Differences Between Pediatric ER and Adult ER

  1. 0
    So I started in an all adult ER. I'm at a combination ER with minimal pediatric contact. I just got offered a position as a pediatric ER nurse with some cross over to the adult side if I want to. I accepted and am a combination of scared and excited. I was a preschool teacher in the past so I have some experience with kiddos and parents. I am unsure of what other issues I will run into and was hoping for feedback on the contrast between the two. What issues have you run into in the adult environment? What issues in the pediatric? I know all ERs aren't the same. My experiences, though, with management and some staff hasn't been good. I've found a lot of nurse cannibalism in both of the ones I have worked. Is this common in the pediatric focus?

    I'm frustrated with where I've been at. There's a lot of working short staffed, increasing assignments, pushing, and passive-aggressive management. Speech between coworkers can be very rude; things I can't even imagine saying to another person. Some of these things are being said in front of patients. I'm hoping that some of this changes in the peds arena; would love any input on that or if I'm gonna be stuck with some of these attitudes regardless of where I go? I understand and recognize that there will always be negative and gruff people wherever I go. Conflict, drama, inevitable... but I've worked other places that it is containable, limited, or short lived. This hasn't been true for either of the ER's I've worked in.

    I'm also looking for suggestions on the best ways to deal with pediatric populations; IV start tricks, assessment tricks, etc.

    Any thoughts, input, or advice would be appreciated!
    Thanks!
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  3. 9 Comments so far...

  4. 1
    kids are not small adults. EVERYTHING is different. For one thing, you cannot escape the input of family members. There will be fewer heart attacks and more asthma attacks. You might get to know your patients better as those with chronic conditions return frequently (sickle cell, hemophilia, diabetes, etc). Your co-workers will show you about tricks of the trade. Good luck!
    canoehead likes this.
  5. 0
    I was thinking about that the other day; more appys, more seizures, asthma/bronchiolitis, etc. So good point! I realize the focus will be totally different. I think it'll be challenging to the skill set. I realize that they also go down hill more quickly and more unpredictably - whereas adults tend to shut down (physically) more progressively.

    Thanks for the good luck and input!
  6. 1
    I second that you'll be seeing a lot more respiratory issues, especially asthma. At the peds hospital where I used to work, 40% of ED visits were for asthma, and it's my impression that that's a fairly typical figure nationwide. Also pneumonia, babies with RSV, etc.

    Good luck!
    Esme12 likes this.
  7. 1
    It may be an adjustment for you re: how long things can take. When you have a uncooperative/irrational child you cannot restrain them the same way you can with adults. IV starts can take 20 minutes or more. Our policy is 2 tries and you are done, someone else needs to step in. Add the factor that they might be a chronic kid with horrible veins, contractures and is doesn't really stop moving because they are MRCP. Also, most peds ER's are teaching facilities. So you have the resident, who then needs to present to the attending, who may ask for a consult. We see tons of seizure, asthma, vp shunt problems, neutropenic and septic pts. PALS will help. Hope this helps
    Esme12 likes this.
  8. 3
    Quote from cadency
    I was thinking about that the other day; more appys, more seizures, asthma/bronchiolitis, etc. So good point! I realize the focus will be totally different. I think it'll be challenging to the skill set. I realize that they also go down hill more quickly and more unpredictably - whereas adults tend to shut down (physically) more progressively.

    Thanks for the good luck and input!
    More trauma and possibly more abuse.....more tragedy.......children are NOT little adults. EVERY aspect of their Tx is different. A child will compensate and compensate and by the time their O2 sat drops or their B/P drops they are in iminent danger of coding. Take ENPC.....it is a huge!!!! insight to caring for children. PALS teachs what to do in a code.....ENPC teaches you what to look for and why they are so sick, what to do for them and how to keep them from coding, what is an ominous sign.

    Wow, IV starting tips......that will probaly come from your co-workers.....everything changes by age of the infant or child. Mechanism of injury and age of the child are very important.......the story should fit the injury. If the child is not using it.....it is injured. Children haven't learned "No pain NO gain" when it hurts they won't use it.....

    DOSAGE ACCURACY IS IMPERATIVE!!!!!!!!!!! Small mistakes have huge consequences........move the decimal by accident and 3 becomes 30, 30 becomes 300, 300 becomes 3,000, 3,000 becomes 30,000......... Remember oxygen, fluids,and keep them warm!

    Never LIE....children will NEVER FORGET. Before you start ANYTHING have EVERYTHING you need. ALWAYS make the parent SIT IN A CHAIR!!!!! A crying child is a good sign.....a silent child is an ominous sign.

    good luck!!!!!:heartbeat
    Pednurse3, bjaeram, and JeanettePNP like this.
  9. 1
    As far as what you will run into staff wise.......an Emergency Nurse is an Emergency nurse.....knowledgeable and competent, bossy and wise......and unfortunately distrustful of new comers. Be patient ask questionsand listen to those who are already there because you are entering a new speciality...
    canoehead likes this.
  10. 0
    Quote from Esme12
    As far as what you will run into staff wise.......an Emergency Nurse is an Emergency nurse.....knowledgeable and competent, bossy and wise......and unfortunately distrustful of new comers. Be patient ask questionsand listen to those who are already there because you are entering a new speciality...
    Thanks for all the input! Gonna try to keep my head up. I try to be so cautious with the adult population but it sounds like it'll be even more important for the kiddos! Will definitely ask lots of questions and y'all make me look forward to the change. It sounds challenging but I believe it'll be a worthwhile change in my skill set.

    Thanks again!
  11. 0
    Quote from cadency
    Thanks for all the input! Gonna try to keep my head up. I try to be so cautious with the adult population but it sounds like it'll be even more important for the kiddos! Will definitely ask lots of questions and y'all make me look forward to the change. It sounds challenging but I believe it'll be a worthwhile change in my skill set.

    Thanks again!

    Although at times very sad......I have always loved peds. YOu can rock them to sleep, hugs make them happy and a kiss makes them better!!!!!!!
  12. 0
    peds are children,
    adults are, well, adults.
    different needs.
    learn to adjust.
    adults tend to be scared in a hospital, kids are along for the ride, but its the parents that can make life hell.


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