Pediatrics in community hospital, a staffing question.

Pediatric patients require nurses with pediatric experience because children are not small adults. And because they're CHILDREN the nurse's assignment should never exceed 4 patients. Children are at extremely high risk for entanglement which can be deadly if they're not observed at regular intervals. If your community hospital doesn't utilize tubing stabilizers, even a 1:3 or 1:2 assignment might not be safe. So that's what needs to be considered for baseline staffing. There must always be 2 nurses with pediatric training on site - even if the census is low - to allow for break coverage and aid in emergencies and events like transferring the patient to a higher level of care. In terms of assisting with procedures like IV starts, catheterization, NG placement and so on, peds training isn't necessarily required. If there are only 3 kids on the unit the charge nurse could be the back-up, but even one admission without a discharge will put you in trouble. You can't rely on parents to be the back-up, because you can't force them to be at the bedside. Patient safety has to be the primary consideration at all times. I hope you're able to get this sorted out, both for your patients' sake as well as your staff's.

Those are exactly the sorts of situations you want to prevent. If you're trying to juggle the responsibilities of two other people in addition to providing patient care, there are going to be periods of time when no one is actually minding the store. Children don't look poopy until just before they crump, and they aren't able to communicate they feel poopy until they crump, so they need regular and frequent visual checks and if you can't visually check them frequently they need some sort of monitoring... which just increases their entanglement risk. Another reason for more close observation is the very high risk of extravasation in children. It's virtually impossible to adequately secure an IV on a small child. I've seen enough really nasty IV burns on kids to last me a lifetime. And let's face it, if a child is in the hospital in the first place, it's most likely that s/he has an IV. People are admitted to hospital for nursing care. Period.

Years ago (before I became a nurse) my son was a patient on an adult isolation unit. He had chicken pox while on chemotherapy so needed acyclovir treatment. He was almost 4 years old and a very compliant child. I wasn't able to saty in hospital with him because his dad was out of town and his sisters were too little to be left alone, so there were times he didn't have me there in the room. One morning I arrived at his room to find him loose in the room and his IV tubing was completely wrapped around his IV pole. The IV itself was obviously out. I went to the nurses' station and told the nurse sitting there that his IV was out. She nodded and kept right on doing what she was doing. I pointed out that he was a pre-schooler and had been left uncontained in his room. She nodded but didn't move. So I said, "Well, I'll just go D/C his IV myself." THAT got her out of her chair. Before I left that evening to go pick up the girls from my neighbours' house, I made sure there were instructions in his Kardex that if he was out of the bed he needed to be constrained with a table or some other means so he couldn't wander around inside the room without supervision. I think they were very happy to see us discharged. But this is the kind of thing that shouldn't happen to children while they're in hospital. While we're talking about extravasation, my unit was sued a couple of years ago over an extravasation injury. Imagine if the child had died, instead of needing some plastic surgery. That's a very real risk your unit is running by not having adequate staffing.