Hey everyone - about to start working toward my CCRN - Pediatric. What do you recommend for studying to ensure a successful outcome? Appreciate any tips!

Hi! I got offered a job as a new grad nurse in a PICU with a ratio of 1:3. Is this ratio normal for PICU or should I be worried? It’s a 12 month residency program with 13 weeks orientation.

Any insight would be greatly appreciated! Thank you

I’m a 4th year MD student who has always loved peds. My little sister grew up really sick and I have wanted to do peds since I can remember. I know a lot of people think that as kids and then change their mind but honestly all through med school I have loved peds and haven’t wavered.

But I’m doing an away at a top 5 peds hospital in the PICU this month and some moments have made me wonder if I can do this. Prior to yesterday, I had never seen a child die, but I had to do CPR on an already dead 2 month old whose mother had rolled over on her while co sleeping and I was traumatized. I then had another 5 month old w new found Sturge Weber I admitted last week go into the most insane status epilepticus I’ve ever seen where eventually we just had to intubate and sedate her because she’d had over 2 hours of seizures today despite all efforts to rescue. I’ve grown so close with that family this week and when her mom kissed her head and said “please just stay with me,” all I could think about was how horrible this baby’s prognosis is and how I know nothing I do can help.

I feel like this has exposed me to babies that I can’t save and I think overall I’m handling it well but idk if I want my life to be full of this, and I’d be lying if I said the last two days haven’t drained me emotionally. I can’t imagine a life of this. Of course there have also been many wins, but I still see that lifeless baby under my hands when I close my eyes.

Any advice? I mean my ERAS is done and I haven’t submitted but idk what else I would do bc this is what I’ve always wanted. Are the first few the hardest? I do think I can handle it better than most bc of what I went through with my sister, but sometimes there is break through of just imagining how awful it is for these families, and I don’t want to ever be at a point where I have to numb myself to the emotions to get through the day because I want to be empathetic in my practice.

Any advice or encouragement is needed.

What is nursing really like in the PICU?

Hello all, I’m looking to get a quick rundown of PICU nursing. I’m applying for residency and interested (from my own research) but never got to shadow PICU , only general peds. Wondering:

• day to day tasks
• types of patients you’ll see
• things you should know
• things to consider before accepting job in PICU
• red flags of PICU
• life on the unit
• what you’ve learned since working in PICU
• considerations that make PICU special/different

stuff like that! I’ve googled and watched every tiktok out there but wanna hear from real people :)

Does anyone have any experience working as an attending in the PICU at Kaiser in NorCal or SoCal? How does it compare to working at an academic place?

I’m a resident interested in picu fellowship. A couple of my attendings have had very different opinions so I wanted to see what the internet thought, anecdotally. Of course I’m doing a literature review as well.

For drowning events, are you all routinely giving fluid boluses, regardless of hemodynamic state on presentation?

Any picu attending here can give me an insight about how attending life is, and what is the pay range of a picu attending. Also want to know what are the best program to consider for a picu fellowship.

I would really appreciate all the help.

Hi, I am a newer PICU nurse and have only been working on a small 15 give or take bed unit. I had a kid who had no orders to be NPO, a regular diet was ordered. There was an order put in at 6:15 am for IV morphine and versed to fit a cast that morning with a rep who was coming in. When I was leaving the unit to go home I got a call from the charge nurse and doctor asking why I gave the kid food… there was a snack in the room all night so I guess the kid woke up wanting to eat it. (Also was getting PO pain meds every 3 hours.) I felt so dumb because I should’ve know better that even a bedside “light sedation” we should stick to npo out of caution but I was running around all night with a bunch of other patients as well. (I know surgery is strict NPO at midnight.) I got 3 admits that night alone. My director was told this and my assistant director apparently stuck up for me saying- “she had no orders for that- she had regular diet orders.” They ended up being able to do it with just morphine.

Is this just a know better do better issue? Or this DR messed up and felt dumb and wanted to put it on me? (She loves a good power trip) also now realizing I do not trust working with this doctor at all and she is the MAIN one on. I am trying not to obsess over this but it’s eating at me..

