Any Peds ER nurses out there???

ItsyBitsySpider, BSN, RN · Mar 8, 2007

Hey taby,

Congrats on becoming a nurse! I know it's a long, hard road through school. I personally didn't think I would work in a Peds ER while I was in school either. When I graduated they would not hire new grads in ER, ICU, or L&D. I'm so glad I did it though!

Level of difficulty is hard to gauge and is seasonal. Winter months, until about April or May, are very busy with mostly respiratory kids. You have to be on your toes with these kids because they will compensate for awhile but when they crash, they go fast. There is very rarely a slow decline in the Peds population like there is with adults.

We also see alot of dehydration right now. Gastro, rotavirus, etc. is rampant and little ones can also get dehyrated very quickly. During the summer months we see mostly broken bones, lots of lacs, head injuries, falls, etc. The kids are out of the house and having fun. We also see a large number of snot noses, fever, otitis, pink eye, tummy aches, head aches, and the list goes on. The population I work with like to think of the PER as a clinic. We could start a whole new thread on that.

The key to success in my opinion, is having a great preceptor and a reasonable amount of time for your orientation. We had 12 weeks and I felt that was great. 6 weeks on days, 6 weeks on nights. Days and nights can be very different so getting a feel for both is important. As far as going from kids to adults, I think the transfer would be easier than going from adult to kids. Many of our previously adult nurses have expressed this to us. When we get 16&17 y/o's they are just about adults anyway.

Winning the trust of the parents is so important. They are much more of a challenge than the kids. Sometimes we don't have time to chat but they always have to be acknowledged, included, and understand that we want to help their child. This is a big part of being a Pedi RN.

You will see your share of heartbreak in the Peds ER. Unfortunately kids are abused, sexually, physically, and mentally. They are neglected, they have parents that don't care about them, they are poor and malnourished, they get pregnant at 12. Sometimes they die. They will break your heart and make it grow at the same time. You will get kissed, hugged, thrown up and snotted on a regular basis. You have to love them to love this job. I am sure there are nurses that work in Peds that don't love kids, but for myself I can't imagine continuing in this field if I didn't. I think it would be very difficult.

Good luck in your decision and feel free to PM me anytime.

RunnerRN, BSN, RN · Mar 8, 2007

Here's my advice (based on the way I did it). I started working at a large level I with a separate peds ER. I was in a fellowship program that allowed me 4 months of preceptored clinical time, both in the adult area and pediatric area. I feel very strongly that one should have lots of supervised time in the pediatric area, simply because the room for error is so much smaller. Think of it this way: we spend a good 80% of our time in school learning about adults, and only 20% learning kids/babies. And probably NO time learning about emergency care!!!

I was fortunate that our hospital, while having a large pediatric floor, is one of 3 level ones in my city, and there are 2 children's hospitals not 10 miles down the road. Therefore, anything REALLY bad gets flown to them. Unfortunately, I am really good at adult trauma/sick cases, but not so comfortable with peds traumas. I also don't get to work peds codes very often.

You're right to be nervous about working strictly with kids. I enjoy my time in the peds unit...and I've gotten to be pretty good - but it is nice to work in the adult ED and flex those skills as well. But then again, I'm a firm believer in variety being the spice of life :)

So I really doubt my rambling has helped you make your decision. Honestly, I'd hold out for an adult position with hopes of being allowed into the peds side to try out your skills there. Is this position a fellowship/precepted position? Good luck!

luckylucyrn · Mar 8, 2007

Well my ER is different from yours, we have a separate peds section, but the nurses that do Peds are expected to be able to do adults if needed. My orientation was actually with mostly the adult ER but I now do almost primarily peds. I love it! If I didn't have to stay at my hospital for one more year (loan repayment) I would probably go to a hospital that does only peds.

I think that if you are only trained with Peds it would be hard to transition to adults, it would be like starting over again. The problems are SO different! How many acute MIs do we have with pediatrics? So you would not get any experience with that kind of thing in peds. That wouldn't necessarily be a problem if you got a good orientation once you switched from Peds to adult. Plus, you'd be great at starting IVs and would be pleasantly relieved by not having to strap down your adult patients to get them! Having gotten orientation on both Peds and Adults before starting, I can transition easily. Some shifts I end up doing half peds and then rotating over to the adults! That keeps it all fresh for me.

The level of difficulty depends on the type of ER you will be working in. Will you have trauma, etc? My hospital does not have peds specialists that will come there so anything too complicated gets shipped to the Children's hospital. The things that we mostly see are the RSVs, Flus, Dehydration, stitches, etc. My code experience and all that is mostly from the Adult ER. I do love pediatrics though, interacting with the kids is what makes my job fun to me. I also love how they bounce back from illness so well, for the most part. A child can look sick coming in, get some fluids and motrin, and they're bouncing off the walls!

Good luck with whatever you decide!

HippieChick_RN · Mar 8, 2007

I had the same problem, I thought I would do adult ED right away, but I was put in Peds. Kids used to freak me out, so I was scared!

I plan on working with adults in the near future. However, I'm grateful for my pedi experience first. Here's why:

1) I had to learn how to deal with families...and fast. With adults, families may or may not be around and their level of involvment varies. Peds...you are dealing with families and most of them are overprotective. It helps with interaction...especially useful for the new grad.

2) You up your assessment skills. With tiny ones, they can't tell you whats wrong. So you have to play detective and really know what you are looking for or whats wrong with the child, because you only have what the parents say, your assessment and your gut. And kids crash fast. I've seen kids do fine then twenty minutes later they're in the critical care rooms. Again, intution is a nurse's most valuable tool, and working with peds (even as a new grad) you'll start to fine tune that.

3) If you can get an IV in a toddler, you can get an IV in anyone. Same goes for the three day old and you have two parents over both shoulders breathing down your neck making sure you "do it right". I've learned how to deal with pressure with that alone.

4) While pedi codes are fewer than adult codes, you can learn a lot! And doing peds meds will keep your brain sharp (all those math tests in nursing school will pay off!).

5) I don't know how your ER works, but once you have a year of ER experience, then you can easily cross train on the adult side. And depending on what type of hospital you work at, you will see really sick kids (even cardiac cases) and that info will carry over with you.

I've known several nurses who have cross trained and all have said pediatric experience when you're still green is great and helps alot.

Congrats and good luck!!! Keep us posted!!

tabymac · Mar 8, 2007

WOW....WOW...WOW.....

you guys have given me sooooo much to think about! The hospital is a county facility in So Cal, it has a large Peds ER/level II trauma and an adult ER level I trauma.

I have make sure that I ask tons of questions so that I can find out the posibility of me cross-training, floating to the adult side since I'm not sure about that just yet. I do know that the orientation is 2 weeks and preceptorship is 6 weeks.....and I think that is the minimum, if you need more, they will give you more time.

Now I 'm getting excited!

Thanks for giving me such positive advice and the ups/downs of the area - I welcome all the info I can get! I am willing to learn and want to take advantage of every opportunity I can so I can do my best!

Anything else you think I should be sure to ask during the interview tomorrow?

*tabby*

tabymac · Mar 9, 2007

OK.......so I went on my interview today! It went SUPER good! The nurse manager is great! Very personable, nice and has a good handle on her units!

She went through her normal q's but when she asked why PED I made sure I threw in "if you can get an IV in an infant, you can get one in anybody!" she LOVED it - even gave me a hi-5!!! It was a great interview.

Basically she told me that if I really want to learn adult also, they would be willing to cross-train me so that I can geet my share of codes in the adult trauma side - since she said there are not too many in PED.

I hope to hear from them soon! I'll keep you posted. Thanks for all your advice!