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Pediatric Intensive Care Unit Nursing Specialty: PICU Jobs Guide

What Is Pediatric Intensive Care Unit (PICU) Nursing?

Unfortunately, according to a study published in 2021, the number of children receiving intensive care in the United States is rising. Consequently, there is an increasing need for nurses in pediatric intensive care units.

If you are considering a career in pediatric intensive care (ICU) nursing, read on to learn all there is to know about this essential and highly in-demand nursing specialty. Learn about the job description of a pediatric ICU nurse, educational requirements, certifications, salary, and more!

Table of Contents

What Does PICU Stand For?

pediatric ICU

First, ICU stands for intensive care unit. There are different types of intensive care units based on the population each unit specializes in treating. The abbreviation PICU generally stands for pediatric intensive care unit, although it may also stand for psychiatric intensive care unit. Similarly, the abbreviation NICU stands for neonatal intensive care unit.

What Does Pediatric Intensive Care Mean in Medical Terms? What Is a Hospital PICU?

By definition, a pediatric intensive care unit is the hospital department that provides the highest level of care to children who are critically ill or injured or who have had complex surgery.

Depending on the hospital, PICUs may care for patients from newborn age to eighteen or twenty-one years old. These units provide therapies that may not be available in other hospital areas, including ventilators and medicines requiring close medical supervision. The level of care provided in PICUs is the same as that provided in other intensive care units, but the equipment in PICUs is better suited for children, the environment is more child-friendly, and the healthcare professionals are specialized in caring for and treating children. The PICU healthcare team includes the following multidisciplinary professionals:

  • Pediatric intensivists—doctors who have completed a three-year residency in pediatrics after medical school, followed by three years of subspecialty fellowship training in intensive care
  • Residents—doctors who are training to be pediatricians
  • PICU fellows—pediatricians training to be attending intensivists
  • Advanced practice providers, such as physician assistants and nurse practitioners
  • Critical care nurses who care for only one to two patients at a time and are available around the clock 
  • Critical care respiratory therapists 
  • Nutritionists 
  • Critical care pharmacists
  • Social workers
  • Child life specialists 
  • Clinical assistants 
  • Subspecialists, such as cardiologists and neurosurgeons, when required

Pediatric patients are usually transferred to PICUs from emergency departments or from other hospitals. Often, healthcare professionals in PICUs establish the child’s diagnosis and stabilize them. Other times, pediatric patients are admitted to PICUs after major surgery or other procedures, such as chemotherapy. Once they are stable, they are transferred to other hospital units or back home. Generally, children stay in PICUs for one or two days. However, sometimes patients require intensive care for weeks or even months. That said, these longer stays are rare. According to one study, only 1 to 4.7 percent of children remain in PICUs for over twelve days.

The following are common conditions requiring care in pediatric intensive care units:

  • Acute kidney or liver failure
  • Brain tumors
  • Breathing or lung problems
  • Cancer and blood disorders
  • Craniofacial conditions
  • Diabetes and other metabolic problems
  • Epilepsy and other nervous system conditions
  • Genetic and chromosomal conditions
  • Immune system and rheumatic conditions
  • Infections, such as bacterial meningitis or sepsis
  • Intoxication or overdose
  • Near-drowning
  • Pulmonary hypertension
  • Sleep apnea and other sleep problems

In order to provide the level of care PICU patients require, these units usually have the following equipment

  • Intravenous catheters (IVs) and central lines
  • Monitoring devices, such as pulse oximeters and blood pressure cuffs
  • Breathing devices, including oxygen masks, nasal cannulas, and ventilators
  • Testing equipment, such as X-rays, magnetic resonance imaging (MRI), or ultrasounds 

Additionally, the PICU healthcare team is generally equipped to provide the following advanced life-support therapies:

  • Extracorporeal membrane oxygenation (ECMO)
  • Continuous renal replacement therapy (CRRT)
  • High-frequency oscillatory ventilation (HFOV) 
  • Inhaled nitric oxide (iNO)

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PICU vs. NICU?

pediatric ICU

NICU stands for neonatal intensive care unit. Some hospitals have intensive care units specially equipped to care for sick newborns and infants up to two years old. However, in hospitals that don’t have NICUs, newborns are cared for in PICUs. Therefore, depending on the hospital, these units may be separate, or they may be one and the same. It must be noted that the prognosis of newborn patients with intensive care needs is more favorable in hospitals with specialized NICUs.

