PALS go by age or weight or what?

Nurses General Nursing

Published

Twice in the past few months I have had co-workers refuse to take care of patients (a small 14 year old and a good sized 16 year old) because the nurse was not PALS certified. We all have to have ACLS.

"For the purposes of these guidelines [PALS], the term "child" refers to the age group from 1 to 8 years."

If anyone has something more than the above sentence that will back up my claim that PALS doesn't apply I'd love to have more information.

I doubt I will change any co-workers minds, seems like they just don't like taking care of "pediatric" patients and will use any excuse. Why let "facts" get in the way of a good argument!!!!!

Up Vote Up Vote ×
Specializes in Tele.

it's by weight.

and if you do not know the weight of the child, there is this ruler type thing, I forgot the name, that you put on the patient and measure their length and you estimate their weight based on where the color square they fall on.

Up Vote Up Vote ×
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
it's by weight.

and if you do not know the weight of the child, there is this ruler type thing, I forgot the name, that you put on the patient and measure their length and you estimate their weight based on where the color square they fall on.

Broslow tape.

Up Vote Up Vote ×

Yes, it is the Braslow tape. We also have PAWS on our computer that generates a form that calculates all drugs for pediatric patients based on height and weight. But I'm not sure with PAWS what they consider the height and weight cut off?????

PS These are baseline "healthy" patients. We ALL have more chance of getting hit by a meteor than our patient coding!!!!!!

Up Vote Up Vote ×
Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Lab is referin to the Braslow tape which only goes to I think 36 KG.

In my humble oppinion as an ER nurse you should be able to take care of whatever comes through the doors, doesn't matter their age or acuity level, or you shouldn't be an ER nurse! PALS or no PALS.

The 16 year old is beyond PALS and probably even the 14 year old since their weight based doses would more than likely equate to an adult dose.

Up Vote Up Vote ×
Broslow tape.

Beat me to it. :up:

Up Vote Up Vote ×
Specializes in Cardiac, ER.

I have to ask where you work that your coworkers are allowed to "refuse" care to a pt,...I would be out on my butt in a sec if I did something like that!

Up Vote Up Vote ×

I work in an out patient surgery center. There are enough nurses with PALS, that these few manage to get a pass. They bring up "I'm not PALS certified", and co-workers just say, "oh ok, you're right."

My point is the PALS course technically states up to 8 years. Then were talking ACLS anyway. Right?

Up Vote Up Vote ×

PALS until they're an adult weight. (Basically, once the weight-based doses start topping out.)

I will say though, as a peds nurse, it's not just about coding. I used to work at a community hospital that really thought the only training required for peds was taking a PALS class. (And looking back, it was scary the things we did there.) Kids can compensate really well, until they can't, then they crash fast. With peds, you have to recognize that there are problems while they're still compensating, and those signs are subtle.

It's not just about giving smaller doses. It's not just PALS they need, it's training and respect for the differences in peds patients that everyone needs at a facility taking peds patients.

Up Vote Up Vote ×

To me, if you are in a predicament where PALS and/or ACLS needs to be used, you don't have time to say "no, im not certified"! These aren't your slight fever, runny nose cases. As nurses, we should be knowledgable enough to handle/stablize any situation until a more qualified professional gets on scene.

And i just took PALS and they said it is PALS until an adult weight...but, unfortunately, these days that could be at any age.

Up Vote Up Vote ×
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Twice in the past few months I have had co-workers refuse to take care of patients (a small 14 year old and a good sized 16 year old) because the nurse was not PALS certified. We all have to have ACLS.

"For the purposes of these guidelines [PALS], the term "child" refers to the age group from 1 to 8 years."

If anyone has something more than the above sentence that will back up my claim that PALS doesn't apply I'd love to have more information.

I doubt I will change any co-workers minds, seems like they just don't like taking care of "pediatric" patients and will use any excuse. Why let "facts" get in the way of a good argument!!!!!

You don't say what type of setting this is...I am assuming that you are in an acute care setting, because ACLS is required.

My take is this...if the kid is in the ICU setting, and absent some extraordinary circumstances, only pediatric trained nurses should be providing care. With today's technology all nurses can have quick access to accurate med dosing, and there are PALS nurses apparently in your department...so PALS is not that much of an issue for each nurse...particularly since all of the nurses are ACLS providers. I would presume that you have adequate medical support for management of children ill enough to need your level of nursing care...so yeah, PALS not a requirement.

There is no question that caring for a pediatric patient is decidedly different. Of course that is true for all nursing specialties. However, it seems to me that if your unit routinely must interact with pediatric and adolescent patients that your employer probably has a minimum knowledge requirement for nurses. Did your skills checklist include any aspects of age specific nursing care when you went through orientation? Look at the job description for nurses in your department. I bet it includes some language about pediatric nursing care.

As mentioned in an earlier post the ER setting is one in which you must be prepared to take a pedi patient at any time...so it is imperative that even nurses who don't "like to" must care for those patients often enough to stay in practice. Sometimes as they hone their skills they don't mind it as much. There are many other areas of the hospital where this would also hold true...radiology, surgery, recovery, etc...if the hospital doesn't have a PICU you are the experts.

I do think it is fine to have "favorites" in patient types and for team members to defer to another's preference or expertise. I wouldn't want to work with nurses who "refuse" assignments without regard to whether or not it (over)burdens a coworker. My guess is that you feel this is inequitable...and you may be right. Who is telling everyone that it is okay for some nurses to refuse some assignments? Are there rules that govern assignment refusal for nurses.

Think about what is specifically troubling you about this practice and have a talk with your manager. He/she will be interested in what you have to say (if they are interested in their staff) and may help you find some resolution.

Of course, this represents the evening musings of an old nurse after a long day and a short glass of wine.

Good luck.

Up Vote Up Vote ×
+ Add a Comment