The Rewards of PICU Nursing


By Susan Kreimer, MS, contributor

For four years, Kristen Hall, MSN, RN, has been taking care of children who face life-or-death struggles.

“We are with these patients and their families through the highs and the lows,” said the 26-year-old pediatric intensive care unit nurse at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

“The real reward,” she continued, “is having a once-critically-ill child come back for a visit just to say ‘hi’ and ‘thank you.’”

In the midst of the nationwide nursing shortage, staffing demands have hit critical care units especially hard. PICU nurses can exercise many options when deciding where to work and live, whether they are looking for a permanent job or short-term assignments.

Meanwhile, the PICU presents new challenges. “We’re seeing sicker kids. More things are being managed at home, so any kids we do get in the hospital are usually sicker,” said Joan Albert, RN, MS, one of two shift supervisors in pediatrics and the PICU at Mercy Medical Center in Cedar Rapids, Iowa.

Albert’s staff nurses tend to children suffering from drug overdoses, diabetic ketoacidosis, respiratory distress and other emergencies. Patients who need more intensive care, such as open-heart surgery, are taken to the nearby University of Iowa Hospitals and Clinics in Iowa City.

“Interdisciplinary care is vital, and the ability to be autonomous and valuable in the total care of the child is what PICU nurses are all about,” said Marcia Summers RN, BSN, director of patient care services in the critical care center at Children’s Hospital of New Jersey in Newark.

While collaborating with physicians, “PICU nurses rarely leave the bedside during their 12-hour shift. Many nurses have only one patient, and at the most, two.” This holistic approach requires attention to every detail.

“Not only do you take care of the children, but their parents and often extended families,” Summers said. “You become very close to many of the children. They are so vulnerable and have special needs.”

Although kids can become seriously ill very quickly, the majority who are admitted to thepediatric intensive care unit get better. Sometimes families stay in touch with the staff long after they go home. “We often get Christmas cards from past patients, and to see them and their parents looking so happy gives the nurses their reason for doing what they do every day,” Summers said.

Starting in pediatric intensive care as a new graduate can be hectic and is best-suited for someone who is enthusiastic to tackle challenges, according to Maria Fernandez, RN, BSN, manager of the PICU at St. Louis Children’s Hospital. “The nurse has to be prepared for a wide variety of patients.”

Not only do the diagnoses differ, but so do the ages of the patients. Patients range from less than a year old to 18 or slightly older if a pediatrician has followed their chronic illness.

“A PICU nurse has to be able to focus in an environment where things can happen at any time,” Fernandez said. Although multiple personnel arrive for emergencies, “A nurse can’t just stand in a corner and let somebody else do it.”

As part of managing the largest PICU in the state (19 beds), Summers recruits applicants from across the country to work at Children’s Hospital of New Jersey.

In addition to the permanent staff members on the unit, she also recruits PICU travel nurses when necessary, to fill certain needs.

“It takes a very confident, competent PICU nurse to go into another PICU and be able to function because of the highly specialized and increasing technology involved,” she said. “They are worth their weight in gold, and I would love to have these nurses come to my unit.”

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