Pediatric Pearls of Wisdom

meanmaryjean, DNP, RN · Dec 24, 2017

You just joined, asked what (might be) a homework question AND tell us to be respectful? Pray tell, how would sharing a pediatric nursing tip even BE disrespectful to another poster?

Just curious

thatpedsnurse · Dec 26, 2017

I apologize if this seems like a homework post. I am a new pediatric nurse and am simply seeking advice from experienced pediatric nurses so I could start off on the right foot. I've been a lurker of the website for quite a while now... I realize now that I should have introduced myself in the initial post.

I do not see the tips as being disrespectful, but I've observed that some posters can be disrespectful to others on Allnurses. This post was simply just to gather more info on the specialty I'll be entering.

PeakRN · Dec 26, 2017

Your number one concern should be safe practice. Never assume, always ask. Don't take shortcuts, do what you would want done for one of your own kids. Know your meds before you give them, memorize your emergency meds. If you need to call the doc or a rapid don't delay because something might change, call early.

Understand that parents of sick kids are rarely rational, but that is par for the course. If you kid was sick you probably wouldn't be very rational either.

Remember that you are there to care for the kids, not be their best friend. Certainly we want to be as kind as possible but some of the things we need to do are unpleasant. If a teen tells you about their dangerous thoughts they need to be evaluated, even if they don't want it. The toddler is never going to want a shot, they don't get to refuse and waiting isn't going to help. Never lie to a kid, once you do they will never forget. Kids are far smarter and more capable than most people think. Talk to them, not at/about/over/down to them.

You'll learn all the little tricks once you get there. We rarely do things with young kids alone, so someone will be able to help guide you when your doing a procedure.

EKTheRN · Dec 26, 2017

Newish pediatric RN here (almost 10 months on the job)!

1. This one is pretty universal in nursing, but use coca-cola to unclog NGs/TPTs/OGs. At my facility you have to have an order to flush with coke, but it just recently saved my butt; the parents were on edge and the last thing I wanted to do was drop another NG!

2. Do NOT slack off on your IV assessments! Protocol at my facility is q1hr IV assessments. As much as I hate to say this, I have to admit that I've gotten caught up in other tasks and put my kids' IVs on the back burner. It's so super easy to lose peripheral access on a chunky little one- it's even easier for them to infiltrate. I had an IV infiltrate on me right at shift change, and trying to fix that mess was not a fun task.

3. Utilize parents and caregivers! If a patient is scared or giving you a hard time in general, have a caregiver console or even help restrain a patient. Pretty recently I had a mom volunteer to wrap her arms and legs around her child before I deep suctioned her. Disclaimer for this one though: don't just assume the caregiver will be OK with restraining their kiddo. It's usually best to bring peers in as reinforcements.

4. As the above poster mentioned, we rarely complete tasks alone in the peds world. Do NOT be afraid to ask for help!

pedi_nurse · Feb 12, 2018

The best advice I was given was by a former roommate, who in the 10 years I hadn't seen her had a child with a chronic illness who passed away at age 3. She was adamant about the need to respect the families of your patients. Incorporate your families/parents. Ask them how they'd like to do things that day. Listen to them. They know their kid better than you. And parents of children with chronic illnesses will even sometimes know their child's diagnosis/treatment better than you. Imagine being a parent of a kid who is in and out of hospitals and having a nurse you don't know come in trying to show you how it's done. On the flip side, explain everything to you families who are less familiar with the hospital life. Parents of kids who are newly diagnosed are dealing with something frightening AND may be in an extremely unfamiliar world.

Pediatric Critical Care Columnist · Feb 13, 2018

As a peds nurse who was the mom of a medically-complex child first, I can't possibly "like" pedi_nurse, ADN, RN's response more. In the first 3 years after my son's diagnosis I learned more about his disease than any nurse I've ever known, before or since. I've had to provide his caregivers with education about it many times over the years. It annoys and frustrates me that I have to beg to be allowed to see his labs, when I'm the one who will know if he's relapsing, not the nurse-with-the-alphabet-soup-title case manager. And it's so much worse now that he's an adult.

Mothers, and usually to a lesser extent (one recent exception comes to mind) fathers know all the details of that child's history and their typical responses to various things. Some of these families are unbalanced in the sense that mom knows it all and does it all and dad only sees the surface. Others are truly teams and each parent takes a similar portion of the responsibility for their special child. Then there are still others where there is only a mom, backstopped by a grandmother or an aunt or a close friend. Those are the ones that need our help and understanding perhaps the most.

To expand on some of the comments above, when your patient is one of those complex kids whose chart weighs more than they do, don't assume the parents want to or expect to be hands-on while the child is in your care. It's best to approach them and say something like, "You're the expert in Joey's care and I know you are very capable. Please let me know how much you'd like me to do. If you need a break, please take one! I know you deserve it."

For kids who have never been sick before, include parents in their child's care to the degree they're comfortable. Don't expect a mom to change a diaper on a kid with multiple IVs, a chest tube and oxygen until you've had a chance to see how receptive she is. By all means, ask her if she wants to do it, but don't pressure her if she says no. There are some things moms and dads are better at than even the best, most experienced nurse is, like getting kids to take their meds. But the caveat to that is sometimes it's better if the nurse does something so mom/dad isn't the "bad guy".

Some parents want to be present for EVERYTHING. Others want it all done without them having to witness it. Take your cues from them. If they look uneasy about watching a straight cath, let's say, then give them permission to leave. Encourage them to take care of themselves, because no one will do it for them. Food, fluid, exercise and fresh air are vital to healthy coping and are essential for good decision making.

Treat parents as members of the team and your job will be so much easier.

pedi_nurse · Feb 13, 2018

To expand on some of the comments above, when your patient is one of those complex kids whose chart weighs more than they do, don't assume the parents want to or expect to be hands-on while the child is in your care. It's best to approach them and say something like, "You're the expert in Joey's care and I know you are very capable. Please let me know how much you'd like me to do. If you need a break, please take one! I know you deserve it."

YES! To all this (not just the quote)! You definitely said it all much better than I could have. I very seriously take the advice this mom gave to me as the most important advice I've ever received in nursing. Approaching families as an important part of the team has made a world of difference in the care I provide my patients/families. I'm so grateful for the time she took to share this with me.

ETA: As an example of a situation referred to in the above quote... I've had so many parents who are incredibly particular about their child's trach, catheterization, or g tube, etc. I always offer to do these things or ask if they would prefer to do it. If they say I can do it, I ask if there is anything specific they would like me to do or look out for (i.e. is there a particular type of product they want used.) Then I've also had others who aren't so particular, or who are just exhausted and in need of respite.

My second bit of advice I just thought of is to remember that ultimately nearly everything is your responsibility. RTs have their expertise which is more specific than your general education. They are incredible partners in care, but ultimately, it's your job as the nurse to make sure your patient is receiving their meds, etc. Techs are lifesavers on busy days, but ultimately it's your job to ensure your patient gets their bath or has clean sheets. Delegating doesn't mean you shirk your responsibility. Doctors and pharmacists have their own role that you obviously cannot fill, but it is still YOUR job to double check dosaging and advocate for your patient. Remembering these things will help you treat your coworkers as you should - equal members of the same team, just different parts/specialties. Peds is phenomenal in that most of those who work in peds actually like kids and want to help them, which helps make it easier to work together.