Pediatric ICU Nurse Interview

Introducing a new series here on Student Nurse Teacher: nursing specialty interviews! I will be interviewing nurses of various specialties, giving them a chance to share why they love their job, and giving you a glimpse into their roles! 

The first nurse is my friend Kimberly. Kimberly and I went through nursing school together. We sat together in classes, shared clinical experiences, and now support each other in this grand adventure of nursing. She is an excellent PICU (pediatric intensive care unit) nurse. Here is her story. 

What type of nursing do you do? 

Pediatric ICU - the ratios are 1:1 or 2:1. I can get anything from a seizure kid who is intubated on sedation drips/paralytic drips to a full-blown septic shock case on 3-4 vasopressors, sedation, intubated on the oscillator and on nitric. Also sprinkle in there the Level 1 traumas post car wreck, some of which end up being organ donors. 

Can you tell me a little bit about yourself and why you chose that specialty?

I have always wanted to do pediatric nursing, and I loved our critical care class in college as well as the ICU clinicals. I thought that maybe one day I would start out on a general pediatrics floor then "someday" transfer to a small ICU. About 9 months into my nursing career, I was dreading going to work on the MedSurg floor. I decided it was time to find something I actually liked, and so I started looking at availability across the country in pediatric hospitals. I found a few openings at Children's of Alabama, and I applied to 10 different jobs on different floors. I got 4 callbacks for the Peds ED, ICU, CV-ICU and pulmonary medicine floor. After interviewing, I knew the 22-bed PICU was the one for me. I haven't always loved it, but at the end of the day, it makes me excited like nothing else. I love a good trauma, full arrest or septic shock coming through the door that needs all the things. 

How is your specialty unique to other types of nursing? What are some of its specific challenges and rewards?

It's unique because of the patient population. These kids haven't been around long enough to develop drug addictions or realize the world is a bad place. They look at life differently, giving them more courage and strength. They also have the ability to bounce back so much better than adults, which means they have much better outcomes long-term after a TBI or code event. Usually the majority of my challenges come in dealing with families and parents. You have to have those difficult discussions about quantity vs. quality of life for their children and incorporate them as much as possible in to the decision-making process. However, it's so rewarding when you get to see the kids get better and back to their baseline so that they can go home. 

Did you work in another specialty before going to this one? If so, how did your prior experience help you prepare for what you do now?

I worked on a pulmonary medicine floor. It was a trach/vent floor, as well as being the grandma-casserole floor of the hospital (you got a little bit of everyone's leftovers). 😄It was a good starting point. It helped with my time management, established how to do basic procedures and taught me a lot of valuable skills. 

Is your current job a step towards a bigger goal?

Yes! I am currently in the process of applying for DNP school. I would like to get my Pediatric Acute Care DNP and work in a hospital setting, probably an ICU or ER. 

Did you need special certifications to work where you do? If so, how did you get them?

Always PALS [Pediatric Advanced Life Support]. Typically, your hospital will provide that class for you upon hiring. CCRN is a great certification to get. It takes a couple weeks to study for, and then you just apply and take it like the NCLEX (don't break out into cold sweats - I hear it's not nearly as bad!). 

What is a "typical" shift like?

Is there a such a thing as typical?😉 All joking aside, usually I start out by writing down all my meds, then go assess my patients based on acuity or whoever has meds first. If it's dayshift, you get as much as you can get done before rounds. I try to be very familiar with both of my patients so that I can contribute as much as possible during rounds. After rounds, I try to implement the new orders as soon as possible. If it's night shift, you scrub the stinky little children and tuck them in for bed! The most important thing in my shift is to roll with the flow and be as caught up on everything as possible because you never know when a kid will start circling the drain. Always have your emergency equipment at the bedside (bag, mask, code sheets, kid's weight/epi dose memorized), always pay more attention to your patient than your monitors. And as for memorizing the epi dose, just take the kilos and move the decimal point one spot to the left and that's how many mL you give (i.e. a kid weighing 5.6 kg will receive 0.56 ml of epi). 

What would you tell a nursing student interested in your specialty? 

A majority of the best nurses I have ever worked with in PICU didn't start in PICU. They started on either a pediatric step-down or general floor (or a different specialty) and then transferred. You get amazing time management skills and get to learn how to be a nurse in a much lower-stress environment (not saying all floors are a cakewalk, but definitely less stress than the ICU). You should also consider a shadow day before accepting a job anywhere, that way you get a feel for the floor, how things work, if the people are nice and whether or not you like the work flow. Overall, if you want to get into peds, the better experiences are going to be found in a free-standing pediatric hospital. They're prettier and have better toys (and parking)! 

Any thing else you would like to share?

Always ask questions. Always keep learning. Never get to the place where you feel like you know it all - because you will make a mistake. And find something you love doing - it will make getting up at 5 am much easier!

Thanks, Kimberly! If you have more questions about the PICU, you can contact Kimberly at peanuts.kim@gmail.com or on Instagram @shortnurse93