PICU vs. PACU?

Although these abbreviations look very similar, these units are vastly different. Whereas PICU stands for pediatric intensive care unit, PACU stands for post-anesthesia care unit. PACUs are specialized care units where patients are taken immediately after surgery and cared for while they wake up from anesthesia. They are staffed by nurses and anesthesiologists prepared to care for patients after surgeries. PACU nurses supervise patients carefully, frequently checking vital signs and dressings, managing IV fluids, and administering pain medication. The connection between these units is that many times pediatric patients are transferred to a PICU after recovering from surgery in a PACU.

What Is the Role of a Pediatric Intensive Care Nurse?

The role of a PICU nurse is characterized by two key aspects: caring for pediatric patients and providing acute care nursing.

Pediatric intensive care nurses treat and care for critically ill pediatric patients. These patients either have or are at a high risk of developing life-threatening health conditions. Therefore, they are highly vulnerable and unstable and have complex health conditions requiring vigilant nursing care and intense, rapid medical responses. PICU nurses must be alert to subtle changes in a patient’s status, anticipate a child’s needs, and understand a child’s nonverbal communication. Additionally, PICU nurses act as patient advocates, seeking support as needed, and acting as liaisons between patients, family members, and other healthcare professionals.

What Does a Pediatric Intensive Care Nurse Do?

Although the specific duties of a PICU nurse may vary from one hospital to another, the following are typical responsibilities of pediatric intensive care nurses:

  • Performing and documenting patient assessments, including biophysical, psychosocial, developmental, cultural, spiritual, and environmental needs
  • Analyzing situations, anticipating potential problems, and detecting changes in a patient’s status 
  • Continuously prioritizing and updating care plans based on new information and changes to the patient’s condition
  • Communicating and documenting updates to other healthcare team members 
  • Participating in interdisciplinary rounds and patient care conferences 
  • Assisting patients and family members in implementing their role in the care plan
  • Assessing learning needs, capabilities, preferences, and readiness to learn as a prerequisite to teaching patients and family members
  • Demonstrating positive and effective interpersonal skills when dealing with patients, families, visitors, peers, and other healthcare team members 
  • Administering and documenting medications and treatments
  • Demonstrating willingness and ability to acquire new knowledge and utilize new skills needed to improve individual, team, and organizational performance
  • Participating in unit performance improvement initiatives

How to Become a Pediatric Intensive Care Nurse and How Long Does It Take?

pediatric ICU

Most PICU nurses are registered nurses (RNs) with at least one year of nursing work experience. To become RNs, aspiring PICU nurses must complete either a two-year associate’s degree in nursing (ADN) or a four-year bachelor’s of science in nursing (BSN) and then pass the National Council Licensure Examination (NCLEX). Although completing an ADN has its advantages, including a shorter time commitment and reduced financial investment, aspiring nurses should bear in mind that many employers prefer hiring nurses with BSNs, or they may even require this level of education.

Nurses interested in or already working in pediatric intensive care can also pursue higher education. Nurses with master’s or doctorate degrees in nursing are called advanced practice registered nurses (APRNs). This higher level of education qualifies them for greater responsibilities and autonomy and goes hand in hand with salary increases as well. Completing a master’s program usually takes two years on top of the four years it takes to complete a BSN. However, there are bridge programs available that allow nurses to jump from an ADN to a master’s in nursing in the same amount of time. Learn more about accelerated nursing programs here.

