Chaunie Brusie BSN, RN
Chaunie Brusie BSN, RN
December 12, 2022 - 8 min read

PICU Nursing: Everything You Need to Know

If you are considering working as a Pediatric Intensive Care Unit (PICU) nurse, you are likely already aware of some of the challenges you will face–such as dealing with seriously ill children and potentially heartbreaking scenarios—and have balanced these with your desire to help care for seriously ill pediatric patients and their families.

Working as a travel PICU nurse can help you gain valuable, diverse experience as you may have the opportunity to work in a variety of hospitals and PICUs which have niche specialties. Do you have what it takes to become a PICU nurse? Check out some of the most asked questions about PICU nursing that are answered below in addition to the pros and cons of being a PICU nurse to find out.

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What is a PICU Nurse?

PICU nurses provide care to pediatric patients with serious illnesses. At any time, the PICU will be home to patients with a variety of diagnoses such as patients with respiratory disorders including:

  • acute asthma exacerbations
  • pneumonia
  • burns and other trauma
  • seizure disorders
  • toxic ingestions
  • seasonal respiratory viruses such as RSV and other serious infections
  • chronic condition management
  • cancer

Pediatric surgical patients are also cared for in the PICU. Patients may be admitted for observation after routine, planned surgical procedures such as Nissen fundoplication or transplantation or for more emergent procedures.

Patients cared for in the PICU may range in age from newborns to approximately 21 years of age. Patients on the older end of this spectrum, or even older adults, may be well known to the PICU due to congenital anomalies such as congenital heart disease. Depending on the patient population of the hospital, patients may be cared for in even more specialized PICUs such as cardiac or neurologic PICUs.

The PICU often prides itself on providing patient and family-centered care, and family members will hopefully be very involved in the care of their child. For that reason, PICU nurses not only take care of pediatrics but are also an invaluable resource to the patient’s family to provide both education and support.

How to Become a PICU Nurse

One of the wonderful attributes of a career in nursing is that it is never too early or too late to learn about a new area of nursing that interests you.

How to become a PICU nurse with an associate degree in nursing:

  1. If you are in high school or college and considering a career in nursing, you should first obtain an undergraduate degree in nursing. Associate degree nursing (ADN) programs are available at many community colleges and are typically 2-year programs.
  2. After completing your Associate in Nursing, you will be prepared to sit for the NCLEX.

How to become a PICU nurse with a bachelor’s degree in nursing:

  1. The other route to take to become a nurse is through a Bachelor of Science in Nursing Program (BSN). Increasingly, many hospitals prefer to hire nurses with a bachelor’s degree in nursing.
  2. To obtain a bachelor’s degree, you will do 2 years of undergraduate pre-nursing coursework and then attend formal nursing training for an additional 2-3 years.
  3. You will then be eligible to take the NCLEX, which is the licensing exam to become a Registered Nurse (RN). There are other programs available for nurses with other educational backgrounds, such as an Accelerated Bachelor’s Degree in Nursing for students with another Bachelor’s degree already.

How to become a PICU nurse if you’re already in nursing school:

  1. If you are in nursing school and dreaming of working in the PICU, it is best to obtain as much experience as possible in pediatrics while you are in school. Your core clinical rotations will likely only contain a short amount of time spent in pediatrics since there is so much to learn while in school.
  2. Try to seek out opportunities to gain more clinical exposure to pediatrics. Many nursing programs will allow you to spend time during your last semester in a more specialized area of your choice. It would be wise to request time in the PICU or even pediatrics in general during this time.
  3. It may also be helpful to seek out other opportunities to gain PICU experience such as spending time with patients as a hospital volunteer while you are in school.

If you are an established nurse looking to make a specialty change and begin working in the PICU, reach out to your colleagues and see if you can spend any time shadowing a PICU nurse to learn more about the specialty and network with other nurses. If an opening comes up in the PICU that interests you, apply! The PICU will value your other nursing skills and teach you what you need to know about your pediatric patients. Learning about what research is being done by the PICU nurses or Nurse Practitioners where you work and attending conferences where they are presenting their work may also help you get your foot in the door.

