Small Patients. Big Differences.

“Those who love pediatric nursing, love it with a passion,” Deb Wesley said.
When the patient is a child, nursing is definitely not a one-size-fits-all proposition. Medical equipment is different. Dosages are different. Even the patient’s level of understanding and communication skills can require a completely different approach.

However, pediatrics is one area where nursing students may not receive extensive training, often because opportunities for clinical experience can be limited.

“When we recruit nursing graduates or any nurse who doesn’t have a strong background in pediatric nursing, they spend their first 14 weeks here in a concentrated program of classroom and clinical training to thoroughly prepare them to be pediatric nurses,” Deb Wesley,  senior vice president and chief nursing officer at Children’s Hospital of Alabama, said.

“We offer the program three times a year, and it is always full. We even get requests from out of state schools and hospitals looking for pediatric training for their nurses,” Wesley said. “We cover every aspect of pediatric nursing, from differences in anatomy to the nuances of how children can respond differently to illnesses and treatment. We discuss developmental issues, along with cognitive and language differences.

“Especially when working with neonates and very young children, nurses have to use a whole different skill set to assess the patient’s condition,” Wesley said. “You can’t ask patients without language skills about their symptoms and how they are feeling. That means you have to learn to listen and distinguish between cries of pain and fear, and look at body language and behaviors to identify problems and judge how they are responding.”

Since pediatric patients range from newborns to age 21, the skill sets needed within the field can vary from patient to patient.

“Blood pressure cuffs come in different sizes, the needles and blood draws and medication dosages may be smaller. Even the beds are different, ranging from isolets and bassinettes to toddler cribs, junior beds and full size beds,” Wesley said.

Since Children’s Hospital draws young patients from across Alabama as well as surrounding states, the types of cases nurses are likely to see are also widely varied.

“Some of our cases from the local area are less acute, but we also see the sickest of the sick,” Wesley said. “That includes burns, trauma and very complex illnesses with different co-morbidities and underlying conditions.

“Illnesses that may not be severe in adults can quickly become serious in a child because of their anatomy or the fact that their immune system is less experienced in fighting off an illness,” Wesley said.

Another factor is that, unlike adults who are usually able to use a call button when they need help, small children can’t be left unattended.

“Parents usually try to stay with the child, and relatives and friends often fill in when they can, but  it’s difficult to have someone there every minute of the day and night. There are also parents who face the economic realities of being unable to take time off work, and children who have only one parent or none,” Wesley said. “In those cases, we staff differently to meet the specific needs of the patient.”

Some pediatric patients come to Children’s Hospital for outpatient treatment and short-term admissions. Others are there for an extended period, waiting for a transplant or undergoing specialized care.

“We have teachers on staff to help children with their school work, and our child life specialists work to make life as normal as possible. They use play therapy and interaction to reduce fear and distract the children from treatments that may be uncomfortable,” Wesley said.

New hospital facilities that opened last year are also helping to streamline care.

“Everything is state of the art and designed with patient care flow in mind. All the things we need to take care of the patient are adjacent, so we don’t waste a lot of hunting-and-gathering time looking for equipment. We have a touchdown space outside the room with a computer and phone, and we can see into the room while we are working with records,” Wesley said.

“Pediatric nurses are very special people. I’ve learned that people are either pediatric nurses or they are not.  If they are, they tend to stay with it,” Wesley said. “We have a very tenured staff. Many retire after 30, 35 or even 40 years in the field. Those who love pediatric nursing love it with a passion.”


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