NICU PICU or Children's ER?? Need to choose for final practicum..

EEK..one month until I need to make a choice as to where I want to be placed for my final practicum in school. I have narrowed it down to 3, that I feel I may enjoy and do well at. NICU, PICU or Children's emerg. Clearly, I have decided that I want to venture into the pediatric population but I can find pros and cons for all 3 choices. I thought I would see if anyone at all out there would have insight to share. Or perhaps just pull from a hat...
I have this same dillemma so its interesting to see that someone else is thinking about going into the same areas. I actually work as a tech. in a Peds. ED so my manager and clinical educator have advised me to look into a different area for my last practicum (even though I really want to work in this same ED after I graduate) this is because they think I need to have a little bit more of a diverse experience so I can see other speciality areas and see if I like them. I am still trying to narrow it down between NICU or PICU and I'm not sure yet. I have been told that NICU is really a world of its own and once you work there you usually end up working there for the rest of your career because it is so highly specialized and NICU nurses are really devoted to their patients. I think if your looking at going into Pediatrics overall (either PICU or Peds ED when you graduate) you should probably choose between those two departments. I think that PICU might be a good place to start because you are taking care of only 1 or 2 very complicated, critical patients and it allows you to develop those highly technical skills and be able to take care of the whole patient. In the ED it can be very fast paced, busy, crazy and a rough place for a student to start if you have never worked in an ED. This is just one opinion.!Chris

Peds ICU or ER would probably give you more variety. You will get to care for infants all the way to teens. NICU is going to be more narrow as in just the newborn population (although some chronic kids stay on the unit until they are several months old they all start out there as newborns). I agree with the previous poster about NICU being a world of its own.Just curious - what are the pros and cons you have already come up with?Good luck!

Quote from cjcsoon2brnI have this same dillemma so its interesting to see that someone else is thinking about going into the same areas. I actually work as a tech. in a Peds. ED so my manager and clinical educator have advised me to look into a different area for my last practicum (even though I really want to work in this same ED after I graduate) this is because they think I need to have a little bit more of a diverse experience so I can see other speciality areas and see if I like them. I am still trying to narrow it down between NICU or PICU and I'm not sure yet. I have been told that NICU is really a world of its own and once you work there you usually end up working there for the rest of your career because it is so highly specialized and NICU nurses are really devoted to their patients. I think if your looking at going into Pediatrics overall (either PICU or Peds ED when you graduate) you should probably choose between those two departments. I think that PICU might be a good place to start because you are taking care of only 1 or 2 very complicated, critical patients and it allows you to develop those highly technical skills and be able to take care of the whole patient. In the ED it can be very fast paced, busy, crazy and a rough place for a student to start if you have never worked in an ED. This is just one opinion.!Chris

I did my practicum in the NICU, because that's where I wanted to work from day 1. I was offered a job in that same unit, and have been there now almost a year, and hope to never have to do any other type of nursing...so, the devotion aspect is certainly true.Having said that, I love my NICU, and am constantly trying to recruit my friends into my area.

Quote from Bortaz, RNI did my practicum in the NICU, because that's where I wanted to work from day 1. I was offered a job in that same unit, and have been there now almost a year, and hope to never have to do any other type of nursing...so, the devotion aspect is certainly true.Having said that, I love my NICU, and am constantly trying to recruit my friends into my area.

I think you'd likely find that you'd be the most versatile out of the PICU. Having worked with bigger small people, you'd be able to go to work in the NICU, especially because you'd likely have seen some infants in the PICU -- just not neonates. Secondly, EDs like ICU experience, so if the ED is somewhere that you're interested in working in the future, the PICU would definitely be an advantage for you.

The largest persentage of nurses who start in the PICU are new grads. I would advise PICU also due to the extensive list of diagnoses that are seen. Very interesting!

