A Day in the Life of a PICU Nurse

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Children's View

It is where the sickest of sick children receive the highest level of care. The Pediatric Intensive Care Unit (PICU) at CHOP is one of the most advanced in the nation. Laura Douglas, RN, BSN, is one of more than 300 PICU nurses who combine rigorous training with innate compassion to care for patients whose lives hang in the balance. This is a day in her life.

PICU nurse working in hospital 5 a.m. Out of bed and the morning routine begins. “It’s quick.” Showers, dresses, lets out Elsa, her German shorthaired pointer, and grabs a bowl of cereal. Then into the car.

6:20 a.m. Arrives at CHOP and begins preparing for her 7 a.m. – 7 p.m. shift.

Douglas will care for one patient today: a 16-month-old boy who has been admitted with the flu and pneumonia. Born prematurely at 27 weeks, he has underlying heart and chronic lung problems that make the flu particularly dangerous. He has now been in the PICU for 12 days; he is on a ventilator to help him breathe and is sedated so that he can rest comfortably. He receives medication to support his lungs.

7:10 a.m. Dons gown, gloves and mask to assess the patient. The child is on contact precautions, so anyone at his bedside must wear protective gear. Douglas listens to his lungs, weighs his diaper to measure fluid output, suctions his breathing tube to clear secretions. Every four hours, she brushes his teeth — a measure to prevent infections. After carefully checking doses, Douglas administers medication, using an electronic scanner to match patient with medicine.

8 a.m. Finishes her first large mug of hazelnut roast. “I drink a lot of coffee.”

8:05 a.m. Patient’s mother calls. After providing her “care code,” a security measure, she receives an update from Douglas: “He had a really good night.”

8:17 a.m. Respiratory therapists administer treatment to open the child’s lung passages.

9:25 a.m. Unit rounds. The care team arrives at bedside: attending physician, fellow, nurse practitioner, pharmacist, nutritionist. Sometimes social work and other specialists join the team.

Douglas briefs the group on her assessment. They review new lab data and physical exam findings and agree that he is “globally better.” Together, they determine the day’s care plan: gradual weaning from the breathing tube, a slight adjustment to medications. They also discuss providing education for the child’s mother about the importance of the flu vaccine.

10:40 a.m. Bath time. Douglas gives the child a gentle but thorough rub-down with anti-microbial soap. Working with another nurse, she changes the sterile dressings protecting various lines into his body, and somehow manages to change the bedsheets while barely moving the patient — the entire process choreographed like a ballet. Throughout, the tiny boy keeps his big, dark eyes fastened on Douglas, who speaks reassuringly to him.

1:18 p.m. Alarms on the bedside monitors go off, as they do frequently. Douglas immediately checks what’s going on: The child’s heart rate is elevated — he is agitated and uncomfortable. This intense one-to-one surveillance lies at the heart of PICU care: “Sometimes all it takes is 30 seconds and they’re in a different spot.”

Douglas came to critical care after stints on other pediatric units and in adult care. She was attracted to the challenge of caring for complex patients: “You have to think, anticipate.”

1:45 p.m. Grabs a turkey BLT for lunch.

2:06 p.m. Outside the patient’s dimly lit room, activity on the unit continues. Characters from Sesame Place are visiting, to the delight of patients and staff alike. A little girl toddles by with several physical therapists — everyone oohs and ahhs at her progress.

3:16 p.m. Mom visits. She is coping with four other children, including the patient’s twin, at home, and the sight of her sick baby upsets her: “He was doing so well. He was so close to walking. Now I feel like we’re back to square one.” Douglas reassures her: “He’ll be doing well again soon.”

4:20 p.m. The child sleeps contentedly. Throughout the PICU, the calm can belie the seriousness of its patients’ conditions. “You can’t take it home with you,” says Douglas of how she copes. “Do we get emotionally involved? Of course. But I have a job to do.”

6:40 p.m. Ends her shift by briefing the nurse who will take over her patient’s one-to-one care.

7:45 p.m. Arrives home. Dinner with her husband of seven months, playtime with Elsa, a little TV, then bed.