Please anyone give me standard protocol for DKA management.

Any online course available for picu. I am a pediatrician. I usually work lot in NICU . But want to work more in PICU . Is there any online course available?

Has anyone transitioned from adult ICU to PICU? I’m wondering how different they are and how hard the transition would be.

I have been a nurse for 2 years (1.5 year in med/surg and 6 months in icu). I learned I like the ICU but I am getting burnt out from the adult world. My patients are heavy so I come home sore even though I’m 24. Also seems like many of the adults don’t listen to the advice we give them then they come back for the same reason (skipping dialysis or continue to smoke etc..)

Thank you for your input.

What are some good PICU/pediatric journals which accept case reports, any help is appreciated?

Any recommendations to give current graduating residents who will be starting ICU fellowship in the summer? I.E. books to read, articles, papers, videos..

I’ve been working in the NICU (level 3) for about 2 years and absolutely love it, but am finding it to be a bit repetitive. I advanced very quickly in my unit and love the highly acute patients and resuscitation nurse shifts. However I am still young and would like to challenge myself. I am concerned because I am very well aware that the PICU is completely different than the NICU and it would be like completely starting from square one. I was wondering if someone could give me a run down of what it is like working as a nurse in the PICU?

a free educational resource for pediatric surgery with a good library of mcqs, videos, charts

https://pediatricsurgery.club/

I’m a fairly new PICU nurse and I am in search of some guidance from seasoned PICU nurses willing to help me gain some confidence and improve my performance and skills. I was under the impression that I was doing well only to learn that how I perceive my performance is not the same as how others perceive it which was disheartening to say the least. It’s not a safety concern, it’s just not being at the clinical level that it’s believed I should be. What do I do going forward? How do I help myself to become a stronger PICU nurse?

Im newly hired at a small community hospital with very....strange practices. I wanted to ask if anyone has had similar experiences with similar management of a DKA pt.

The intensivist stopped checking gasses when the pH was 7.2 and not fully corrected. Additionally he allowed the pt to PO a full regular diet prior to being fully corrected and while still on the insulin drip.
My question is, has anyone else ever had an intensivist be this liberal with management? And if so, have the explained why they would stop checking gasses and allow a regular diet prior to correction?

What are your nurse to patient ratios for a new-admit, new-onset DKA?

Ex: blood glucose >1000, pH <6.5, bicarb undetectable; altered mental status —> potassium <1.8; Mg <1.5 despite 2-bag system and repletions.

Would you have other patients with this patient and, if so, how many?

Also, do you guys use intra aortic balloon pumps, pacemakers, CRRT, Swanz Ganz Catheters?? What type of modes of ventilation do you more commonly see? I’m a newer nurse in a different field trying to learn more about what you see in the PICU. Thanks!

Hello,

We are engineering students working on a senior design project about NG tubes for premature babies. We would greatly appreciate if you could fill out the survey below.

https://forms.gle/R97w9QcSwew356AZ6

Thank you so much for your time.

Hello! I am a current bioengineering student at Pitt and my and my team are looking for information into trach tubes in infants/ children and some common issues or complications people have encountered whether than be with insertion, management, or really anything. Any insight helps! Thanks again!

I have one year of nursing experience. I’m interested in switching to PICU and I have a few questions. -What are the pros/cons? -Does the schedule vary per child or are there care times? -What do 1:1 vs 1:2 assignments look like? -What types of things do you do/see on a day to day basis - drips, intubations, cooling, etc? -Are there different levels of PICUs? -Anything else you think I should know Thank you in advance!!!

I’ve been working in the NICU since I graduated May 2022. I worked as a tech and desk clerk there for all 4yrs of college. My mom has worked there for 36 years now and my sister also worked there from 2015-2018 (both as charge RNs). They used to have the highest retention of any unit in our hospital system. It was so competitive to even land a position in the unit.

Please try to refrain from negativity, nurses see/hear enough of it at work (and in the world in general). I know COVID has wrecked pretty much every unit in the hospital system but curious to read if anyone’s had success with rebuilding their unit.

