By: Farra Kurniawan
Jennifer Kang is a pediatric nurse at SickKids hospital. Graduating as the valedictorian of her class in 2014, she started her career in the Operating Room at Sick Kids. Although working in the OR was not her first choice, it was her way in. In 2017, she made the jump into the world of intensive care and started working in the PICU. At the time of the interview, Jennifer was a few months shy of finishing her MN-NP, Pediatrics at U of T.
Although Jennifer was working, doing her master’s, and NP program, she did not pass on the opportunity to share her experiences with current students at her former UNB/Humber program.
Even though every day may be different in the pediatrics’ intensive care unit (PICU), can you give us an idea of what a day in PICU would look like?
PICU is really interesting because you really never know what is going to happen. A typical day would start with getting hand-over at 7-7:15, either in the morning or evening. One of the nice things about PICU (at least in our PICU) is that we are one-to-one with all of our patients. So, I would just get a hand-over report on one assignment.
[Although majority of the time, we are 1:1 ratio, there are certain situations where we may have a 2:1 ratio – such as when patients are not unstable or acute and are getting ready to be transferred to the ward; or on the other hand, if our census is really high and we’ve surged in patient number. But we’ve never found ourselves to have more than a 2:1 ratio.]
I start my shift at 8:00 with my safety checks – I make sure that my ventilator settings are good and I review the medications that my client is on. The PICU can be a little unpredictable because you never know if you’re going “travelling”. “Travelling” can include a trip to the image guided therapy (IGT) clinic, magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, or to the operating room (OR). If my patient was not intubated, they may become intubated. And if they are intubated, they may be extubated.
So, the 12 hours in an ICU can go very by quickly – which is kind of nice. Then 12 hours passes, you do your hand-over, and then you do it all over again the next day.
What was a challenging situation that you’ve found yourself in at the PICU? And what did you do to overcome it?
At SickKids, we are part of CritiCall Ontario, where physicians from any hospital in the province can call SickKids for additional support or resources for their urgent clients. If the children are far too ill or their trauma is too much, then they get transferred to SickKids by our in-hospital transfer team, by Ornge, or through emergency medical services (EMS).
Once every other shift, we will get a transfer from one of the community hospitals. Those days are really challenging because you don’t know what is going to come. Traumas are really bad. During COVID-19, we have had a lot of pediatric strokes. Those are really challenging because the kids are very ill. There are a lot of preparation that goes into getting them ready and comfortable when they come. The current visitor restrictions (due to the pandemic) has also been an added stress factor – making the day a little bit more challenging.
What do we do to overcome it? We are really lucky to have a fantastic team! Although we don’t do team-based nursing, we still work together. For instance, if you don’t have a very ill patient, you can drop what you are doing and support the hallway. Really, the only way we get through our days is through teamwork. I would say that getting over conflicts and working well with others is the biggest transferrable skill in nursing.
Throughout your career, what was the most rewarding situation that you found yourself in?
It’s very difficult to pick one situation because there are a lot of rewarding experiences when you’re working in pediatrics. Because we see a lot of trauma, sadness, and death in a PICU, the success stories are always very nice. A couple of months ago there was a teenager who was very unwell, and it did not seem like they were going to make it. While they were with us, they had a tracheostomy, and they were having difficulty speaking for a long time. Yesterday, we received an email from the client through our Child Life specialist. In the email was a video of the child singing “Somewhere over the Rainbow” song. It was really incredible. So, things like that – when we get emails from the department about someone who has done really well, or going off to college/university - things that I never thought could’ve happened.
What is your master’s and NP program like?
The MN-NP program at University of Toronto (U of T) takes 2 full years to complete. I chose to do a combined program, where I did my master’s courses and NP courses simultaneously. So, for each term, I took one masters course and one NP course. I chose this route because of the timing and my lifestyle. Plus, I was worried that if I did my master’s first, I might not get good grades and I wouldn’t be able to apply to the NP program afterwards. But if you’re thinking of doing your master’s then your post-master’s NP a couple years later, you don’t have to worry about your grades. The master’s program is very fair and accommodating – very different from undergrad for sure. If you choose to do your post-master’s NP on its own, you would just be taking one course per term.
During my first year, we did two terms of pathophysiology. So, imagine the fourth-year complex care course at UNB/Humber but 100 times more difficult. In my second year, we did two terms of advance health assessment, where we learned how to diagnose and treat patients. On top of the courses, we have over 700 hours of total clinical hours to complete. The placements are very similar to the bachelor placements at Humber; which I will have to say, I don’t think you’ll appreciate until later on. They have the placements, and you get to pick the ones that you’re interested in.