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Pediatric Critical Care Nurse Certification?

Let’s start with the basics: Practically all nursing jobs require nurses to be certified in life support or cardiovascular resuscitation (CPR). The most commonly required certification across specialties is the Basic Life Support (BLS) certification. Additionally, nurses working in intensive care will need to complete an Advanced Cardiovascular Life Support (ACLS) certification. Furthermore, nurses working with pediatric patients in intensive care or emergency settings should also complete the Pediatric Advanced Life Support (PALS) certification. Click here for more on these essential nursing certifications.

The previously mentioned certifications are essential for PICU nurses but not specific to this specialty. Nurses interested in pursuing a specialty certification in pediatric intensive care nursing should consider the following credential offered by the American Association of Critical Care Nurses:

  • The Acute/Critical Care CCRN (Pediatric) certification is tailored to nurses working with critically ill pediatric patients in intensive care units, cardiac care units (CCUs), combined ICU/CCUs, medical-surgical ICUs, trauma units, or critical care transport/flight. Registered nurses or advanced practice registered nurses interested in pursuing this certification must meet the following eligibility criteria:
  • Current valid RN or APRN license
  • 1,750 clinical hours in the direct care of critically ill pediatric patients within the previous two years, with 875 hours gained within the last year
  • Or 2,000 clinical hours in the direct care of critically ill pediatric patients within the previous five years, with at least 144 hours accrued during the last year

How Much Does a PICU Nurse Make?

PICU nurses are mostly registered nurses working in the hospital setting. Therefore, on average, they earn between $84,800 and $85,020 annually.

APRNs, such as nurse practitioners (NPs), working in the hospital setting can expect to earn approximately $122,960 annually. 

That said, nurses must bear in mind that multiple factors can affect their potential salary as PICU nurses, including location, work experience, certifications, etc.

What Is Pediatric Intensive Care Nursing Like?

PICUs have one of the lowest patient-to-nurse ratios, usually one or two patients per nurse. Therefore, PICU nurses are very involved with their patients and their patients’ families and are integral members of the healthcare team. Every day, PICU nurses participate in “rounds,” when the healthcare team meets to discuss each child’s condition and care, including any changes to the patient’s condition or the care plan. 

In hospitals offering “family-centered care,” families are encouraged to participate in rounds as well. Some hospitals also allow parents to stay overnight in the PICU with their children and allow other family members—including children—to visit during visiting hours.

Nurses are always the members of the healthcare team that most interact with patients and family members. Therefore, in family-centered PICUs, nurses can expect to have extensive interaction with parents as well as their patients.

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Is PICU Nursing Hard?

Of course, PICU nursing is hard. However, that does not mean it isn’t equally rewarding. Nurses who choose to work in pediatric intensive care usually like children. Nevertheless, liking children can make PICU nursing even harder since nurses interact with patients who are critically ill and witness patient deaths as well. Therefore, for many PICU nurses, the hardest parts of the job are related to witnessing their patients’ suffering. This PICU nurse on Reddit helps to illustrate specific aspects of the job that make this nursing specialty challenging:

Expense Caps with Insurance Companies

“I have heard stories from some of our chronically ill families about reaching lifetime expense caps with their insurance companies when the child was 14 months old (before the affordable care act). I have seen children whose parents insurance companies have denied them home nursing care, despite the child having medical needs that would make most laypeople terrified. And so many kids come in over and over, near death from asthma attacks because inhalers and steroids are so expensive that the scrips aren't getting filed after each stay. It is easy to call that neglect, but I have seen how much the parents love their children”

Keeping Children Alive Regardless of Their Condition

“For me, there have been times when I have been horrified that a child who is practically braindead is kept alive, because it can seem to border on cruel. To me, taking a child that has little to no brain function and putting a trach in for the ventilator, a g tube for feeds, warming and cooling blankets for thermoregulation.... where does the child go in all that? They aren't really there anymore. That said- I have the utmost respect for our families and their wishes. That is not my child. How dare I question their wishes? That isn't my job. I can be there for them in family meetings, and be honest about the facts. That is my job.”