One of my coworkers recently started a nurse wellness committee and ran a bake sale to raise funds to provide snacks a few times a month to staff. She also began doing a water drinking and steps challenge and placed all of us on teams. (In response to our annual staff satisfaction survey).

I love my job and want to strengthen it and make it a place where people want to show up despite the long hours and the insufficient pay and burnout etc. etc. etc.

I’ve been working in the nicu since I graduated in May 2022. I was speaking to an older traveler a few days ago who told me (politely) that our nicu in particular is really old school. She said she feels micromanaged here compared to some of the places she’s been. She mentioned Colorado Children’s has PRN X-rays (and I think PRN blood gases as well)… but they’re only able to do it because their providers give a ton of education to their nurses. In my unit, we of course rely heavily on our NPs and providers and do not have the liberty of ordering x-rays. I wouldn’t even know how to interpret the dang thing. :/

Was curious what sorts of RN education that would be? We have a S.T.A.B.L.E. course in my unit taught by our attendings and of course there’s RN-Certification but I’m just curious what other types of education are out there. I’m not going back to school and I know there’s online CE and conferences.

Should I just study a textbook? That can’t be all there is, right? There’s tons of stuff out there for adult critical care but the infant population has vastly different anatomy and physiology.

Any suggestions or experiences with any of the above?

Hi everyone, I'm a Ph.D. Student in Pediatric Psychology at Northeastern University and I am recruiting participants for a study that examines the barriers to visitations of primary caregivers (parents or legal guardians) during their children’s (ages 0-3) admission to a pediatric intensive care unit (PICU) or pediatric post-acute care hospital (pPACH)/Pediatric Rehabilitation. I am passing this information along in case there are individuals in your hospital, community, and network who may be interested in participating. If you would be willing to share information about the study with your organization and community, it could significantly contribute to the success of the research, and I would be deeply grateful!

To participate in the study:
- Primary caregivers must be at least 18 years of age.
- Primary caregivers must be able to read and respond to questions in English or Spanish. 
- The caregiver’s child must have been admitted to a pPACH or a PICU in the United States within the past 3 years.
- The caregiver’s child’s admission lasted, or has lasted, at least 28 days.

Participation in the study involves completing a 25-30-minute survey, available in English and in Spanish.

Please feel free to reach out with any questions or concerns. Thank you in advance for your time and consideration.

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Just curious if all units change their sterile fluid tubing/bags q24hrs despite the recommended practice of q48 (reduced risk of infection). If so, why?

I've only been an RN for 1 year so forgive me if the answer is obvious. Our unit does q24hr sterile fluid changes regardless of what the fluid is. The reason I'm asking is that I stumbled upon a NICU physicians' forum discussing this topic and figured I'd ask others ab this.

Working on a noise reduction bundle for my unit and thought I'd check with how other facilities tackle this difficult issue. Here's what I have so far;

Behavioral changes:

• staff education (ELearning module) on NICU noise bundle and the role each staff position plays in noise reduction
• elect “Sound Supervisors” from nursing at safety briefing ("unit huddle")
• “Shh.. I’m growing” signs requesting quiet voices and silenced cell-phones.

Environmental changes:

• ear protection be placed on all LBW infants,
• routine unit-wide “quiet hours” during both A-shift and P-shift
• sound-proof furniture with silicone bumpers on all metal bedside cart drawers and isolette doors,
• tuning alarm volumes to emit a max of 50dB. *Visual sound meters alone were noted to be unsuccessful in reducing sound.

I just finished my 1st year of medical school and will be starting an internship in the PICU soon. What are some of the most common diseases or protocols I should be familiar with prior to my start date? I was told I will be assigned 1-3 patients and expected to present and follow them each day. I would also like to know how to be a good rotating medical student in general. For example, what would be some helpful things I can do within my role?

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So far, I've come up with the following things to study:

-normal vitals for different age groups

-basics of ventilation and ECMO *my university has a big PCICU

-RSV, influenza, and COVID because I've heard we have a lot of that right now

-congenital cardiac diseases and/or genetic syndromes? I have no reference point for how common this would be in the PICU but I saw a lot of this while rounding with peds hospital medicine