Is this unit more demanding than others?
Yes - it's so unpredictable. You can't predict when someone's heart is going to stop or when she is going to bleed. When they're really sick it sets them up for more life-threatening events that have to be monitored, so we closely watch heart rates, blood pressure and physical signs. Some treatment is often very critical because we're giving it to them right on the spot; there is no delay. It's fast paced. A PICU nurse's assessment skills have to be very keen because there are rapid changes.

Is a traditional nursing degree sufficient for the PICU?
No. We go through a critical care internship, which can take three to six months, depending on how sophisticated the hospital's unit is. It's classroom and on-the-job training. Later we take other courses outside the hospital dealing with different machines and subjects. Children do die, so there are workshops on death, dying and how to deal with that too.

Do nurses specialize within the PICU?
Yes. The more complex the illness, the more certification and experience you need. Some specialize in cancer patients and have chemotherapy certification. Others specialize in knowledge of certain types of machinery. Until kids get a heart transplant, some of them wind up on a Ventricular Assist Device, and there's special training for that. There's also specialization for dialysis and life-support systems.

What is the biggest ethical challenge facing a PICU nurse?
Well, there are religious issues a nurse has to respect. I once had a newborn child of parents who were Jehovah's Witnesses. The parents didn't want the child to get a blood transfusion even though the physician said it was necessary. In the end, we wound up complying with the parent's wishes, but that child did die.

What's the most positive aspect of what you do?
It's seeing the resilience that children have that adults don't have. I don't know if it's whether they don't have the fears that adults do or their bodies are better equipped to handle trauma. But they are so sick and sometimes they wind up enduring a lot more than adults do, yet their outcome is much more positive.

What's one thing a PICU nurse always has to keep in mind?
You're taking care of a whole family. You have to take care of these people without expecting anything in return.

Are there growing opportunities for PICU nurses?
There will always be a demand for PICU nurses because people come into it and can't take it for one reason or another. We're getting more patients in the hospital and we're getting sicker kids for longer periods of time. The demand is high for nurses in general. Between two local hospitals here in Arizona, they need about 150 nurses. It goes through cycles. Ten years ago we had an influx of nurses and now we have a huge need for them again. It may be because many nurses get burnt out. Also, because it's a predominately female profession, once we have families we tend to quit or go part-time to focus on our homes instead.

What's the average salary?
It ranges from about $35,000 yearly for a new grad to $50,000 or $60,000 for more experienced nurses, depending on where you are in the United States.

Have there been many changes in nursing since you started over 20 years ago?
There's more of camaraderie between physicians and nurses. Nursing is respected more as a profession now. I also think nurses are more prepared straight out of school, in all aspects. There are negative changes too. The ratio of nurses to patients has increased because they are cost-cutting across the country due to the HMO issue, and hospitals across the country are decreasing perks we used to get too.

Is it difficult not to bring this kind of work home?
Sometimes. For those of us who have families, our kids sense when it's been a particularly hard day or a child has died because they get that extra squeeze and hug.