As of August, I have been specializing in Pediatrics, working on a step down ICU unit with little ones as young neonates up to children of 18 years of age. As many of you may know I was previously working primarily in MedSurg with adults for most of my career thus far. If I’m being completely honest, I was very nervous about this transition, as it was a major change from what I was used to doing. When it comes to working in a vulnerable population, such as pediatrics there were many questions and concerns that I quickly started to develop. We could literally fill our minds with fear for eternity, but I decided I was going to change my way of thinking, because all the things I was concerned with I had already dealt with it in adults, if you really think about it. Are some things different, yes. But one thing that I quickly realized was that my foundation nursing skills were already developed, which made my transition very smooth. So, lets jump right into it:
· Nurse to patient ratio: I came from med surg so I was use to working with 6 patients max, so that’s the mindset I had coming into this new position. Although, because the kiddos I work with now are a little more complex, our acuities are higher, and my ratio is now 1:3 with possibly 4 depending on how staffing is. This I love, safe ratios bring better patient outcomes! Also, because I was so used to having 5-6 patients, my time management skills were already built. Having fewer patients, really allows me to focus in on the ones I have and fully care for them in the way that they need.
· Types of patients I work with: This really is a broad spectrum and changes so often. For the most part almost 90% of the patients I care for are trach/vent dependent for various reasons. Many of my patients have heart abnormities, autonomic instability, CP, down syndrome, failure to thrive, gun shot wounds/recovery, new onset diabetes, narcotic weans, accidental traumas, anoxic brain injuries, and developmentally delayed. Just to name a few! Every little one is different and bring something different, many of them are also G-tube dependent, I as well have a few cases where I work with colostomies and ileostomies, all just depends on the kiddo.
· The presence and involvement of family: This is a major point to make when it comes to working with children, because they are often too young to make any decisions for themselves, parents and or guardians are heavily involved. GET OVER IT. For me I’d say, treat the parents like they are the patient as well. In the aspect of, this is their child and they are many times afraid and just want to know what’s happening with their little one. Always keep them informed of any updates or changes with their child. Let them know what you’re doing and why you’re doing it before you come in just touching on their baby. Lastly, just listen to them. They often know their child better than anyone and because children can’t communicate with us, it’s very important to look at and examine physical changes and any other changes, listen to mom, she knows what she’s talking about.
· Weight Based Medication Dosing: The major difference between adults and pediatrics, is that most of their medications are administered based upon their weight. For the most part, pharmacy will do this for you. Medications are generally already prepared for you and the only thing you’re doing is verifying that it’s accurate. Although, with many narcotics and pain medications this requires you to do a little math and verifying with another nurse if applicable. Miscalculation of a dosage can be life or death in our little ones, so this is a must. If you’re like me and math is a weak area, PRACTICE!
· Assessment and Vitals: Doing a complete head to toe assessment, along with reviewing vital signs is key in pediatrics, because they can not tell us what’s wrong. This is where you always want to be very detailed, noting any work of breathing, nasal flaring, or even change in color. Vitals were another transition for me because with adults I was use to one range of vitals that accounted for everyone. Whereas in peds you have different ranges for different age groups, because I’ve only been in this specialty for 3 months I use a cheat sheet with NO SHAME. I keep it right on my ID badge, it’s readily available and I can always double check. This also plays a role with pain, because our little ones can’t talk, we rely on looking at other factors just as their heart rate, body language, and inconsolable crying.
· Death: It comes with the job, unfortunately not all our patients are going to survive and that’s a harsh reality. I have not experienced this with working in pediatrics yet, but I have in other areas in my career. Know your position as a healthcare provider, but also allow yourself to be human for a moment. Take a moment to talk with another coworker, seek professional help if needed, and know it is okay to cry! We are human, let’s face it we sometimes find ourselves getting attached to patients and families and if I’m being honest even if you’re not close with a patient it still hurts. Talk about it in a healthy setting. Lastly, never question or blame yourself. If you know you did everything in your power to care and advocated for the patient appropriately, your job was well done.
In all, my transition as been great and I’m beyond happy with my decision to go into pediatrics! While in some cases it can be sad, but it also very rewarding and challenges me in a positive way, it requires me to use my critical thinking skills a little bit differently. It’s amazing to see some of our little ones return home with their families, our trach/vent babies being weaned off the vent and our CP and rehab kids up and learning to walk and work with PT! Pediatrics is place like no other in nursing, I find that my interdisciplinary team is very different than what I’m use to. The doctors and residents are very friendly, and you get to see everyone become a kid again for a couple hours out our day. I mean where else have you seen a full blow nerf gun game going on in an inpatient nursing unit?! No seriously, this is almost every day! Lol Or even dressing all our kiddos up in Halloween costumes and have them all lined up at their doors for a mini Halloween parade brought on by all the staff in fun Halloween costumes as well. Plus, every day is a bonus when I can whatever color scrubs I choose and wear cute kid friendly tops! Everything in nursing doesn’t have to be sad and I’m glad that I found that within pediatrics!
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