Nursing Issue in Pediatrics?

llg, PhD, RN · Feb 17, 2011

Here's one that may or may not work for your assignment as it is more "nursing" focused than "patient" focused.

A lot of undergraduate nursing programs provide little education regarding inpatient pediatrics as it is not emphasized on the NCLEX and not required by many State Boards of Nursing. Therefore, the burden of teaching that subject matter falls upon the hospital who hires a new grad from such a school. Most hospitals are strappend for money and don't want to pay big bucks to provide that education -- leading them to not want to hire new grads from such schools.

What do you see as the best solution to this problem? Whose responsibility is it to provide that education? If students choose to go to a school that offers minimal inpatient peds experience, should they then expect an employer to give them that education for free? Is the answer for hospitals to offer such programs, but charge a fee to the new grads for taking them ... or to pay them less than they would pay a new grad who went to a school providing a better peds foundation?

This is a problem faced by many hospitals in many different specialties -- not just peds. But it is a big problem for children's hospitals because so many new grads have had so little education in peds in schools who emphasize only what is required for NCLEX.

How much peds education should be required? Should schools revise curriculums to allow students to focus on 1 or 2 areas of special interest beyond the basics needed for NLCEX?

classicdame, MSN, EdD · Feb 17, 2011

In response to llg - we may have to do like other countries and require students to declare an area in which they want to pactice, then focus their education on that area.

In response to original post: consider pain management. It is difficult to asses with patients who are non-verbal, fearful, parents answer for them, etc.

Pediatric Critical Care Columnist · Feb 17, 2011

Both of those issues are very significant. I must say though that my very first thought was pain management. Our hospital is taking part in a pilot project to improve the assessment and treatment of pediatric pain, including prevention of pain where possible. The use of topical anaesthetic agents for painful procedures is often neglected due to the length of time required for the stuff to work, although there are newer agents that are effective in a much shorter interval. The difficulty arises when the chosen site, properly perpared, ends up not working out and a secondary site has to be sought. Now the kid is cranky from being held still and poked, the person starting the IV is frazzled and just wants it done, and maybe the IV meds are way behind... a bit of a concern. But there you go, that's something you could think about - how would you improve pain management for children?

MassagetoRN · Feb 17, 2011

Thanks for the great input, keep it coming! I am thinking that the pain management would be too medical and not so much a nursing issue (although super important!). I recently found an article about ped's new grad orientation programs.....

Purple_Scrubs, BSN, RN · Feb 17, 2011

I guess the immunization debate would be a medical issue too? Hmmm...well if you have any interest in school nursing, you could talk about recent budget cuts to education causing some districts to cut nursing positions. As the students are coming to school sicker and sicker (diabetes, asthma, life threatening allergies, seizure disorders...) the nurses are being stretched thinner and thinner.

Anything else I can think of is more of a medical issue

annabeap, MSN, APRN, NP · Feb 18, 2011

How about medication safety in pediatrics?

In my unit, we have all meds double verified once ordered- we annotate in our documentation what page number in the Harriet Lane we found the dosing on, and the names of the nurses that found it appropriate. This is done upon the initial med order, and every time the med dosages change.

Upon administering the medication, we're fine going through the 5 rights by ourselves- given it's not a high alert med that needs another RN anyways.

I'd be curious what info is out there, and what other institutions go through and double verify ALL new med orders. Even IVF.

Anyways, good luck with your capstone! :)