From Med/Surg to Peds

Pediatric Critical Care Columnist · Sep 25, 2007

There is a bit of a learning curve going from adults to peds, but it isn't that steep, and lots of nurses make the transition successfully without a great deal of angst. The kinds of things that bring kids into hospital are different than for adults; chronic conditions are typically not lifestyle related and therefore are a bit easier to take. The underlying causes of illness in children can easily be learned by browsing through a peds nursing textbook. The harder part is knowing how to gain cooperation from a suspicious toddler or truculent teenager. If you have kids in your life, then you'll know how to talk to them, and that's half the battle. The HARDEST part for some nurses is working with parents. (My dear friend is a perfect example; put her in with the dregs of society in an inner city ER and she's in her element. Put her in a room with anxious parents of a toddler with croup and she's lost!) My best advice is to view them as your best resource in how to interact with their child and to gain understanding for their child's illness... particularly if it's a chronic thing. They know their child better than anyone and respond very well to being treated as part of the team with valuable contributions to make toward caring for the child. And if you remember, no matter why the child is in hospital, that these parents are going to be taking responsibility for the child on discharge, and include them in routine care and decision-making, you'll be fine.

As for orientation, you'll probably have several classroom sessions to learn about the typical problems that hospital sees in its peds population, a med calc exam with no room for error (and there is no room for error in med administration to kids. None.) and then several buddy shifts where you can observe how an experienced peds nurse interacts with patient and family, learn some tricks for gaining cooperation and getting a handle on little people equipment, instruments and procedures. Becasue you have a med-surg background the actually nursing care will be familiar... a dressing change is a dressing change, but with peds you might put a sticker on it after you're done.

Don't make promises you can't keep. Don't ask permission to do things that have to be done, but offer real choices wherever possible. "I'm going to have to change your dressing later. When do you think would be a good time? Do you want to do it now or after Dora? Should we use pink tape or white? Would you like me to give you your Amoxil, or would you rather have Mommy do it?"... You get my drift. Don't wake sleeping kids unless you absolutely have to... they wouldn't have their diaper changed at 3 am at home unless they were already awake, so they don't need it done in the hospital either! (This does NOT apply to kids with head injuries who need hourly neurovitals, but I'm sure you realize that!) And DON'T EVER put the TV on in the room in the middle of the night when the kid asks you to. You'll create a monster and the parents won't thank you for it! Night time is for sleeping!

llg, PhD, RN · Sep 25, 2007

If the hospital is a good one, they will give you plenty of orientation. If they don't, then that's probably not the type of hospital you would want to work for anyway.

However, don't underestimate the difficulties in switching from adults to peds -- not that I think you are. A lot of people DO struggle with the transition. That's why those of us in peds staff developmentment usually do not recommend that people get adult med/surg experience first. It can complicate your peds orientation.

The biggest problem for many people tyring to make that transition is that they feel as if the rug has been pulled out from under them. Their sense of security is shaken by the fact that their sense of what is normal and what is not normal ... what is is "big enough" or "small enough" ... what is customary ... etc. is disrupted. They have developed judgment in the adult med/surg world that does not apply in peds and they feel as if they are incompetent and might hurt somebody. Dealing with the emotional discomfort of being a beginner again is difficult for some people and they run back to where they feel secure in their practice -- the adult med/surg world.

Another thing that causes problems for some people is the emotional impact of workin with children who are sick, in pain, in bad family situation, dying, the victims of abuse, etc. Be prepared to have to deal with some pretty heavy issues that tug at your heart differently than many of the issues on an adult floor.

Another thing is the families. While families can complicate things with any type of patient, with peds, they are a big factor almost all the time.

Another thing is that there are few "normals" in peds. With the kids being in different age groups, "normal" is always a moving target. The question isn't "Is the normal or not?" ... The question is, "Is this normal at this stage of development?" and the child's stage of development changes over time. A question as simple as "What is a normal heartrate?" becomes complex as it varies with the age of the child.

But if you can handle the emotional issues of becoming a beginner again, then "go for it." Peds is a great field. And once you make that transition, you will find that your adult med/surg background will have taught you things that will come in handy.

RNSuzq1, RN · Sep 30, 2007

Hi,

OP here. I wanted to Thank you both so much for the Peds info - definitely a lot to think about. I've got a major beef with NS, maybe not all, but at least mine. Like I said in the orginal post, instead of encouraging us to go into areas we were interested in - that rite of passage through Med/Surg was drilled into our heads. Instead of helping, it's gotten me off track and from what you've both said - could make it much harder making the transition from adults to Peds. I've only been out of school a little over a year, but almost sounds like that short a time in another area could have ruined my chances of switching over, or at least made it a lot more difficult.

Recently talked to an ICU Mgr. His opinion about New-Grads going into Specialities was the total opposite from our NS Instructors. He said something very similar to what llg said about new-grads in Peds. Said he loved getting New-Grads - without prior experience in other areas and not being "set in their ways" like experienced Nurses, he could easily mold them into great ICU Nurses, makes sense to me.

You both gave great advice about how to handle Peds pt's - not asking permission to do things, but offering choices about how and when (we do that with our elderly dementia pt's). I have 3 Sons that I adore -raising them has taught me enough about Child Psychology so I could at least have a running start, but no doubt there is so much more to learn. My husband has told me all about working with the Parents - said the kids are usually great, it's the folks that can give you grief. I can only hope that as a parent myself, it'll help me be more understanding and relate to their fears.

I've been looking around for Peds jobs. Ironically - there are openings for New-Grads (something I no longer qualify for) and Peds Nurses with at least 1-2 years experience, go figure - but I'll keep looking.

Thanks again, Susan

Pediatric Critical Care Columnist · Sep 30, 2007

Keep your eye out for reposted positions. That's a signal that the applicants (or lack of same sometimes) were not acceptable and you can often get in the door that way. It's worth a shot. Good luck; you want this and I think you'll get it.

timosi · Nov 4, 2007

I am currently thinking of the same transition, I have worked with adults in Med-Surg for 3 years and my desire has been to work on a LD floor, I am currently a LPN and will graduate this December with my RN license. I am desiring a new position and I have prayed on my new role as a RN and peds has crossed my mind more than a few times, I have been having this urge to go into NICU, but I am terrified, I love taking care of people but I am unsure how I will perform in the NICU setting, should I start off taking care of normal peds or should I just jump into NICU after graduation...seeking advice:).

Pediatric Critical Care Columnist · Nov 4, 2007

I don't know that I would lump NICU into pediatrics. Agreed, the patients are "pediatric" patients and not adults, but they have their own specific set of common diagnoses, they have their own physiological response package and the nursing has a somewhat different focus. In my experience (no flames please!) NICU nurses can be a little rigid, and there are a lot of 'rules' in that environment that generally don't extend to other areas. I tried it and didn't like it, but to each his own. I like my patients to talk to me...