Tips & Advice for a Brand New RN Starting Out in Pediatric Med/Surg

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    After graduating in May & passing the NCLEX-RN in June, I am scheduled to start working as a nurse on a med/surg floor in a pediatric hospital next week. I am extremely enthusiastic about finally beginning my career & I am very optimistic that peds is where I am meant to be. I love kids, although I don't have any of my own. I used to babysit when I was younger & I worked as a Child Care Provider at a day care (for a class of 2 year olds) & I loved every minute.

    Unfortunately, my school only focused on adult care, so I am completely unfamiliar with pediatric nursing care. I would appreciate any help regarding anything about peds, med/surg, or starting out as a new nurse. What are some things you wished someone would have told you? What are some tricks or techniques that you couldn't live without in peds?

    Thank you!
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    I never worked in Peds Med-Surg but I did work in Peds Psych as a new grad. Best advice I have for you is be patient with the families. They can be something else at times but it is their baby that is under your care and they are concerned. Pay special attention to the medication doses (especially the high-risk drugs). Keeping a drug reference book near by is always a must especially if your facility doesn't have computer references etc. There is nothing like having a family asking you about a med and you have the deer in the headlight look. NEVER tell the family "I don't know". They lose confidence in you as the care provider. Something like, "I will double check on that so that I can provide you the most accurate information" or provide them handouts in response to their question is a good idea. And ASK QUESTIONS! If you are unsure, take the safe route and ask somebody!
    Soliloquy and YouSmellLikeCDiff like this.
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    Wow. Great advice! Thank you! I'm afraid that learning to communicate effectively with patient families will be my greatest challenge. I completely understand their concerns. After all, I am caring for their most precious loved one. Thanks again! I will have to remember these.
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    KelRN215 and YouSmellLikeCDiff like this.
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    Thank you! I will definitely check them out!
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    Listen to what the families have to say! I work Peds home health and many of the children that I take care of have very rare diseases. Parents are the experts on their children and if they say something doesn't work, trust them! Same thing goes if they say their child doesn't "look right" - they know and can many times identify the earliest inkling of an emergency that possibly could be avoided.
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    Respiratory failure in kids can be easily missed. They compensate very well for a long time, then poof! Respiratory arrest. I was a new grad who had the wonderful fortune to have a Ward Clerk who was also an experienced CNA who warned me one of my kids respirations were very elevated and she was worried he was "gonna poop out." I called the respiratory therapist, who told me to call the resident, and the kid was transfered to ICU, a few hours later he was intubated.
    Listen to others who have experience and they will save your (and your patient's) behinds.
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    Familiarize yourself with normal VS for each age (I carried a cue card for the first 8 months in case I was unsure), developmental miletones, and differences in pediatric anatomy (ie airway). Learn all about the common conditions the kids on your ward will have. Whether it's neuro, respiratory, cardiac, or medical, you can bet it will be pretty different from the conditions adults would face on a similar unit.

    Become aware that compensatory mechanisms in children often differ from that of adults. With hypovolemic children for instance, we tend to see changes in their heart rate long before changes in blood pressure (in nursing school we learn about shock from an adult perspective). If children are going sour they tend to enter respiratory distress before facing cardiac involvement. This is critical though because they can quickly progress to respiratory arrest then cardiac arrest. Children can quietly continue along until they finally crash - learn what the early signs are to avoid an emergency.

    Learn about startegies to assess and perform interventions on children of all different ages (hint: you can't usually reason with the little guys). This will help you immensely in your practice! Try to keep current on popular TV shows and bands. Ask them questions about the things they love and it can help them open up to you.

    Pediatric nursing is all about caring for not only the child but the whole family. That child needs the family for comfort and support, the family needs you to for teaching and support, and you will learn so much about that child from the family. Sometimes we are so busy taking care of the kid it is hard being a nurse to the family, especially if they are a challenging/demanding one. Try to give them a time frame where you can talk to them ("I'm just about to start giving out morning medications to my patients. How about in a half hour or so I will come back and we can discuss some of your questions in more detail?"). Give realistic time frames though or you might tick them off!

    Seeing you are calm, competent, take time to listen to and address their concerns, and genuinely care about the child goes a long way in starting to build a therapeutic relationship.

    Pediatrics is a really special branch of nursing. It is oftentimes challenging and all the while incredibly rewarding. Be confident but humble. We're all learning; it's okay to ask for help We learn something new every day (or 10 things!)

    All the best!
    Last edit by PedRN86 on Oct 28, '12 : Reason: typo
    yginay likes this.


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