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On the Clock: A Nurse’s Day in the Pediatric Intensive Care Unit
“While it can be a difficult role, it’s an honor to help families stay strong during their child’s treatment.”
Hassenfeld Children’s Hospital’s Pediatric Intensive Care Unit (PICU) specializes in caring for children with serious, complex health problems.
PICU nurses balance expert medical knowledge with warmth, humor, and grace to help kids and families throughout the hospital stay.
One senior staff nurse, Emily Johnson, BSN, RN—who’s been with the PICU for five years—shares some highlights and reflections from a typical day on the floor.
Clock in on the 9th floor with a quick “hi” to the night shift.
Pop my oatmeal in the microwave for a quite bite as I check the assignment book to prepare for the morning safety huddle and the night nurse report. It’s going to be a full day. Lots of great kids and families.
Hands-on patient assessments with the night nurses. Greet new kids and families and ask about their concerns and goals. I tell them it’s a two-for-one special on nurses today, so they have two friends to hang out with.
Wrap up a few minutes before medical rounds and visit a child who’s been with us for a while. He misses his parents, so we play with noisemakers. I got him laughing so hard he snorted. Mission accomplished.
Kick off medical rounds. Doctors respect our insight, which is why PICU nurses started leading medical rounds. We present the patient’s history and big events from the past 24 hours.
Our rounds stop by one of my assigned patients, a teenager who had been intubated after a brain surgery. With MyWall, I put on a playlist to keep her company. Ariana Grande is always a favorite.
MyWall allows patients and families to choose from different entertainment options, see their chart and medical information, use video virtual interpreters (which we utilize all the time to communicate with families), and more.
Help RN Grace get medication to stop a patient’s abnormally fast heart rhythm. I’m always ready to draw labs or just generally help out. Camaraderie is real in the PICU.
One young child I'm assigned to has a room full of parents, aunts, and uncles. They worry she’s in pain, and I explain which medication she’s on and that she’s got the best doctors. I help her parents change her diaper, a small act that helps parents feel involved and connected to their child, even when the child is in critical condition.
Checking on patients often means checking in with families. Keeping everyone informed and comfortable is a huge part of what I do.
The mom of my teenage patient is anxious about missing floor rounds with the medical team. She’d been stuck on the train and just got here. I update her on the care plan and how we’re managing the sedation for her child’s extubation. Mom is hesitant about the medication changes, so I page the doctor.
Someone’s going home today! An oncology patient who’s been in and out of the PICU. He won’t leave without beating me one more time in a game of Don’t Break the Ice. Grab a quick bite before getting back to work.
Huddle with the medical team about the younger child I’m assigned to. Her case is growing more complicated and we agree on a good path forward.
Run a blood test for another nurse’s patient with bad pneumonia. She has trouble speaking, so I tell her about my favorite Paw Patrol and PJ Masks characters while her mom gets lunch from Kimmel Café. The girl smiles when I brush her hair into buns. She looks just like Princess Leia.
Call in the doctor to evaluate my teenage patient who hasn’t woken up two hours after the sedation medications were turned off. Everything looks fine, but her mother still has concerns.
Uncertainties bring out lots of feelings. Emotions are heightened in the PICU. Kids are the focus, but we have to make sure that parents and siblings are comforted, too.
Hassenfeld Children’s Hospital has a fantastic multidisciplinary team of psychologists, psychiatrists, social workers, and child life specialists who support the emotional well-being of children and families. That can include anything from music therapists singing babies to sleep to support dogs for the kids (and staff!). Child life therapists are great at explaining to kids on a developmentally appropriate level why they’re in the hospital and what’s going on. But working with patients and families on an emotional level is really a favorite part of what I do as a nurse.
Help settle a post-op patient into his room. I teach him how to use the MyWall remote, and he gets cozy. I show his family around our new facilities while his bedside nurse takes care of him.
Delivery from Eons Greek is here! Time for a break.
Clear my head by visiting a patient who graduated from the PICU to general pediatrics. We play house with her baby dolls and I catch up with her family. Her happiness makes me feel inspired and hopeful after seeing her so sick just a few days ago.
My teenage patient still hasn’t woken up from sedation, so I alert the neurosurgery team to examine her. Her mother starts to cry. I assure her I’ll be there the whole time while we prep her daughter to go downstairs for a STAT MRI.
New patient arrives. Bring extra pillows to make him feel at home.
Transport the teenager quickly and safely to the MRI. Significant coordination with the incoming night shift RN, medical team, attending, and respiratory therapist makes it a seamless move.
Bring the girl back to her room. The medical teams tells her mom that the MRI appears as expected. The girl’s brain is probably still tired from the big surgery a few days ago. She’ll wake up soon.
My shift ended an hour ago, but sometimes it’s best to stay with the patient when you know everything that’s going on. I give handoff to the night RN on my assigned patients, including plans for the night, vital signs, medications, and things to watch for.
Clock out and check my phone. Ready to clear my head and relax after a long day.
Emily Johnson, BSN, RN, has a BS in nursing from the University of Pennsylvania and is finishing a master’s degree to become a pediatric nurse practitioner.