Non-Accidental Traumas

pediatric ICU

“One of the hardest things for me has been non accidental traumas. The simplest answer I can give is that I have to remind myself that my job is to care for my patient. In the moment, we just have to focus on the needs of the baby/child. That makes it easier. But it will never be easy. And it will always affect me. I try not to take it home, and I work with great people (not just nurses, our docs are fabulous) who are all supportive. Some of the cases of abuse we see are more horrific than you could imagine, and we take care of each other.”

Why Choose Pediatric Intensive Care Nursing?

The most obvious reason to choose PICU nursing is loving kids. If caring for kids makes you smile, energizes you, and fills you with a sense of purpose and self-fulfillment, then don’t think twice about it: pediatric nursing is for you. The only thing you still have to consider is whether you are cut out for intensive care. Here are reasons why experienced PICU nurses love their jobs and wouldn’t change them for any other:

“PICU nurse for nearly 20 years. I can’t imagine doing anything else! The sads are so sad, but oh my, the happies are everything in the world. Kids are just so beautiful and strong, and when you get a miracle you can ride it for weeks…I don’t want to sugarcoat it or anything, but to me the journey has been totally worth it. And when covid started I picked up some adult ICU shifts and those were the worst shifts of my life. Kids all day, man.” – Reddit user MountainTomato9292

“35 yr PICU vet here. To borrow a phrase: the hardest job you will ever love. Kids motivate you because they don’t deserve their disease and don’t have habits that have given them disease…I sit here at the end of my career and know there are people out there who were once my kids. Zero regrets.” – Reddit user Alger6860

What Makes a Good Pediatric Intensive Care Nurse: Tips for New Nurses?

Perhaps you recently graduated from nursing school and passed the NCLEX; technically, you are ready to work as a nurse, but you still don’t feel prepared. As this PICU nurse on Reddit put it, relax: You will be okay.  

“Say this to yourself: I will be okay, I will be okay, I will be okay." You will not be supernurse. You will not be amazing. That takes time…But you will be okay…I knew it was going to be hard, but I had no clue how hard. It is incredibly demanding, and the world is expected of you. In the beginning, you wil feel like a bad nurse. You will feel like it is ridiculous, that it is unfair, like there is no way you will ever be able to do everything you are supposed to do in 12 hours, much less anticipate and handle the curveballs. But it gets better. Ask for help when you need it, as soon as you need it, not 2 hours later when your head is popping off and you have fallen even more behind. Listen to everything the senior nurses have to say, and respect their experience. Some of them will be rude…But many more will be a huge asset. Document document document- if it isn't written down, it basically didn't happen...” – Reddit user GoodbyeNurse1988

Other tips from experienced PICU nurses include the following:

  • Focus on pediatric drug dosing. Learn to dose for code meds, vasopressors, fluid boluses, and basic drugs to be ready at any point.
  • Review respiratory and cardiac conditions, such as congenital heart defects.
  • Prepare for the conditions your hospital specializes in, such as transplants, trauma, genetic disorders, etc. 
  • Take advantage of free resources like the Heartpedia app and Khan Academy.
  • Finally, don’t take your job too seriously; the worst PICU nurses can’t talk to kids or take a joke.

Final Thoughts on Pediatric Intensive Care Nursing

Deciding what population you want to work with should be your very first consideration when deciding on a career path. If you know you want to work with kids, PICU nursing might be the perfect choice for you. However, remember that many other specialties work with children, too. Also consider working as a pediatric emergency room nurse, a pediatric operating room nurse, or a pediatric telemetry nurse. Furthermore, remember that pediatric nurses may work in many different settings, including physician’s offices, children’s hospitals, and schools. Therefore, make sure you explore all your options before making a decision!

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