As Challenges Weigh Down, Pediatric ICU Nurses Press Forward

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Inside the Yale New Haven Children’s Hospital Pediatric ICU, nurses meet for their evening shift change, after a day where their patient count more than doubled.

“Yesterday we had seven patients and then since I’ve been here, we've gotten hit with another five admissions, so we're up to 17 patients,” nurse Sara Cicero said.

They say it’s been like a revolving door since late summer when RSV cases among children surged and the 21 beds in the pediatric ICU were full.

“Our poor colleagues in the ED were overwhelmed,” nurse practitioner Clair Dickenson said. “We had ICU patients in the ED and housed on other units. It was like I’ve never seen before.”

Pediatric ICU patents were treated across different departments including the emergency department, surgical units and the general pediatric floor.

Cicero says the hospital will never turn a patient away. That has been the pattern the last three years.

Nurses have endured never-seen-before moments during a pandemic that caused the nurses to take on more patients and at the same time, spread out to other departments to continue caring for patients with worsening illnesses.

On the day NBC Connecticut visited the floor, Cicero says they were down eight nurses.

“We're, you know, kind of at our max capacity, despite not increasing our staffing numbers,” Cicero said. “And the kids are much sicker than they've ever been before,” she said, explaining that various illnesses are lasting longer with more impact.

“The mental and physical challenges, you know, it's just, it's been, it's been a lot,” said patient care assistant Mary Brushett.

Pediatric ICU nurses are trained in a number of different practices including oncology, cardiology, respiratory, pulmonary and trauma. Children and young adults can come to the unit with any of those issues.

The nurses never know what skills may be needed. 

“Working in a pediatric ICU with critically ill children, a lot of times, you may not know what the outcome is going to be,” nurse Stephanie Fortier said. “Obviously, you're hoping for the best and you're working for the best, but it's a challenge.”

While they’re caring for the youngest, most severe patients, they’re making time for the families, too. One patient’s mother recalled a night where he was having nightmares in the middle of the night.

“And the nurse just gave me a hug and sat with me and made sure I was okay,” Molly Rudolf said. “And then before she went on to like the next case that she needed to get to, she took the time to just like be there and check in.”

What goes on here can be hard. One of the toughest days is when a patient doesn’t survive their stay.

“When something nasty happens, it's not so much them, because maybe they've gone to a better place. But it's the poor family that's left behind,” Dickenson said.

She adds that it’s better that people don’t really know what goes on inside an ICU.

“So our patients are like our kids. Our patients are like our family members. So, it definitely takes a toll on us. And we definitely are all reaching out to each other,” Cicero said.

On hard days, whether it involves death or a tough diagnosis, she says there may be a little longer break time, extra snacks in the break room and extra texts messages.

That support is a big part of how they get through each and every day.

“In like the landscape of the last three years, and in the trials that have kind of come with it, the one thing that has always stayed the same and we've maintained is our teamwork,” nurse Brooke Matthews said.

Every day here is different, but the last three years have been one long stretch of many of the same daily pressures. Still, they say it’s an honor to do what they love: treat these young children.

Cicero said it’s the resilience of the kids and staff that comes together to make their jobs worth it. She says there was a day when she had a young patient whose breathing and neurology was getting worse.

“He wasn't doing well,” Cicero said. “And I was getting ready to go bring him down for an MRI. And down the hall came running a little girl who just started yelling my name, and she was standing there holding up an ‘I'm cancer free sign.’ And we honestly never thought that she would leave the PICU.”

“And to see that while taking care of now my sickest kid, and the sickest kid in the unit, is just incredible,” she continued. “The work that we do here, I don't think people in the public truly understand the magnitude of the work that we do.”

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