Ykes! The PICU!

Pediatric Critical Care Columnist · Feb 23, 2009

I'm really sorry you were made to feel like you were in the way. None of that was your fault and you don't deserve to feel like you failed in any way. You learned several important lessons though. Such as people are in intensive care because they could go sour any minute without any warning. This is especially true for kids. What likely happened with this kid is that he "threw a plug" or moved around a glob of really thick secretions that he had no ability to move again.

You now know that people in a pre-arrest state will have behaviour changes, and the next time you see that happening for no reason, you'll call for help.

You learned how to use a cough assist device and will be able to use one in other situations without needing instruction. You might even find yourself in a situation where you suggest it be tried- and do the patient a big favour in the process.

You've seen a central line placed and now know what some of the uses of these are.

And you validated something about yourself that you already knew... peds is not for you. Perhaps ICU is not for you either, because these things happen with adults too. What you described is a fairly typical day on an ICU. It's why I continually advocate for appropriate staffing and appropriate assignments. On our unit, this patient would probably have been assigned to one of our junior nurses... and trust me when I tell you that their experience would have been very similar to yours.

This young man already had several strikes against him; kids with certain types of muscular dystrophy, even now, have a shortened life span. They are prone to respiratory infections due to muscle weakness and ineffective airway clearance; the muscle weakness also contributes to the development of significant scoliosis which only further compromises their respiratory capacity. They aspirate due to poor control of their swallowing. Several weeks ago our unit had a similar patient who'd had a spinal instrumentation. He developed severe SIRS (you might need to look that up) and we spent much of that first night just keeping him alive. He got 9 litres of fluid while progressing from dopamine to epinephrine to norepinephrine before we got his BP in a good spot. The nurses on that night were all highly experienced and we all felt the same pressure to perform. While it's unlikely that this boy will survive to see his 30th birthday, he's still alive and living his life NOW because of our care.

SnarfGirl · Feb 23, 2009

I'm really sorry you were made to feel like you were in the way. None of that was your fault and you don't deserve to feel like you failed in any way. You learned several important lessons though. Such as people are in intensive care because they could go sour any minute without any warning. This is especially true for kids. What likely happened with this kid is that he "threw a plug" or moved around a glob of really thick secretions that he had no ability to move again.
You now know that people in a pre-arrest state will have behaviour changes, and the next time you see that happening for no reason, you'll call for help.
You learned how to use a cough assist device and will be able to use one in other situations without needing instruction. You might even find yourself in a situation where you suggest it be tried- and do the patient a big favour in the process.
You've seen a central line placed and now know what some of the uses of these are.
And you validated something about yourself that you already knew... peds is not for you. Perhaps ICU is not for you either, because these things happen with adults too. What you described is a fairly typical day on an ICU. It's why I continually advocate for appropriate staffing and appropriate assignments. On our unit, this patient would probably have been assigned to one of our junior nurses... and trust me when I tell you that their experience would have been very similar to yours.
This young man already had several strikes against him; kids with certain types of muscular dystrophy, even now, have a shortened life span. They are prone to respiratory infections due to muscle weakness and ineffective airway clearance; the muscle weakness also contributes to the development of significant scoliosis which only further compromises their respiratory capacity. They aspirate due to poor control of their swallowing. Several weeks ago our unit had a similar patient who'd had a spinal instrumentation. He developed severe SIRS (you might need to look that up) and we spent much of that first night just keeping him alive. He got 9 litres of fluid while progressing from dopamine to epinephrine to norepinephrine before we got his BP in a good spot. The nurses on that night were all highly experienced and we all felt the same pressure to perform. While it's unlikely that this boy will survive to see his 30th birthday, he's still alive and living his life NOW because of our care.

Thanks for the encouragement! I actually found it to be somewhat exciting (in a wierd way) I just wish I knew more....instead of being a fumbling student...I know I'll get there some day. And you are right- I did learn that PICU is not for me, just because it's kids...but for some reason I think I might like adult ICU more. I start that rotation in 2 weeks and I'm looking forward to it. By the way he did have Herring Rods also, r/t the scoliosis.... I hope you will continue to advocate for appropriate staffing, had that kid not had the nursing staff he had - who knows what would have happened. . . Thanks again!

