inadequate pediatric training

[skylar ian]

Hi everyone,

I am a critical care nurse for an adult neuro/surgical trauma ICU and I work at a hospital that has a pediatric flex unit. I didn't realize until just recently that the pediatric nurses were only given 3 days of didactic training and 3-7 days of clinical training. Many of the nurses report that more than 75% of their clinical experience was spent shadowing a pediatric nurse. Admin's rationale for such minimal training is that these pediatric nurses would only be taking care of "stable" pediatric patients, and only pediatric patients with certain diagnoses between the ages 3-15 years would be admitted. I have no experience in pediatric training, but I don't believe such minimal training is safe to provide care to such a fragile population. I have been tasked by our Nursing Quality Forum to assess the training and the quality of care provided by the training. We have already had near misses and I'm afraid that a sentinel event is in our future. Are there any pediatric nurses or CNS's that can share their training experiences?

[Double-Helix, BSN, RN]

Theoretically, nurses who have passed their licensure exam are already competent to care for the pediatric population. Yes, there are some differences in children vs adults, (such as medications being dosed per kilogram of weight and different ranges of normal vital signs) but pathophysiology is pretty similar. There are plenty of smaller hospitals that admit children to same floor as adult patients. ED nurses at critical access hospitals have to be prepared to care for any age group, even if they rarely treat children.

What kind of patient population do these nurses care for when they aren't flexing to peds? Are they patients with the same diagnoses as the kids? In my experience, hospitals without a dedicated peds service will transfer out their complicated kids- what types of diagnoses are being admitted? A school aged child with an asthma flare is treated very similarly to an adult asthma flare. A teenager in DKA is managed just like an adult in DKA. A toddler with an arm fracture has the same assessment needs as an adult. A child s/p appendectomy has the same treatment plan as an adult s/p the same.

Without knowing what the education needs are, what training has been given, and what near-misses you've had, it's difficult to say what's required for your staff. Are they just nervous and unconfident because they haven't cared for kids before and feel like this change is being forced on them? If they aren't going to be caring for kids very often, there may not be any amount of orientation that makes them feel comfortable. Have you thought about getting them PEARS trained? Unlike PALS, PEARS is pediatric emergency assessment, recognition and stabilization. It's an AHA course and it may give them all a little more confidence that they can recognize and respond in the event of a medical emergency involving a child. You can also conduct pediatric simulations and allow staff adequate time to familiarize themselves with the layout of the pediatric unit (if separate from the adult unit) and the location of their emergency equipment.