Blended units: pediatric patients on med/surg units

[LouCadet]

What are the disadvantages of putting pediatric patients in general med/surg units? There is a helpful thread on allnurses on this topic of blended units, but it is several years old now. Looking for the most current opinions. If someone wished to argue in favor of dedicated pediatric inpatient unit, what would be the strongest arguments?

[traumaRUs, MSN, APRN]

Pediatric pts are not little adults, therefore they should be housed separately.

Adult nurses should not have to take care of peds pts and vice versa. It isn't fair for either the adults or the children.

It is very hard to be an excellent peds nurse as well as excellent adult nurse all in the same shift.

The equipment is different, the illnesses/injuries are different, the family situations are different.

Then, there is the security necessary for a peds population.

Nope, shouldn't be done. You need two units. Too much chance for errors.

[Fiona59]

Children should never be placed with demented adults and many seniors are at less than their best when hospitalized due changes in meds, routine, etc..

Many children today have little exposure to the elderly who make up a large part of the population of general med and surgery patients.

They just don't expect nor should they be exposed to those "senior" moments when their roomate strips off, becomes verbally abusive to family and staff or throws their urinal at staff.

Children are children and should be sheltered and nursed in a safe environment.

If there are no beds in our Children's Hospital, they are provided with a private room (in adult acute) and a peds nurse is with them.

[blamejoe]

I agree that there needs to be separate units, but depending on the number of peds your facility sees, this could be impractical.

I work for a large health network. We have 3 hospital campuses, and our largest (flagship) hospital has a peds department, peds units, PICU, and they are building a pediatric ED. A second hospital is mostly a community clinic and ED. The hospital I work in has a full-service ED with critical care and subspecialized med/surg units, and adult and adolescent behavioral health units. The culture of each hospital is different, and the community opinion differs based on which location you are at. For most pediatric services, patients are delivered to the flagship site and families are encouraged to bring their children to the appropriate location based on their needs.

However, the floor I used to work on was medical/surgical/oncology with a subspecialty of GI disorders, and was the only med/surg unit where adolescents could be admitted. The theory was something like - often times oncology patients need surgery:: often times GI issues require surgery:: often if an adolescent needs inpatient care it is related to surgery (i.e. tonsils, appy, etc.) So since we were surgical, it made sense we would take those other patients too. Now, families in my community prefer one hospital over another based on their experience, so they'd bring their children to us for surgery (or to the ED and then to surgery) because they liked our building better. We might have averaged 20-30 adolescent patients a year. It would have made no sense to have a separate unit for them.

[NightOwl0624]

We occasionally get a pediatric patient on our medical floor (between 14-17 years old - no younger). After working where I do, I would not want my child on such a floor, (even though they always get a private room). If it had to be done, you can bet someone would be with my child every minute, day and night. There are way too many psychotic, demented, withdrawing patients wandering around that I would not want my child to be in contact with.

[NurseCard, ADN]

I have worked on two separate Med/Surge floors that also housed pediatric patients, in two separate hospitals.

The first hospital was a rather small, about 120 bed facility. On our floor, we generally only cared for children who needed some extra monitoring. In other words, they were just barely sick enough to spend a night or two in the hospital. If they were much sicker than that, they were usually shipped out. I still did not like having to care for them as I never felt very comfortable doing so. There were nurses on my floor who were much more comfortable with babies and toddlers than I, who would usually volunteer to take those patients.

The second hospital was a bit larger, and the unit I worked on had one hallway of private rooms that was reserved for peds, though there might be adult patients on that hall as well, depending on need. The peds patients there were a bit sicker usually, and there were usually more OF them, maybe about 4 at a time. One nurse would usually have the whole hallway. I thought that it was a good setup.

[rnmi2004]

I'm thinking many parents would have the same response as I do: not my child!

If my children become ill enough to be hospitalized, I want them on a pediatric unit. I want them cared for by staff with experience taking care of pediatric patients, with equipment designed for peds, and the support staff and activities directed towards this population.

I'm interested to know, on a blended unit, what if you have an adult patient who is a sex offender?