Pediatric LTC

dawn30 · Sep 17, 2008

When I was in nursing school, we did our peds clinical rotation in a pedi LTC. It was a very difficult place to work. Extremely sad. you will gain a lot of experience with trachs etc. and that is fantastic if you are planning to make a career of peds. However, be prepaired for some heart breaking days and nights. there's a lot of happiness too, as long as you can handle the saddness along with it. Good luck, I hope it works out for you. :twocents:

:)

HappyPediRN · Sep 17, 2008

When I was in nursing school, we did our peds clinical rotation in a pedi LTC. It was a very difficult place to work. Extremely sad. you will gain a lot of experience with trachs etc. and that is fantastic if you are planning to make a career of peds. However, be prepaired for some heart breaking days and nights. there's a lot of happiness too, as long as you can handle the saddness along with it. Good luck, I hope it works out for you.
:)

Thank you Dawn. Would you be able to please elaborate on your experience? Was it the loss of their childhood in a way due to illness that was sad, or are you referring to lack of family interaction, or a lot of death? A combination of all three? Thanks so much!

MerdalRN · Sep 17, 2008

Hi OctoberBride,

I did my pedi clinical rotation at the exact facility you are talking about. It was hard at first, and it was excellent experience, but be prepared... these are the sick of the sick kids. Trachs, gtubes, vents, mental defecits... some of these kids are just existing- no interaction with the outside world, or even with you. It's hard (until you know them for a bit) to tell how the child is feeling, or if they even know you are there. There were some parents that were very involved- visited often, brought toys and clothes, and there were some that weren't involved period.

I actually interviewed there and was given an offer, but it changed from nights to overnights and I declined the job. The facility does great things for these kids, but you need to go in knowing that these kids no nothing different then how they are now. Most of them were born this way, few were due to accidents.

Pedi-Gree, BSN, RN · Sep 17, 2008

I would think it would be a combination of all three. I worked peds LTC for about 5 years. The kids who were patients when I began working there were all gone when I left. Some of them were placed in medical foster care, and some died. Over the years we admitted and discharged many kids whose lives were very limited by their illnesses. Some (the majority) were born with syndromes that meant they'd need frequent surgeries and would be dependent on technology simply to exist; some had very short life expectancies. Some were severely impacted by respiratory illnesses that damaged their lungs; some were paraplegic or tetraplegic following some mishap or other. Their conditions restricted their access to play, to contact with other children their age, to school, to family. Some of our kids never saw their families again once they were admitted to our unit. It was like they were abandoned. The ones whose families were still involved in their lives often saw them only infrequently (as in months between visits). Of the two dozen or so kids I cared for in that time, only three went home with their families of origin when the teaching had been done, and one of those children died.

One boy who was thought to be normal at birth began losing milestones when he was about 2. His underlying disorder was never identified. By the time he was in his early teens he was essentially vegetative, and as his body grew bigger his care became more difficult. He had ongoing issues with his chest that gradually deteriorated to the point where he needed BiPAP. The PICU had a backlog and he was waitlisted for a trach; by the time he got his trach his drive to breathe was gone. He then went to the ECU where he often would have severe bradycardic episodes (to the 20s) for no obvious reason. He didn't recognize anyone, not even his mother, and he had no reaction to anything except to cry with chest physio and diaper changes. His parents were not interested in learning his care so they could eventually take him home; they did come to visit for part of most days though. They refused to consider a no-escalation order so whenever he had a severe brady, we had to resuscitate. He's now an adult, but no adult facility in the city will take him, so he lays in his bed in the pediatric extended care unit not truly alive but not allowed to die. The staff are deeply affected by his situation and some are not able to stay in the environment for long.

Having said all that, there are lots of rewards to that kind of job. When a child who was expected to just be is suddenly smiling and interacting it's hard not to see the value of the job. Because these kids are medically fragile, emergencies do happen, so your skills will not get rusty. And if you like developing a relationship with your patients, this will be the place to do that.

DDRN4me · Sep 17, 2008

If it is the facility I am thinking of (in Billerica) I started there as an LPN many many years ago; and got some of the best experiences of nursing and caring as a human being that one can get.

I only left because of my family needing me home more.

Yes, the children are very ill. trachs vents gtubes you name it. but they are more than cared for, they are loved and cared about.:redbeathe Yes you will work extremely hard..but it is soo worth it!!

pm me if i can help!!

momnmotn · Sep 17, 2008

I,have adopted out of foster care, special needs children, whom otherwise, would have been, placed in a LTC facility, many of the children, will not have family support, and love, which is essential, for these kids, to thrive. human touch, is so important. A job like this,will be awesome, with ups and downs. good luck

Pediatric4077 · Sep 17, 2008

I work in pediatric LTC, I've been a nurse just over a year and it is my first job. I don't know any specifics about your facility but mine suffers from lack of organization. It has made the beginning tough, there isn't a head nurse or always someone to go to. In someways this has helped me to be able to be a better decision maker and I've had to acquire a lot of different skills in a short amount of time. But I think this is probably the case for any new nurse in any setting.

I see a lot of people have brought up the difficulty of these patients.. The stories are heart breaking. At my facility we have a lot of abuse, gun shot wound victims, ex-NICU babies (some the result of maternal drug usage/no prenatal care), we also see a fair amount of almost drownings (pools, kids left in the bath tub alone.. etc..)

If you love respiratory, and trach/vent care (it is AWESOME!!) it can be very rewarding. To see the ones come in on all this support and O2 and then to work their way to being decanulated is amazing. Of course if it's like my facility you'll take care of your veggies too, but you really bond to them as well. It's very different when you have the same patients all the time, you do get attached.

I don't know if this helps.. let me know if you have any other questions, or need further info.