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. It's fast paced. A PICU nurse's assessment skills have to be very keen because there are rapid changes. We go through a critical care internship, which can take three to six months, depending on how sophisticated the hospital's unit is. 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.
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.