Peds clinical

llg, PhD, RN · Jun 4, 2008

It's not an uncommon situation.

A lot of the work of pediatric nursing is different from the work of adult med-surg. It's difficult for students and instructors to step into that environment and be as "active" in it as they are with adult med-surg. Peds nurses work hard and can be quite busy ... but it's hard for someone to step in temporarily from the outside and get deeply involved unless they are an expert.

The better instructors plan learning activities for their students in addition to their direct care opportunities that augment the learning. If you are just being put in the area and left to "amuse yourself," then that is sad. I recommend that you ask your instructor to help you find good learning opportunities in the area. Can you go with the staff and help them as they care for their patients?

TexasPediRN · Jun 4, 2008

I dont know if its just your instructor or in general, but I work peds - and most places are very iffy about what students can do, but it seems peds can be more iffy.

I suggest either

- offering to help the nurse assigned to your patient, and at least go into rooms with her and do an assessment along with her so that you can learn and practice

- sitting in the room with your patient - bring coloring books or find some there, or grab some blank paper and crayons. Send parents out for breakfast or let them get a shower. Most parents are so scared to leave their children alone and would love someone to sit with them for an hour or two so that the parent can go take care of themselves. (Also works great for kids who have no parents there with them).

-Also, speak with the instructor about wanting to do more. She/he may have a reason why you are doing only a few things, and it would be helpful for you to know.

Good luck!!

Trauma Columnist · Jun 4, 2008

What about asking to observe in the peds ICU? Or the NICU? In both my LPN and RN programs, peds and OB involved the least amount of clinical time. Another thing, try to observe in the ER or peds ER if that is available. It may be that you need to ensure the instructor knows you need/want more clinical experience.

RS0302 · Jun 4, 2008

I think your peds rotation sounds about normal for what most schools do. I think it has to do with the hospital and nursing schools being a bit more cautious about students being in peds than med-surg. If you think about it the outcomes of a student making a mistake in peds could be much worse than on an adult in med-sug. We were not even allowed to give PO meds during my rotation. I spent most of the time sitting with the children, talking with families, and observing the staff nurses with procedures.

EricJRN, MSN, RN · Jun 4, 2008

You're getting good suggestions so far. When I worked days on my unit (NICU), I'd sometimes hear the same complaints from students. One of the keys may be to think outside the box. Your learning opportunities won't be the same as they are on med-surg, but they're still there.

- Assessment is a critical (and often challenging) skill for working with peds patients. If you're able, take the time to listen to breath sounds and heart tones, look at pupils, etc. Do your findings correlate with what is in the chart? I know that it's hard to develop pattern recognition when you're working with one patient, but it's a start.

- If you have access to the chart for a good while, make sure you read progress notes and even try to decipher physician order sheets. Write down questions that you run into and ask your instructor or the staff nurse.

- Many people will come and go from the unit over the course of the shift (OT/PT, social work, clinical nutrition, case management, respiratory therapy, etc). If there's downtime and you see someone like this, it might be worth finding out if you could observe them as they worked with a patient.

Some of this stuff is going to depend on how strict your instructor and your unit are. By all means, talk to the instructor, as Meghan suggests. I can't imagine that they want you sitting and reading for lecture if there are any other opportunities.

BittyBabyGrower, MSN, RN · Jun 9, 2008

That isn't out of line for what students can do where I work. Most hospitals are very strict on peds guidelines for students....not that it is better, but if you are going to make a med error, better on a bigger person than on a little kid where even sometimes 0.5ml can mean a big difference! As for the glucose sticks....that is a whole new game there...it is hard to hit a wiggling finger or heel...and if you do it wrong you risk osteomelitis!

Students need to be proactive also....there are literally a hundred things to do on the floor and if our nurses on our peds floor saw you sitting and reading they would have you busy with helping out. There is also child life, OT/PT, talking to your kiddos (if they are old enough), relieving the parents for a bit, talking to the parents (if they are talkative). You can observe how different age groups handle being hospitalized, how parents of these age groups handle it as well. Do a huge assessment on the kiddos...make it fun for them...that is part of the game of working peds! Are there any kids with odd diagnosis....ask the nurses about it, do some research. I really hate to see students miss good opportunities. And if you only have one patient, you should be making that family feel like royalty and giving them some extra attention that the regular staff can't provide! Embrace this experience and make it work for you!

suanna · Jun 10, 2008

By the time you finish the rotation you my be suprised how much you did learn. Honestly, I was glad they limited what we could do as a student in peds- it's just too easy to cause harm to a kid. There is a lot to learn that dosen't require "hands on" skills. Keep your eyes open and your ear to the ground and I'm sure you will pick up a lot of info before it's over.

