How to Become a PICU Nurse

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Written by Alexa Davidson, MSN, RN Content Writer, IntelyCare
A PICU nurse greets her patient.

Have you ever wondered what it’s like to work in a pediatric intensive care unit (PICU)? If you picture yourself holding a tiny blood pressure cuff with one hand, a pacifier with the other, and managing to silence a cardiac monitor — while singing along to Frozen — you may be on to something.

In this article, we share what it’s like to be a PICU nurse and how you can join this nursing specialty. Read about the actionable steps you can take to reach your goal of becoming a pediatric ICU nurse.

What Is a PICU Nurse?

Pediatric ICU nurses belong to two nursing specialties: pediatrics and critical care. Working as a pediatric nurse involves providing family-centered care to infants and children up to 18 years old. Critical care nurses have a unique scope of practice that combines advances in scientific knowledge, clinical practice, and technology to care for patients in critical condition. When you merge these skill sets, you get a highly specialized type of nursing that can be equally challenging and gratifying.

As members of a multidisciplinary team, pediatric ICU nurses collaborate with colleagues like medical residents, fellows, intensivists, respiratory therapists, social workers, dieticians, and child life therapists. The bedside nurse is often the gatekeeper between healthcare providers and the patient. Have you ever heard the expression, “Never wake a sleeping baby?” It was likely coined by a pediatric ICU nurse who appreciates the importance of rest and reduced stimulation for the critically ill child.

What Does a Pediatric ICU Nurse Do?

A pediatric ICU nurse cares for infants, toddlers, children, and adolescents who need close monitoring in the hospital. Depending on the severity of the illness, kids may require 1:1 or 1:2 nursing care, which means their nurse only has one or two patients. A child may be hospitalized for a number of reasons, from chronic illness to acute injury. Nurses in the PICU are prepared to care for all kinds of diagnoses. The most common reasons for hospitalization in children include:

  • Respiratory distress
  • Respiratory failure
  • Asthma
  • Epilepsy
  • Pneumonia
  • Sepsis
  • Heart defects
  • Complications from diabetes
  • Trauma

Patient populations vary based on the services offered in a medical center. For example, at a trauma hospital, you may care for children with gunshot wounds or victims of motor vehicle collisions. In a research center, you may take care of kids with rare cancers undergoing experimental treatment.

No matter which type of facility you choose, it takes a quick learner and fast thinker to handle PICU nursing. Examples of PICU nurse responsibilities on a typical shift may include:

  • Performing age-appropriate head-to-toe assessments
  • Administering medications
  • Managing arterial lines for hemodynamic monitoring
  • Interpreting EKGs
  • Monitoring intracranial pressure (ICP)
  • Managing artificial airways, such as endotracheal tubes or tracheostomies
  • Titrating drips
  • Assisting with bedside procedures
  • Feeding patients via bottle feeds, gastric tubes, or TPN

Many hospitals reserve a number of PICU beds for patients undergoing open heart surgery if they don’t have a dedicated children’s cardiac intensive care unit (CICU). Nurses in this type of unit need additional training to care for kids requiring an advanced level of care.

What Are the Training Requirements?

When starting a PICU position, your nurse manager will ensure you get the appropriate training with an experienced preceptor. The length of a training period, also called nursing orientation, depends on your level of experience. During this time, you’ll complete hospital-based orientation and unit-based training, where you get checked off on nursing skills specific to the PICU. Your hospital may also offer a new graduate residency program, which allows nurses to engage in practice-based learning while adapting to organizational culture.

What Are the Steps to Becoming a Pediatric ICU Nurse?

So, how long does it take to become a PICU nurse? To join this specialty, you’ll need a solid nursing foundation, starting with education. Many of your PICU skills will develop with on-the-job experience, but nursing education and training courses help lay the foundation for the critical thinking skills necessary for the role. Below are the general steps to begin your journey to securing a PICU job.

1. Earn a Nursing Degree

The first step to becoming a pediatric ICU nurse is to get either a BSN or ADN degree. While a BSN is not mandatory everywhere, many employers require new hires to have this degree, particularly facilities with Magnet designation. Check the requirements at your desired workplace before applying.

2. Pass the NCLEX

After earning a nursing degree, you’ll need to take and pass the NCLEX-RN exam. Passage of this test allows you to become a licensed registered nurse in your state.

3. Get Certified

Hospital nurses must be certified in Basic Life Support (BLS) to respond to emergencies like cardiac arrest. Nurses working in the PICU must be certified in Pediatric Advanced Life Support (PALS) to respond to pediatric emergencies.

Once you’ve gained experience in the specialty, you may choose to achieve Certified Pediatric Nursing (CPN) or Critical Care Registered Nurse (CCRN) certifications. Although these certifications aren’t required for employment in the PICU, they can elevate your nursing practice.

4. Get Nursing Experience

Nurses may either be hired directly into a PICU as new graduates or after years of nursing experience, depending on the facility’s preference. You may consider building foundational nursing skills in another department before joining this highly specialized area.

What Are Some Good PICU RN Qualities to Develop?

Pediatric ICU nurses should first and foremost be good with kids — being up-to-date on the latest Disney hit isn’t a must, but it certainly helps. Here are some qualities that make a good nurse in the PICU:

  • Attention to detail
  • Critical thinking
  • Quick decision-making skills
  • Multitasking abilities
  • Team-player mentality
  • Strong communication skills
  • Advocacy
  • A focus on family-centered care
  • Willingness to learn and pursue advanced skills

Where Do Pediatric ICU Nurses Work?

Pediatric intensive care nurses work in hospitals. The size of the unit and the range of patients you see will depend on the population a medical center serves. For example, a community hospital may have a small PICU with a little bit of everything, whereas a freestanding children’s hospital may have multiple intensive care units separated by specialty.

After getting solid experience, nurses may leave a facility to pursue pediatric ICU travel nurse jobs in their location of choice. The decision to become a travel nurse shouldn’t be taken lightly, as you’ll be demonstrating competency to care for any patient in any children’s hospital across the country.

How Much Do Pediatric ICU Nurses Make?

The average PICU nurse salary is $62,749 per year. Hourly rates vary by facility and location and are adjusted based on years of experience. There’s always a need for nurses to work nights, weekends, and holidays in the PICU — all great ways to increase your hourly rate.

Pursue Your Dream of Becoming a Pediatric ICU Nurse

Ready to take the next step in your nursing career and begin working in pediatric critical care? Take the next step toward becoming a PICU nurse today by browsing exciting opportunities on IntelyCare’s job board.