Adult to pediatrics

CritterLover, BSN, RN · Feb 16, 2020

I've done it. Well, not to NICU exactly but to a general pediatric facility that takes patients up to age 21.

I found that the most difficult aspect was getting hired. Pediatric only facilities often shy away from adult nurses as it can be difficult to "retrain" them to pediatrics. You have to recalibrate expectations and normals. I tried for YEARS to get hired in a NICU before moving to a different part of the country where I found my current employer. Since the facility you are looking already has a transition program, you are one step ahead at breaking that barrier -- it sounds like something they are already used to doing.

In my interview, I came straight out and asked about their experience converting an adult nurse to a peds nurse. I felt like that was a good way to acknowledge that the two are different, I was aware of that and I was prepared for that. I also asked about what they felt most nurses struggled with when making the change, and asked how they helped the transition.

I talked about how I had moved from being afraid of taking care of kids when I first started working in a general ER, and how at one point I decided to tackle that fear and forced myself to start volunteering to take the kids to the point that it became very comfortable for me. I tried to come across as open minded and adaptable.

It isn't something I considered back when I interviewed, but in retrospect I'd probably ask about their palliative program/process. I've seen a fair number of new hires fizzle out because they realize they can't deal with sick kids or dying kids. This is especially true working in a level IV -- there will be infants who don't make it, and some of those deaths will not be "good" ones. Staff need to be supported in those situations just as much as parents need to be supported -- sometimes more, because we are the ones doing the procedures and treatments that make their dying days/hours/minutes less than pleasant and that can be tough to process. I'm not sure I'd want to work somewhere that didn't have good support for staff. The support doesn't necessarily need to be a formal program, but if they look at you like you're crazy when you ask (staff support? What's that?) you might want to reconsider.

Once hired, you just need to be open to the differences between adults and peds. Small quantities matter. You need to calculate doses. I still struggle a bit with developmental milestones and assessing reflexes -- it doesn't come naturally to me and I have to stop and think about them.

I remember running out of formula one night when I was in orientation. I think I was 15cc or so short -- a quantity that had the patient been an adult, I would have just flushed the tube and not worried about it. But, this was a kid. I was genuinely uncertain as to if we needed to make more formula or not. This kid's formula had to be made from powder; it wasn't ready to feed. Formula was generally made once a day at 7:30am, but if you ran out ahead of time you had to have someone make an entirely new (full) recipe. It seemed like such a waste. So I asked my preceptor -- do we really need to have a whole new recipe made for just 15cc? The look I got was basically one that said "how dare you even ask that???? OF COURSE YOU DO." Which, I understand now because I'm used to the very small quantities we often deal with -- 15cc might be 80% of the entire feed for that baby (though it wasn't for this particular infant). But at the time it seemed like a very legit question (until it came out of my mouth).

Another thing I had to get used to was the very structured clustering of care. We *talk* about that when caring for adults, but with infants we actually do it pretty diligently. Things are organized around feeding times. It makes good sense to me now, but when I started out I found that weird. If you are going in to do an assessment/bath/weight/feed, there is an order to things. Assess first, then weigh, then bathe, then feed. You can't weigh after you feed (the weight of the food in the stomach will falsely elevate the weight), you can't weigh after you bathe (can't leave a naked wet baby on the scale long enough to weigh -- they will drop their temp). Feeding should be the last thing you do as they will likely drop off to sleep while eating and you don't want to disturb that. They need their sleep.

And then there are the parents -- many are great, but parents of chronically ill children tend to come in two flavors -- they either micromanage everything you do (don't flush that tube so fast!) or they are rarely around and when they are they spend more time paying attention to their phone than then spend paying attention to their child.

Lots of luck to you! Overall the transition is totally worth it.

AccelCNL, MSN, RN · Feb 17, 2020

Thank you for the reply CritterLover. I really appreciate it.

llg, PhD, RN · Feb 17, 2020

Part of my background is that of coordinating NICU orientations for 14 years. I agree with everything CritterLover said. Here are a few additional thoughts.

You have to go into the transition knowing that things will be different and prepared to feel like a novice. That is an uncomfortable feeling for some people. They like feeling secure and competent -- and when they suddenly find themselves feeling incompetent again, they hate it. Also, be prepared to NOT be able to do as much comparison with your old jobs than you might be inclined to do. Just because they do XYZ in the adult world, doesn't mean they are going to do XYZ in the NICU. And the way the NICU does is not automatically wrong or inferior. That type of thinking can really derail a successful transition. You have to be able to emotionally accept the fact that you will be doing things differently and that you will have to start at the beginning to learn the NICU ways.

Once you have made the transition, then you will be in a position to better judge what is "good" and what is "bad" in the NICU and you will find commonalities between the NICU and your old jobs. But at first, making those comparisons and being judgmental about them may get you into trouble.

Good luck!