WineCountryRN · Jul 1, 2008

nursing student...did those reponses suffice?

my hospital leaves the SN with so little to do and the census varies. I encourage my students to spend time with the other disciplines. They spend a day in the clinic, day in the ICU, day in the OR and the remaining days on the units. We do a lot of rehab which make the hours of nursing care limited. Ask around for things to watch, shadow your nurse, do you chart on the patients (we use EMR so I have the students practice old school style...on papers). In post conference we do lots of hands on practicing giving report, spending time talking about the pediatric assessment and the differences with pediatric systems. So how the time flies and when it is done the students ask for more. As an instructor I wish there was more we could do together but then I find that I am going way over the head of the students (for example, they hadn't studied ABGs in 2nd semester, so should I even bring that up). I wish I had more students eager to learn b/c if I give more to learn, some the students will groan.

got to go...my own kids are in need.

best of luck to you

Nrsstudent09 · Jul 11, 2008

Hey everyone,

Thanks so much for your suggestions, they were very helpful. In the end I ended up loving peds. It confirmed that this is where I want to go when I graduate in May of 2009. :lol2:I ended up learning there is more you can do than just the physical aspect of things such as meds or IVs. There is the communication aspect that I felt improved with this rotation. I just needed to look outside of the box. I was even sad to leave after my group had built a bond with a few of the chronic kids on the unit But thanks again for all your help.

scribblerpnp · Jul 13, 2008

I teach peds clinical, and let me tell you- YOU are NOT alone. Sorry my post is so doggone long!

Many times, parents are terrified of their child being in the hospital and the protectiveness shoots through the roof. They do not always appreciate having students and view them as "practicing or experimenting" with their sick child.

In my clinical we do not stick IV's, though for the most part, we do everything else. Parents often assume control of their child's bathing and eating, and often students on adult floors spend the majority of their clinical time feeding and bathing pts (or it was that way when I was in school), so having a peds pt may mean the bath and feeding are taken care of without you.

Even though, you can still make the best of your situation! Do a thorough head to toe physical exam. If you child is under 5 and not too sick to cooperate, do a Denver II. Use your peds clinical as a time to learn to:

1. Complete a phsycial assessment on a child of every age group using age and developmentally appropriate techniques. The way to do an assessment on a preschooler and toddler are radically different. And be thorough. Take your time! Enjoy the fact you can spend 20-30 minutes doing this, cause once you graduate, it isn't going to happen again.

2. Use the time to educate the family on something! EVERY parent or caregiver has some education need. Teach them how to do CPR, or the s/s or dehydration or resp distress, how to make a hospital stay less traumatic on the kid, etc. Peds is a great area to do education in.

3. PLAY with your pt. Have fun, entertain them. You can bring in some safe, age appropriate toys. I love to see my students coloring and talking to their pt. You can and will learn something by playing with a child.

4. Assess their development. Is it on the mark, advanced, or lagging? Do a denver if possible, if not, ask the mom and dad questions about their child's abilities. Most parents love bragging about what their kids can do.

5. Once you sense the parents trust you, give them a breather. Offer to sit with the child while they go shower, eat, run home quickly, etc.

Doing peds nursing is more than bathing, changing linens, doing procedures, or passing meds. I know that the students I have can already do these things. They have done them 100's of times on adult floors. I want my students to come from their peds clinical with an increased knowledge of child development, how children react to hospitalization and illness, how to assess children, and how to talk to them, educate and interact with them and their family.

Previous posters have given you wonderful ideas on how to get the most from your clinical. Good luck!

scribblerpnp · Jul 13, 2008

Oops, sorry I didn't see your f/u post on the 11th. I was too late!

I am glad you had a positive experience!