Become a PICU Nurse in 3 Steps

Nurse Types / PICU Nurse

Pediatric Intensive Care Unit (PICU) nurses provide exceptional nursing care to very sick children or adolescents. PICU nursing is a type of critical care nursing that requires advanced knowledge and skills specific to this patient population.

This article will help you understand the ins and outs of PICU nursing, including:

• What is a PICU nurse?
• What do PICU nurses do?
• Where do PICU nurses work?
• What are specific types of PICU nurses?
• How do you become a PICU nurse in 3 steps?
• What are additional requirements of PICU nurses? 
• What are the salary and career outlooks for PICU nurses?

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What is a PICU nurse?

PICU nurses care for the most severely ill children and adolescents who need the highest level of medical care. Patients in the PICU need intensive monitoring and frequent interventions, often requiring one-to-one level care.

Qualities of a successful PICU nurse

PICU nurses provide very specialized care. Nurses in this specialty must have:

• A love of working with children and adolescents
• A deep understanding of pediatric health issues, including disease processes, and other conditions
• Advanced knowledge of critical care nursing specific to the pediatric population, including:
  • infusion therapy 
  • ventilator management
  • cardiac monitoring 
  • management of endotracheal tubes; extraventricular drains; intravenous, intraosseous, and arterial lines 
  • catheters
  • dressings and wound care
• An ability to provide developmentally appropriate patient education as well as teaching to the family
• Strong critical thinking skills
• Ability to work independently and as part of a team

What do PICU nurses do?

PICU nurses have a big job that requires compassion and highly developed knowledge and skills. PICU nurses must also be flexible and quick on their feet. One study of PICU nurses found that they perform an average of 90 tasks per hour, requiring changing tasks every 40 seconds!

A day in the life a PICU nurse

Many PICU nurses work with one or two patients at a time. Most patients in the PICU need very close monitoring, and their conditions can change swiftly. A PICU nurse must pay attention to indications of a change in status, particularly for patients who can’t speak due to age, condition, intubation or sedation. 

A typical shift in the PICU begins with receiving a report from another nurse. Next, the PICU nurse performs a full assessment of their patient. This includes:

• Vital signs 
• Drain output
• Skin condition
• Pain assessment
• Respiratory waveform and cardiac rhythms
• Neurological status

PICU nurses must administer medications requiring frequent assessments. This medical care must be balanced with daily care activities, like diaper changes, bathing, or feeding. 

Throughout the shift, the PICU nurse will need to provide updates to the patient’s care team. If the patient requires blood draws, respiratory therapy, occupational therapy, imaging studies, or surgery, the PICU nurse will coordinate care with different members of the healthcare team.

The PICU nurse must document and communicate assessment findings, medication administration and patient response, daily care activities, and changes in status. The nurse must balance these responsibilities with providing emotional support and education to the patients and their families.

Common conditions treated by PICU nurses

Patients admitted to the PICU tend to have more complicated medical histories, like prematurity or pre-existing congenital disorders. One study found that 77% of PICU admissions involved at least one pre-existing chronic condition.

Respiratory infections are the most common condition treated in the PICU, and up to 40% of PICU patients require mechanical ventilation during their hospital stay.

Common conditions treated by PICU nurses include:

• Respiratory infections, like flu or RSV
• Chronic respiratory issues like asthma
• Congenital anomalies, like congenital heart defects or neural tube defects
• Neurologic disorders
• Infections
• Injuries
• Neoplasms (cancerous and non-cancerous growths)
• Endocrine disorders
• Circulatory disorders
• Sepsis and shock

Patients in the PICU may pose additional challenges. According to the Society for Critical Care Medicine, up to 38% of children admitted to the PICU have some sort of developmental delay. 

In addition, PICU patients often require lengthy stays in the hospital, which poses unique challenges as far as supporting the emotional and developmental needs of these patients. 

Where do PICU nurses work?

PICU nurses work almost exclusively in hospitals due to the complicated and advanced level of care required for these patients.

There are different types of PICUs. Some specialize in a particular condition or disease, like cardiovascular PICUs or transplant services. Additionally, PICUs can provide different levels of care. 

What are specific types of PICU nurses?

Nurses who are interested in critical care pediatric nursing are in high demand, so they have options available when it comes to where to work.

PICU nurses can choose between community-level PICUs or more specialized units in hospitals. There are PICU nurses who specialize in burn care, cardiac care, or cancer. Others work with the youngest patients in the neonatal intensive care unit (NICU). 

Some critical care pediatric nurses transition into flight nursing, which involves transporting critically ill patients via helicopter to specialized care facilities.

Closely related fields

PICU nurses are a type of critical call nurse. Critical care nurses provide specialized nursing for patients with serious medical or surgical health needs. 

Other critical care nursing fields include:

• Emergency and trauma nursing
• Flight nursing
• Neonatal intensive care unit (NICU) nursing 
• Adult intensive care unit (ICU) nursing
• Burn units
• Step-down care after surgery
• Cardiac intensive care unit (CCU) nursing

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How do you become a PICU nurse in 3 steps?

Step 1 – Become a registered nurse

The first step is to become a Registered Nurse, which involves earning a Bachelor of Science in Nursing (BSN) and passing a national exam to prove competency.

