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Some nurses love working with children, but working as a pediatric critical care nurse and providing care for them when they’re in critical condition is quite different from caring for them when they have a cold.

So what skill sets do you need to work in pediatric critical care? What is it like? If this is for you, how can you become involved?

We interviewed Tatiana Zedan, MSN, APRN, FNP-BC, a nurse practitioner with Pediatric Critical Care of South Florida  who works as a pediatric critical care nurse practitioner at Joe DiMaggio Children’s Hospital in Hollywood, Florida, about what it’s like working in pediatric critical care.

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Tatiana Zedan, MSN, APRN, FNP-BC, is a nurse practitioner with Pediatric Critical Care of South Florida

How did you get interested in being a pediatric critical care nurse? What drew you to it? How long have you been doing it?

I always loved working with kids, so when I started as a nurse, I knew pediatrics was where I wanted to be. After doing a clinical rotation in the PICU as a nursing student, I knew that was where I eventually wanted to end up, as it always gave me an opportunity for critical thinking.

I started as a new grad nurse in the pediatric critical care residency program at Joe DiMaggio Children’s Hospital and ended up specializing as a cardiac critical care nurse. I worked as a pediatric critical care nurse for five years before becoming a pediatric critical care nurse practitioner.

Explain briefly what a pediatric critical care nurse does. What types of patients do you serve? What do you provide for them?  

Pediatric critical care is a broad term that has so many components to it. As a pediatric critical care nurse practitioner, you take care of the sickest patients in the hospital that require close monitoring given their circumstances. We closely monitor their breathing, heart rate, blood pressure, ICP, and intra-abdominal pressures to make sure the patient remains stable throughout hospitalization. Once the patient requires less invasive monitoring and support, our goal is to be able to transition them to a lower level of care with a disposition to home. Depending on how severe the illness is, this may take days to weeks or even months, but ultimately, we can achieve this goal with multidisciplinary involvement.

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Patients we see range from strokes to viral respiratory illnesses, congenital heart disease, post cardiac/respiratory arrest, heart, and kidney transplants, patients on dialysis, septic shock, spinal fusions, endocrine dysfunctions requiring the use of vasoactive medications, and the list can continue.

Pediatric critical care is a broad topic, and within that, many specialties are involved in the plan of care for a patient, as often, a patient may come in with multi-organ involvement.

An example of this multidisciplinary approach would be for a patient after congenital heart disease repair with a cardiopulmonary bypass. A patient would require critical care of close cardiopulmonary monitoring. Most patients will come back intubated. Cardiology, as well as cardiothoracic surgery would be involved in the patient’s plan of care. Should the patient have acute kidney injury after cardiopulmonary bypass requiring dialysis to pull off fluid and wastes, then nephrology would be consulted to guide care while on dialysis and recovering from acute kidney injury. This is just one example of how complex our patients can be in pediatric critical care.

As a pediatric critical care nurse practitioner, I stabilize critically ill patients and closely monitor their hemodynamics while intervening and adjusting their care plan to ensure adequate end-organ perfusion.

Did you need to get additional education for this position? Please explain.

As a pediatric critical care nurse practitioner, I was required to obtain my master’s degree in either acute care or as a family nurse practitioner. This degree entails two years of higher education and 600 clinical hours.

What do you like most about working as a pediatric critical care nurse? 

What I love most about working as a pediatric critical care nurse practitioner is the resilience these kids have.

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Throughout my career, I have seen many patients with poor prognoses. Yet, these kids showed their strength and resilience in overcoming a diagnosis that we had labeled “poor prognosis.” Regardless of what they are going through, you can never fail to put a smile on their face, whether with bubbles, singing, or even bringing them toys.

Working in pediatric critical care throughout the years has shown me that there is light at the end of the tunnel, and these kids are creating that light for themselves. It’s a beautiful example that we should all live by every day, and I can see that day in and day out by working in pediatric critical care.

What are your biggest challenges as a pediatric critical care nurse? 

My biggest challenge working as a pediatric critical care nurse practitioner is seeing the families suffer throughout this unimaginable time. Another challenge would be seeing patients not be able to overcome their diagnosis.

What are your greatest rewards as one? 

My greatest reward is similar to what I like most about working as a pediatric critical care nurse practitioner. Seeing these patients overcome what doctors say “has a slim chance of overcoming” is one of the greatest rewards of being a nurse practitioner in pediatric critical care.

Is there anything we haven’t asked you that is important for our readers to know?

It’s important to remember that as a pediatric critical care nurse practitioner, you are treating the patient and making sure their family is involved with the care plan and understands why we do what we do to have the best outcome for their child. This is a very important aspect of pediatric critical care that I find often may be missed.

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Involving parents/guardians in caring for their child and allowing them to do what is safe in the hospital–even in pediatric critical care–is an important aspect that can decrease hospital stays.

For example, post-extubation, a patient may have an oral aversion given having a breathing tube in their mouth. Most kids feel better with their parents/guardians, so allowing the parents/guardians to feed the patient while working with therapies could help them feel better, ultimately allowing for sooner discharge.

Looking for a job as pediatric critical care nurse? Then check out the Daily Nurse Job Board to find a career opportunity near you.

Michele Wojciechowski
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