I graduated a year ago this month! :-) To all the nursing students, just get past school and you will have so much more autonomy when you are on your own. It is so rewarding!!
I work at a children's hospital on the airway floor. I started out in PICU but decided I didn't like it for many reasons. Now I'm still semi-ICU but I focus on kids with trach/vents, RSV, pertussis babies, pneumonia, and other airway issues that are less acute than the ICU kids.
Someone asked about dealing with the medical model-- most of our kids are pretty sick and I agree with the meds they are prescribed. Of course if they are scheduled meds I have to give them. The PRN meds are more at my discretion to give or not give. I never like a kid to be in pain and I will give those meds if the kid is in pain-- being in pain means they can't rest and get better, and they are using energy to deal with pain rather than heal. However you usually have an option to give for example, 1-2 mg of morphine or ativan or whatever, and you can try the smaller dose first. You can also try other things such as heat or ice packs, music, and I often will tell stories to distract the kids and help them relax if they are old enough or cognitively aware. But sometimes you just gotta give the pain meds.
I am conservative with oxygen use and will try other things first (oxygen is after all a drug). I try to deep suction the nose and that's often all that's needed for the RSV babies to raise their sats. Or I will give a bit of O2 and then adjust up or down according to activity level. I can call the doctor and gently suggest other things. Example I had a 2 year old developmentally delayed kid who was teething. He was very agitated and had chewed his cheek trying to grind the teeth. All he had was ativan for agitation, and morphine for pain. (He was chronic and severe health issues and really did need those meds at times.) I told the MD I thought he was teething and needed some more traditional teething meds, and he prescribed tylenol and teething gel. I wrappped gauze around my fingers and massaged his gums with that gel and it made him soooo happy!
So within reason nurses really do have a lot of power to work within the parameters they are given, and be creative in healing.