New to Nursing and Peds

suzanne4, RN · May 13, 2005

Good luck to you................

Please let us know if you have any quesitons once you get started.......it will be easier that way for you. Not sure what type of pediatric practice that you will be working in, as well as the type of patient population....

PedsRN2005 · May 13, 2005

Suzanne,

Hi again.

The practice is a regular Pediatric Office practice - sick visits, well visits . . .

We're in N. VA, very close to DC so the patient population is very diverse.

I don't know as I'll have questions to post once I'm started as I'm pretty sure I can get them answered there.

I was just looking for suggestings, information, helpful hints that anyone had experienced when they were just starting out in a Peds Office.

Thanks,

Gayle

mtngrl, ASN, RN · May 13, 2005

I am a new nurse and I have been working in a peds office for 3 months. I didn't particulary want to work in peds, I just took the job because I liked the hours. I only do sick visits, I work evenings and weekends. It is not what I expected. The pace is sooo fast and rushed..get them in, get them out. It is a very busy office. I also find it very hard to perform most any procedure on a child. They wiggle and squirm so much, it makes me scared I will hurt them. I try to hold them down as best I can, and have the parent help, too, but sometimes they still manage to move just as I get the needle near, then they end up getting scraped and I feel awful. There is no way I would do well visits...all those immunizations! I am also the only nurse there on weekday evenings, so that is nerve-racking, too! Let me know how it is for you. Maybe you will have some advice on how to give shots to kids without it being such a struggle.

jeepgirl, LPN, NP · May 13, 2005

I am a new nurse and I have been working in a peds office for 3 months. I didn't particulary want to work in peds, I just took the job because I liked the hours. I only do sick visits, I work evenings and weekends. It is not what I expected. The pace is sooo fast and rushed..get them in, get them out. It is a very busy office. I also find it very hard to perform most any procedure on a child. They wiggle and squirm so much, it makes me scared I will hurt them. I try to hold them down as best I can, and have the parent help, too, but sometimes they still manage to move just as I get the needle near, then they end up getting scraped and I feel awful. There is no way I would do well visits...all those immunizations! I am also the only nurse there on weekday evenings, so that is nerve-racking, too! Let me know how it is for you. Maybe you will have some advice on how to give shots to kids without it being such a struggle.

Don't take this the wrong way, but I have never scraped a child with a needle when giving an IM injection. I think you should probably work on finding a way to restrain the child that minimizes the child's anxiety. A blanket might help... wrapping the child up with the extremity to be injected out. You can also position the kid so you can use the table to help you hold when injecting the thigh muscles. I usually have the kid laying back, with the leg being bent at the knee and the knee against the edge of the bed or table. I then use the forearm on my non-dominant side to secure the leg, keeping my hand in position so that I can stabilize the needle when I go to aspirate. Bottoms are hard no matter what, but we very rarely use them on our floor. Usually it's only on the bigger kids.

I usually try to avoid having the parents restrain if at all possible. Parents are supposed to be the protectors and comforters. I do, however, realize that in an office you might not have any other help! But if you did have a circulating MA or another staff member available for just a few seconds, that might be something to think about.

I work on an inpatient peds unit. We are trained when starting IV's and doing any sort of injection that parents are unreliable at restraining... they jerk and release when they see that the needle is hurting their child. And thats normal. That's why we pretty much tell everybody who works on the floor that you never have the parents help restrain. We do, however, keep them available to comfort. But, then again, we usually have more staff available.

I also think that performing the injection quickly and confidently helps cut down on the struggling.

I know that when I started working as a nurse on peds, it hurt me to hurt these babies. But it does get better.

Promise. :balloons:

mtngrl, ASN, RN · May 14, 2005

jeepgirl

yes you are right about not depending on parents to restrain their child. the one time a patient did get scraped was when her mom let go of her hands and she pushed the needle. she was an older child, like 8. we do all our injections in the thigh. it sucks being the only nurse at night since then i don't have anyone to help me, besides the dr, and i so far i haven't had to ask yet. i am also wondering what size needle do you use for im injections? our nurses are always in debate over whether to use the 1 in or 5/8 in. some think the 1 in is too big for children, but the 5/8 is pretty small.

by the way, my daughter changed the font and color on me while i was away for a moment!

jeepgirl, LPN, NP · May 14, 2005

jeepgirl
yes you are right about not depending on parents to restrain their child. the one time a patient did get scraped was when her mom let go of her hands and she pushed the needle. she was an older child, like 8. we do all our injections in the thigh. it sucks being the only nurse at night since then i don't have anyone to help me, besides the dr, and i so far i haven't had to ask yet. i am also wondering what size needle do you use for im injections?
our nurses are always in debate over whether to use the 1 in or 5/8 in. some think the 1 in is too big for children, but the 5/8 is pretty small.
by the way, my daughter changed the font and color on me while i was away for a moment!

the thing here is that you want to make sure that you're not accidentally going to go into the sub-q tissue. for instance, some 8 year olds can be pretty big. an inch for them would probably be more appropropriate, especially in a large muscle like the thigh. for an infant, a 5/8 inch would probably be just about right. we give most of our im injections on small children and babies, and we use 25g, 5/8 inch most of the time.

i've seen nurses on our floor that try to give 17 year olds im injections with a 5/8 inch. they don't even realize that there is a good chance that it's not going in the muscle.

when i took my daughter (3 and very petite) to a clinic that doesn't regularly do peds for vaccinations... they used a 1 1/2 or 2 inch needle on her deltoid. i about died... before i could say anything she was already poked and it was done. she had to get a series of vaccinations so we were going every two weeks for a while... most of the time they sited properly and used the correct needle, and she was really wonderful about it. she didn't try to run away, push away, or fight. she'd take it, have a few tears afterwards and was fine. when the nurse used the huge needle... she screamed! and she wasn't even looking... i was holding her head and talking to her. i don't even think the nurse took enough time to site properly... i almost wonder if she hit bone. it was bad. i really felt for my baby.

an 1 1/2 inch or even a 2 inch would be decent for a glut injection on a medium to large adult. if i remember correctly, in nursing school i think my instructor said that on very large people, when using the glut (bottom), a 2 1/2 inch might be needed just to ensure you were going in the muscle.

see ya!!