Pediatric Critical Care Columnist · Feb 23, 2009

I'm glad I could give you some perspective. PICU really isn't for everybody and I wish more people would recognize that sooner. I believe that to be a good PICU nurse, you really have to love it. But it sounds as if you learned something else about yourself and that is that you are able to think through critical situations. If you choose ICU later, that will be a valuable asset. Nobody says you can't be Jell-o after the fact, but if you can keep your head and do what's necessary in the moment, you'll do great.

I will continue to advocate for adequate staffing, at least for now. I'm feeling more than a little burnt out these days and feel like I'm the only one who's willing to stand up and say what needs to be said. I have arranged a meeting between front-lines staff and management for a couple of weeks from now and have been encouraging people to come and air their own grievances but I fully expect that I will be the only front-lines nurse there. Again. And I'm telling people now that if I don't get some support, I will stop listening to their beefs and they can live with it.

(BTW, they're Harrington rods...)

SnarfGirl · Feb 23, 2009

I'm glad I could give you some perspective. PICU really isn't for everybody and I wish more people would recognize that sooner. I believe that to be a good PICU nurse, you really have to love it. But it sounds as if you learned something else about yourself and that is that you are able to think through critical situations. If you choose ICU later, that will be a valuable asset. Nobody says you can't be Jell-o after the fact, but if you can keep your head and do what's necessary in the moment, you'll do great.
I will continue to advocate for adequate staffing, at least for now. I'm feeling more than a little burnt out these days and feel like I'm the only one who's willing to stand up and say what needs to be said. I have arranged a meeting between front-lines staff and management for a couple of weeks from now and have been encouraging people to come and air their own grievances but I fully expect that I will be the only front-lines nurse there. Again. And I'm telling people now that if I don't get some support, I will stop listening to their beefs and they can live with it.
(BTW, they're Harrington rods...)

Yes...Herrington Rods....I knew something didn't sound right there :icon_roll

Good luck with the meeting - it takes good nurses like you to really get something done. If I were in the PICU I'd want people like you taking care of me or my child. Thanks for your insight, and I learn something more about myself everyday I am in clinicals, and I really think that one of these days I will be a darn good nurse . . . just going to take time..

Pediatric Critical Care Columnist · Feb 23, 2009

Thanks for the support.

I know you're never going to stop learning, about caring for others, knowing and caring for yourself and making choices that work for you. The day we stop learning is the day we should quit. We'll never know everything and it's a waste of effort to attempt it, but we can know a whole lot! You will be a darned good nurse, I feel it.

SnarfGirl · Feb 23, 2009

Thanks so much!

live4rachael · Feb 24, 2009

What a very crazy day for you as a nursing student. Kudos for surviving and keep it up!

As a parent of a child who was in a similar situation (she passed away in a PICU after having similar experiences though only 7 months old; she had Spinal Muscular Atrophy - a type of MD), I still remember what those days were like, Cough Assist and BiPap and suction and sats that won't maintain. And those nurses, God bless them. I remember so many of them and their passion, their drive, and their true love in taking care of mine and all those other kids. I didn't understand how they did it, but now am excited to help others eventually, though I've got a long ways to go (I'm in semester 1 of 4).

If you are sure you don't want peds, then kudos for you on knowing about yourself. That's half the battle. It sounds like you've got the makings of a great nurse.

SnarfGirl · Feb 24, 2009

Thanks for the kudos. I am sorry about your baby :crying2:

Trust me those 4 semesters will go by very fast - good luck!

live4rachael · Feb 25, 2009

Thanks, you too!

I appreciate the condolences. Sweet Rachael (hence my username) is who motivated me to be a nurse. I started nursing school 3 years to the day of when she passed (tell me that was a coincidence...)

SnarfGirl · Mar 1, 2009

Just thought I'd pass on that the patient I refered to in my original post died after I left :cry: . I found out when I went back today...I am glad he's not suffering anymore but I feel bad for his family. The RN said they chased him all day and the rest of the night but he just couldn't maintain resp and BP no matter what they tried. He finally coded and they were unable to get him back.

Is it strange to be glad that he went and doesn't have to suffer....it's a very confusing feeling. I'm sad, yet relieved he doesn't have to live the way he was....

live4rachael · Mar 1, 2009

Sorry to hear the news but I think your confusion is right on. It shows your concern for the patient's well-being. Of course you're sad but the not suffering is a bit of relief.