A Peek Inside Pediatric Nursing

pediatric nursing

By Megan M. Krischke, Contributor

Nursing is a rewarding profession regardless of which specialty or clinical setting you decide to practice in. But when it comes to pediatric nursing, there are few things comparable to the joy, satisfaction and even heartbreak that comes with working with children.

Pediatric nursing also involves more family-centered care than many other types of nursing. Because most nursing programs offer relatively little pediatrics-specific training and education, nurses planning a career in this field should expect the need for extensive on-the-job training.

“One of the most important lessons a nurse starting in peds [pediatrics] has to learn is that children aren’t little adults. You can’t just translate what you learned in school to peds. Children are not only physiologically different, but also developmentally,” explained Ruby Jason, DCH, MSN, RN, NEA-BC, division director for women and children at Oregon Health Sciences University (OHSU) and Doernbecher Children’s Hospital in Portland, Ore.

“Children will view their illness or injury based on their developmental state,” she explained. “For instance, a toddler doesn’t know he isn’t going to bleed out when he cuts his finger and will likely have a more dramatic reaction to the sight of his own blood. Children can also suffer extreme separation anxiety because they don’t understand why their parents have to leave or when they will come back. Teaching new nurses how to deal with those issues is extremely important.” 

“Nurses who are interested in working in pediatrics also need to realize that you don’t just treat the child, you treat the entire family,” said Judith Harris, MS, RN, CPNP, nurse practitioner at Phoenix Children's Hospital. “You need in-depth knowledge of parental psychology so that you can navigate through parental issues and help parents care for their kids.”

Jason added that because parents feel so much responsibility for the well-being of their children, seeing their child sick or injured sometimes makes the parents more critical patients than the child.

“Another issue we deal with is that children aren’t allowed to make decisions on their own. An adult can turn down an IV, but you might have a child saying, ‘No, no, no, don’t hurt me. Don’t put that needle in.’ Children do not have the ability to consent to treatment, but we want them to assent to their treatment,” remarked Jason. “This issue becomes even more complex when you are working with teens and they are wanting more autonomy.”

Among the more recent developments in pediatric nursing is the increasing number of children being diagnosed with “adult” conditions such as high cholesterol, now typically related to juvenile obesity. At the same time, young patients suffering from traditional childhood-specific diseases such as type I diabetes, childhood AIDS and cystic fibrosis are living well into adulthood, creating the dilemma of where to draw the line between pediatric and adult care.

“One of the questions we are starting to ask is, ‘How long can you remain a peds patient when you are really an adult, but have what was previously considered a childhood disease?’” Jason explained. “Nursing is transitioning its care of these patients to allow them more autonomy in their care as teens, so that they are more prepared to manage their illnesses as adults.”

Jason pointed out that pediatric nurses are also seeing families struggle with the cost of health care.

“There have been so many medical advances, for instance surgeons are working miracles on children with congenital heart defects,” she said. “But these life-saving procedures are extraordinarily expensive and can tap out a lifetime insurance cap when a child still has a lifetime ahead of him.”

But along with the challenges, pediatrics offers a number of rewards.

“Working in pediatrics is very refreshing. Children are amazingly intuitive and give very honest responses,” reflected Harris, a 30+-year pediatric nursing veteran.

“Children are very courageous and extraordinarily resilient,” she continued. “While adults may want to stay in bed for a few days after a major abdominal surgery, kids are often wanting to go to the play room the next day.”

Loving to work with children is not always the best qualification for working in pediatrics, however. The reality that children die or have to return to less-than-ideal family situations when they leave the hospital is too difficult for some nurses to handle.

“One of the greatest challenges of pediatric nursing is maintaining a professional distance,” said Jason. “I still remember every child that I’ve lost and I’ve worked in pediatrics for 25 years. It is always so hard for a nurse when they lose their first patient.”

While pediatric nursing doesn’t require certifications for practice, there are a number of pediatrics certifications available that can enhance skills and prepare nurses for further specialization.

“One of the great things about a pediatric specialty is that there are so many subspecialties,” Harris stated. “You can specialize in cardiology, pulmonology, oncology, etcetera. It is a very diverse field with room to explore any interest you might have, such as research, critical care or nursing education.”  

“Pediatric nursing is extremely competitive because there are a lot of people who want to work in peds and there are not many spots. If you want to work with kids, you don’t have to work at a children’s hospital,” Jason advised. “Especially in areas where there isn’t a children’s hospital nearby, there are children in the mainstream hospitals—those kids would really benefit from having a nurse who is passionate about kids and understands that they aren’t just small adults.”

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