Surviving PICU

The thought of 6 months in PICU may terrify you prior to starting; how will you cope with treating the sickest children in the hospital?! It was a challenge I was looking forward to as part of my PEM training as I love any emergency scenario but PICU is definitely out of my comfort zone of the resus room! 3 months in to the job, the good news is that I love it and here are my top tips to surviving your time in Paediatric criticial care…..

1) PICU nurses are worth their weight in gold: This is true for all paediatric nurses but especially true for those on critical care. Most have worked on the unit for years and have seen their fair share of problems and dealt with a vast range of clinical scenarios. Ask them their advice and take their concerns very seriously. If they are worried, you should be too! I spent a lot of time asking “what would you normally do in this situation?” At the end of the day, the buck stops with you and you have to make the right clinical decision but to work as part of a team and involve the nursing staff is vital for a happy and stress-free time on PICU

2) Use the consultant presence to your advantage: Our unit is very consultant led as most registrars coming through have not done any training in PICU previously. This does not mean you can not make decisions and think through problems yourself before getting the consultant on board. Be pro-active and ask to try any clinical procedures, now is a perfect time to perfect skills with consultant supervision. Having consultant presence is also ideal for getting WBA’s completed  without the usual stresses of not being directly supervised very often, that is a definite bonus!

3) Forget any of your previous neonatal intensive care knowledge: it is not helpful! The way children and neonates is managed is VERY different so trying to to compare them through prior knowledge will just confuse you. Go back to basics of ventilation which are the obviously still appliciable but any settings or mode of ventilation you may have previously used are best ignored.  My moto is to think how I would have done in on neonates and then do the total opposite, this is usually correct.

4)Look after yourself:  This may seem like an odd point but I think it is the most important. You will be treating the sickest children in the hospital and times this can become a little emotionally draining. Over Christmas I really struggled emotionally with a few patients who were really sick and it just didn’t seem fair for it to be happening over the Christmas period. My non-paediatric friends always joke that all I do is blow bubbles and give out stickers-although this is true at times, the harsh reality of a sick or dying child takes all the merriment out of paediatrics. It is difficult at times to leave work at work, and to not think about cases whilst I put my own children to bed. From talking to friends and colleagues this is natural, it’s how you deal with it that is important. Therefore, make sure you look after yourself. Talk to people, debrief about difficult cases and make sure away from work you make time for yourself. Enjoy a glass of wine after a difficult shift, a walk on the beach on a day off-anything that allows you to de-stress.

5) Enjoy it….!! Unless you are going into GRID, your time on PICU will be short. Aside from my time in the ED, it is the job I have learnt the most from in my short time on the unit so far. The knowledge I gain will be vital for jobs and cases in the future so make sure you get the most out of it you can. Throw yourself in head first and enjoy it! I am loving my time on the unit- I can see why people fall in love with the hugely challenging and rewarding speciality-don’t be too daunted by PICU…..perhaps you will love it too!

Dr Hannah Murch