[When you get out into the working world, the reputation that Humber students have - in terms of clinical skills, knowledge, critical thinking, eagerness, and work-ethic – is really great. Humber offers really good placements so it does look really good on your resume. I have friends who went to other schools who did their consolidations in long-term care, as opposed to everyone that I knew at Humber who had really great consolidations.]
In my cohort, there are 25 of us in the pediatric stream, maybe 50-60 students in the acute, and about 100 students in the primary care. So, in total, we are just over 200 NPs. The pediatric stream is pretty competitive, but definitely reasonable to consider. In the year before me, U of T had only accepted 14 students, and this year, they are only offering admissions every other year. However, there are a lot of other really great schools such as Ryerson, McMaster, and Athabasca (a very well-known and accredited online program). They are all pretty equivalent, and I think our experiences and knowledge coming out are quite similar.
What are the strategies that got you into the master’s NP program?
In terms of grades, I don’t think you would need a particularly high GPA (I would say above 75%). I know people who got into the program without fantastic GPAs, but had a lot of extracurricular activities, projects, and demonstrated interest; while those who only had high GPAs didn’t get in.
I did my research by attending a lot of nursing fairs to chat with different schools that offered the master’s and NP program. I found out that I needed a certain amount of hours to apply to the program – which worked out be 2-3 full-time years of work. So, when I was building up to that, I thought a lot about what experiences would help me get into the program. I thought the ICU would be the perfect place to learn a lot of information and to learn it really fast.
For my extracurricular activities, I joined the nursing council at my hospital, and I picked up projects – anything to get my name out there. If I met other NPs, I would just reach out and say, “Hey, how did you get to where you are?” I made it a goal to network with somebody new every week.
What does the job market look like for NPs at the moment?
Unfortunately, my job prospects as a pediatric NP in the next couple of months in not fantastic. It seems to be better in primary care because my colleagues in that program do not seem as stressed about positions as the pediatric students. But I’ve been told that there is always maternity leave! It’s very difficult to say, but I think it will change. There will definitely be more options outside the GTA, in smaller towns, and in northern communities.
What was it like when you first started nursing? And how did you overcome fears of not being capable, if you had any, as a fresh nurse?
Well, I definitely had fears. Because I started in the operating room, the skills that I did there were very different than what I had learned in nursing school. I felt that I had to forget everything that I had learnt for the past four years and re-start all my nursing skills in a different capacity. I spent the first six months terrified. I cried a lot. The nice thing was that through this challenging time, I got really close to the people that I was hired with. When we were having a bad day, being able to call them and chat through things really made a big difference. Everybody was going through the same thing and experiencing the same feelings, and I was comforted by the knowledge that I wasn’t alone.
Even when I moved to the PICU as a senior experienced nurse, I was terrified once again. I was new again. For six months, I had a lot of anxiety and frustration. It happens. The key thing to keep in mind is that it’s not only happening to you – everybody feels scared and frustrated. Once again, I got a really nice group of people to start with and was able to bounce things off of them.
How did you get into pediatrics? Did you have to take additional courses after the bachelors?
Although I had a lot of placements in pediatrics during my undergrad (because I knew I wanted to work in pediatrics from the very beginning), SickKids understands that pediatric placements are limited so previous experience is not a requirement. However, you could get a Pediatric Advance Life Support (PALS) certification to show that you are interested in pediatrics. But once you are hired into pediatrics, the company will support you through the PALS course, so it’s not a requirement to get the job.
To work in the OR, you will need to get an additional certificate. To work in PICU, SickKids offers a specific training program that is equivalent to the critical care program that the colleges offer. However, if you’re going to work in an adult ICU, you will need to have completed the critical care course or be enrolled in the critical care course when you’re applying. Both Humber and George Brown offer the critical care course.
If anyone is currently in their fourth year and interested in working at SickKids, I was just looking at the career website and all the new grad postings just went up!
Are you wondering how you could get to where Jennifer is? Here are her top four tips:
1. Take every opportunity because you never really know where it is going to lead. This includes opportunities for networking, employment, and even something as small as watching an IV insertion. When I first graduated, I had a specific plan for where I was going to go and every step that I would take. Even though OR wasn’t my first, second or third choice, it worked out even better in the end.
2. Keep your notes from Nursing in Complex Situations course in fourth year. This course prepared me to know the systems and what to expect when I see different illnesses with different systems. I didn’t realize how much that had helped me until years afterwards when I went into the ICU.
3. Get your name out there. If there are specific units at SickKids that you are interested in, touch base with the managers and educators of those units. Ask them, “What do I need to do to get this job?” and “What do I need to do to make my resume stand out?” Sometimes just for them to know your name will help you stand out when you eventually apply for jobs.
4. Don’t be afraid to ask questions. When you are doing your placements, sometimes you don’t want to ask a question because you don’t want to look stupid. But every nurse that I know at SickKids loves when students ask questions because it shows that you are interested and that you want to learn.
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