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Pros and Cons of Being a PICU Nurse

When thinking about working with seriously ill pediatric patients, you may automatically think about the difficulties you may face in caring for these children as a nurse. However, for every downside of providing care in the PICU, there is a benefit as well. Here are some common pros and cons of being a PICU nurse:

Con: Seeing children in difficult situations can be very hard emotionally

First, it may be very emotional to work with pediatric patients with a serious acute or chronic illness. You may know that your patient faces a difficult road ahead and is at risk for continued hospital admissions, which take a toll on the patient and family’s quality of life, such as in the case of a patient with congenital heart disease. For patients with a severe acute illness, such as a burn victim, it may be difficult to watch your patient suffer physically while you are providing routine care such as dressing changes.

Pro: You will get to care for someone in need

However, you must remember that your patient would be dealing with this illness regardless of whether you are this patient’s nurse. If you as the nurse can provide excellent nursing care and therefore improve the patient’s outcome, you have made a positive impact on the patient and family, even as they deal with a difficult diagnosis. You can always improve your patient’s quality of life in some way.

Con: There will be unique challenges in caring for children of different sizes

If you ever struggled in nursing school to place an intravenous (IV) catheter or nasogastric tube, you may be concerned about performing these procedures, among others, on children. Your patients may have tiny limbs and not be as cooperative as adult patients.

Pro: You will gain specialty skills

It is important to remember that no nurse is born knowing how to do these procedures well. It simply takes practice and once you’re proficient at placing an IV on a small child, this is a skill you will have for the rest of your career. You may then be called on as a resource for other nurses and other units when they have a patient with limited access. It is a source of pride to be called upon to help fellow nurses care for their patients and you can do it with practice. Another benefit of caring for children is that they are typically smaller and lighter than your average adult patient. That will save you from straining your back!

Pro and Con: You’ll care for the entire family, not just one patient

As we mentioned earlier, as a PICU nurse, you’re not just caring for the pediatric patient; you’re caring for the entire family too. That counts as both a pro and a con, because that can be a wonderful experience but also a challenging one.

For instance, it can be a pro because you can educate and equip a family to care for a child who will need long-term care and have a true teamwork approach to care, but it can also be challenging if the family is not interested in being involved or places emotions on you.

You must remember that the family is coping with their seriously ill child’s illness as best they can. One coping strategy may be to try to control your care. The benefit to working with families is that once you show them you are a competent nurse, you can make a great team taking care of your patient. It is a great feeling to have a family member be excited that you are their loved one’s assigned nurse for the day. Once they let you into their extended family, you will not want to leave.

Con: There will be negative outcomes

Despite receiving excellent nursing and medical care, some patients will still succumb to their illness and deteriorate or die. This will be emotional for everyone involved in the patient’s care. You may even find it difficult to not think of something similar happening to your own children or family members in these situations. However, there is support available.

Pro: Your colleagues will know what you are going through and be there to support you.

Most hospitals also have staff to help both family members and staff work through losing a patient, such as psychologists through an employee assistance program, a chaplain, or a peer mentor with training in helping grieving colleagues. Ultimately, you will get through it, and you will learn from each patient to provide better care to the next patient.

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PICU Frequently Asked Questions

What is the difference between the NICU and the PICU?

The neonatal intensive care unit (NICU) provides care to newborn babies in need of intensive care due to diagnoses such as prematurity, congenital heart disease, necrotizing enterocolitis, and other congenital anomalies requiring surgical repair, among others. The PICU provides care to older infants and pediatric patients of all ages, as outlined above.

What is the typical nursing ratio in the PICU?

Most PICUs will strive for a nursing ratio of 1 nurse to 1 or 2 PICU patients. If a PICU shares beds with an intermediate care or step-down unit, a nurse may have 3 patients, due to the lower acuity of these patients.

Is PICU nursing medical or surgical care?

PICU nurses provide care to both medical and surgical patients.

How much are PICU nurses paid?

As with any occupation, salary will vary based on location and level of experience, among other factors. According to ZipRecruiter, the average PICU nurse salary in the United States is $108,031 annually.

What is the career outlook for PICU nurses?

Nursing in general is a constantly growing field, and the PICU is no exception. The care provided in the PICU is highly specialized and hospitals need to employ a high number of PICU nurses due to the nursing ratio required to care for these patients. The job outlook for PICU nurses will continue to be strong.

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