usually the difference between living and dying.

I'm currently a floor nurse on a specialized adult neuro floor. I'm considering switching to the PICU. And alot of what you just said has scared me silly. On the floor we dont have much autonomy. We read the plan of care "the instructions" and we carry it out. Mixed in with feeding the patient, bed pans, refilling pitchers of water getting snacks and etc. on occasion a pt will need a blood trasnfusion or IVIG treatment but thats about as complex as we get. If they go south we call an RRT. I fell as though for lack of a better term the floor has made me "lazy" and "less smart" and I feel as though I've lost a lot of the critical thinking that I learned in school and I feel as though this holds me back from going to an ICU. What is your advice ? I feel so confused :down:

Pediatric Critical Care Columnist · Jul 17, 2015

Oh no, please don't let my post scare you away! Of course PICU will be very different from what you're doing right now but no one is going to expect you to function at the level of someone like me, with 17 years of PICU experience. For the first while when you're learning the ropes, your assignments will be patients with single-system illnesses (mostly respiratory) and then as your skills and comfort level grow, you'll get sicker and sicker kids. You may be spoon-feeding toddlers occasionally at first, but not often; PICU kids don't get pitchers of water... they have no self control and the barfage isn't worth it for them or for the nurse. I feel like there's a lot more interdisciplinary teamwork in PICU than on most other floors. We work closely with our physicians, respiratory therapy, dietary and pharmacy to ensure the patients' needs are met; our care plans evolve rapidly and are patient-centric. You'll always have somebody to back you up. The more complex therapies provided in the PICU are not provided by novices on the unit. You'll grow into your role. If I can do this job, anyone can.

al3x117, RN, EMT-B · Oct 17, 2016

Fantastic Post!!! :)

kaewing2003 · Dec 8, 2016

Thank you for this information. I am returning to the PICU (hopefully, interview Friday) after being a PCICU nurse for one year and then a 5 year hiatus to do utilization management with only a couple years of PRN med/surg and hospice nursing during that time. I feel like I am a new grad again. I have been cramming my brain full of all the things that I can remember were important in the PCICU. After reading this post I realize that there was a lot that I had forgotten. I am scared but hopeful that I will still make a great bedside nurse and be able to pick up on all the new skills and recall the old ones. Thanks again!