It really depends on where you see yourself working in the future. I had my practicum in the PICU and I loved every second! I seriously was so sad on my last day, I didn't want to leave. The PICU sees a wide range of patients, so I have taken care of a 2 week old up to an 18 year old! (Some PICU's have patients older than 21 come in as well.) I honestly enjoyed the variety; no two days were the same! One minute you could be taking care of an 18 month old in respiratory distress, and the next moment a 12 year old with diabetic ketoacidosis could be getting admitted and they are starting to exhibit mental status changes. Overall, I loved how the PICU (or any ICU for that matter) allows you to really know the patient and their families. I'm very detail oriented and I love how I can provide so much care for one patient. =) The ER would allow you to provide important care as well, but it isn't for a long period of time and I feel as though you take care of their immediate problem and then transfer them elsewhere or discharge them. So for me, I know that forming a relationship and really getting to know the patient was what I wanted to do and why I chose PICU over Peds ER.With PICU experience, I know in the hospital where I had my practicum and the hospital where I have interviewed for *I'm keeping my fingers crossed that I get a call back* sometimes require the nurses to float to other units (general peds floor, pediatric step-down, or NICU.) I know that jobs for NICU sometimes say PICU or NICU experience preferred, whereas PICU is usually going to just ask for PICU experience.But you know what is best for you! I absolutely loved NICU as well, but PICU is where my full heart is set on! Good luck to you and please let us know what you decided to do! I'm sure you would love any of them, PICU, NICU, or Peds ER. They are all interesting and I found that I loved anything related to pediatrics. So good luck!!!

[quote=luvmyboys;4501325]Just curious - what are the pros and cons you have already come up with?quote]Hi there, well I am merely basing pros and cons a lot on my hunches of what each area may bring. I hope to do more shadowing soon to confirm these beliefs hopefully. Basically, like you mentioned...the ER or PICU would have the variety aspect, which I feel I would enjoy. As much as I love acuity, I think not being able to give the focused attention that you may be able to in an ICU setting would get to me after awhile. However, the ICU setting really intimidates me, partially b/c I am not familiar as it, as I am emerg. Other reasons, simply involve the actual units themselves regarding staffing/mgmt issues I have learned. I have basically tried to match my personality to pick the best place but find that I am kind of in the middle of the road and could adapt to either or.

Quote from chloecatrnI think you'd likely find that you'd be the most versatile out of the PICU. Having worked with bigger small people, you'd be able to go to work in the NICU, especially because you'd likely have seen some infants in the PICU -- just not neonates. Secondly, EDs like ICU experience, so if the ED is somewhere that you're interested in working in the future, the PICU would definitely be an advantage for you.

Quote from Summer BreezeIt really depends on where you see yourself working in the future. I had my practicum in the PICU and I loved every second! I seriously was so sad on my last day, I didn't want to leave. The PICU sees a wide range of patients, so I have taken care of a 2 week old up to an 18 year old! (Some PICU's have patients older than 21 come in as well.) I honestly enjoyed the variety; no two days were the same! One minute you could be taking care of an 18 month old in respiratory distress, and the next moment a 12 year old with diabetic ketoacidosis could be getting admitted and they are starting to exhibit mental status changes. Overall, I loved how the PICU (or any ICU for that matter) allows you to really know the patient and their families. I'm very detail oriented and I love how I can provide so much care for one patient. =) The ER would allow you to provide important care as well, but it isn't for a long period of time and I feel as though you take care of their immediate problem and then transfer them elsewhere or discharge them. So for me, I know that forming a relationship and really getting to know the patient was what I wanted to do and why I chose PICU over Peds ER.With PICU experience, I know in the hospital where I had my practicum and the hospital where I have interviewed for *I'm keeping my fingers crossed that I get a call back* sometimes require the nurses to float to other units (general peds floor, pediatric step-down, or NICU.) I know that jobs for NICU sometimes say PICU or NICU experience preferred, whereas PICU is usually going to just ask for PICU experience.But you know what is best for you! I absolutely loved NICU as well, but PICU is where my full heart is set on! Good luck to you and please let us know what you decided to do! I'm sure you would love any of them, PICU, NICU, or Peds ER. They are all interesting and I found that I loved anything related to pediatrics. So good luck!!!

So just an update to my decision. I have done some shadowing in the past few weeks. Children's Emerg never got back to me, so I spent a day on a pediatric oncology ward, which wasn't bad but I wasn't in love with it either. I then shadowed at a NICU which is considered level II and III, however since I would be limited to the intermediate care, I only got to shadow this side which was mostly grower/feeders, with no invasive care. It was an alright experience. The staff weren't jumping for joy to have me tag along, which I can understand but the one nurse I followed spent more time making sure I knew the problems with their staffing, morale and lack of teamwork at times. Finally, I shadowed PICU and I had the complete opposite experience. My buddy nurse showed me around, made me feel ultra comfortable, let me ask lots of questions and the majority of all the staff made sure that I got in there to see complex procedures being done and kept me involved. I did enjoy the variety of cases presented in PICU as well, so I guess it is safe to say this will be my number one choice for practicum. Now, if I get accepted....is a whole other thing!