Earn a BSN degree

There are many ways to earn your BSN degree, from traditional four-year college programs, accelerated second-degree BSN programs (ABSN), and RN-to-BSN bridge programs.

Many hiring managers prefer to hire BSN-prepared nurses, and these nurses often earn higher salaries than nurses with associate degrees.  

Choosing the right program for you depends on your educational and professional history as well as your professional goals. 

Pass the NCLEX-RN exam

After obtaining your BSN, it’s time to take the NCLEX-RN exam. Once you pass the NCLEX, you are eligible to apply for a nursing license in the state you wish to work.

Once you have your BSN and have passed the NCLEX, you’re ready to start your job hunt. Check out Incredible Health’s career resources to help you find and prepare for your ideal job.

Step 2 – Accumulate experience

New graduate nurses can sometimes find jobs in the PICU, but it can be difficult due to the specialized skills required for this position. Many nurses transition into the PICU after obtaining experience in other units first.

Helpful skills and experience

You can boost your chances of finding a job in the PICU by completing your nursing school practicum hours in a PICU. Newer nurses might also start by targeting community-level PICUs that serve patients at a lower acuity level.

You can also demonstrate your interest in PICU nursing through continuing education units (CEUs) in pediatric topics. Incredible Health offers free CEUs on a variety of topics, including pediatric care.

Changing specialty to a PICU nurse

Are you looking to change your specialty from another area to PICU nursing? Many PICU nurses start in another area of the hospital, like med-surg. This previous experience will help you stand out when you apply for a position in the PICU. 

If you currently work in a unit that serves children (like the ER, urgent care, or med-surg floor), try talking to your manager or charge nurse about your professional goals. They may be able to help you by assigning you pediatric cases when possible.

Another option is to reach out to nursing colleagues to see if you can shadow them for a day to learn more about the job.

Step 3 – Obtain certifications

There are three main certifications available to pediatric nurses, and each of them requires several years of experience working with pediatric patients.

Once you obtain a job working in pediatrics, you can pursue either the Certified Pediatric Nurse (CPN) or Pediatric Nursing Certification (PED-BC™) certification. 

These certifications are less specialized than the Critical Care Nurse (Pediatric) Certification (CCRN), but they can help demonstrate your dedication and knowledge of pediatric disease processes and developmental needs. 

The CPN and PED-BC exams require 2-5 years of pediatric nursing experience. This can take place in many settings:

• Children’s hospital
• School
• Home health
• Specialty clinic
• Special needs daycare
• Public health agency
• Primary care practice

The CCRN is an advanced certification available to nurses with demonstrated experience caring for pediatric patients who are critically ill. There are two-year and five-year options for certification, and both pathways require passing an exam to demonstrate your knowledge.

Check with your current employer to see which certifications they prefer (sometimes, you can get the cost of the exam covered by your employer!).

What are additional requirements of PICU nurses? 

PICU nurses must be able to work in high-stress, fast-paced work environments requiring attention to detail and specialized knowledge of advanced medical technology. Successful PICU nurses are calm under pressure and willing to tackle challenges head-on.

In addition to providing exceptional and specialized care, PICU nurses need to be able to bear the emotional burden of caring for very ill children and adolescents. These nurses must walk a delicate line between providing compassionate care while protecting their own mental health.

PICU nurses must also be great communicators who can provide emotional support and education to their patients and worried family members. 

What are the salary and career outlooks for PICU nurses?

The career outlook for PICU nurses is strong. These specialized nurses often earn more due to their experience and advanced certifications. Additionally, nursing in general is a growing field, with expected job growth of 6% between 2021 and 2031. 

While the U.S. Bureau of Labor Statistics doesn’t break down salary according to specialty, the median pay for all nurses is $82,750 per year. Nurses with additional certifications and expertise can reasonably expect to earn even more than this. 

The average annual pay for a PICU nurse is $94,000. The top 5 cities are:

Curious to see how much you could earn? Try our free salary estimator. 

There are many other ways that employers provide benefits to their nursing staff. From childcare benefits to paid time off, qualified and experienced nurses are compensated in many different ways.

Job satisfaction

The PICU can be a challenging place to work, given the high morbidity and mortality of patients in this environment. The need to perform advanced nursing skills and demonstrate continued proficiency with advanced medical technology can also make PICU nursing difficult.

One review study found that working in a supportive work environment with a good team can help protect PICU staff from burnout. PICU nurses also benefit from a strong sense of competence that comes from using advanced skills in a specialized setting.

We can help you find the right PICU for your next career move. Set up a free profile today, and we’ll help connect you to employers competing to hire PICU nurses!

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Next steps 

PICU nurses looking to expand their career options might look at the CCRN certification or additional training to work as a charge nurse in their unit. Another option is to move to a specialty pediatrics center that serves more acute cases. 

Some PICU nurses obtain a Master’s of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) and subsequently move into a different role on the healthcare team.

PICU nurses looking to advance their career might consider positions in management, academics, or advanced practice nursing. These paths may offer increased salaries or job responsibilities.

Ready to take the next step? Join Incredible Health today to make your next career move…incredible!