Pros and Cons of pediatric floors?

NeoPediRN · Apr 1, 2009

I love it. I work per diem in pedi psych and full-time on an acute pediatric floor. I'm definitely a Type A but it also takes a lot to get my feathers ruffled. I'm relaxed and I don't panic, so peds comes easy to me. The parents feel comfortable with me and vice versa. Knock on wood, I haven't had any parents yet that have made me want to pull my hair out. The hardest situation for me is seeing a kid in severe pain - facial grimacing, gripping the rails type of pain, and the parents refuse to let them have medication because of the side effects or because they're afraid of addiction. It's like okay, let's be real here. Your kid has 15/10 pain and is pouring buckets of sweat. Tylenol is not going to cut it, let him have the damn 2mg of morphine every four hours and if he's is still asking for it six months down the road then we can start worrying about addiction and recreational use!

classicdame, MSN, EdD · Apr 1, 2009

Pros - the kids.

Cons - their parents

Really, to me it was like "pure" nursing because you develop assessment skills. You cannot depend upon your patient to give you information, so you use your skills for assessment and re-evaluate FREQUENTLY.

mustlovepoodles, RN · Apr 1, 2009

I've been a peds nurse for about 20 years, mostly NICU & PICU, but also some telephone triage and school nursing thrown in there. I think the thing you have to remember is that 80% of ped nursing is educating and dealing with the parents. The kids are a piece of cake. If a child is sick enough to be in the hospital you can bet the parents' stress level is through the roof. They need some special management, not babying, but you have be respectful of their fear and their anger. Remember that you're all on the child's side; everything you do promotes the wellness of the child. Some parents lose sight of that and you may need to gently remind them. Parents are the resident experts on their child--nobody knows them better than Mom & Dad. Most parents are very grateful for the job you do and a few with be critical and hard to please. It's the nature of the beast. :nurse:

Pediatric Critical Care Columnist · Apr 1, 2009

The parents that are most difficult to deal with are the ones who have been "institutionalized". They're the ones that have kids with chronic problems who rapidly become "experts" in everything to do with their child, even when they aren't. Like for example, a child is on continuous renal replacement therapy (not out on the peds ward but in PICU... this is my best example though) and has had multiple organ failure in the past. The doc orders a negative 250 mL fluid balance for the child and there are standing orders for adjusting the fluid removal rate and so on. In the (distant) past the child didn't tolerate a significantly negative fluid balance. You come on and the kid's positive about 300 mL, is tachypneic and crackly as can be and the O2 requirements have increased. So you adjust your fluid removal to achieve your desired fluid balance over the course of the shift. A few hours later the mom comes in, looks at the CRRT charting, see's that the kid is now negative 100 mL and she goes ballistic. She herself puts a cuff on the kid to get a BP and starts badgering you to give a fluid bolus to get the kid positive again... because Little So-and-So doesn't tolerate being negative. (Meanwhile Little So-and-So is sound asleep with stable BP, no longer tachypneic and O2 requirements are back to baseline. You politely explain about the orders, the rationale for them, the desired effects and so on. She leaves the room and in a few minutes returns with the charge nurse, who tells you to give the fluid bolus, writes a verbal order that she never actually obtained from a doc and you're hooped. Or the mother who tells you that you're doing chest physio WRONG because you're pummelling her 11 year old with both hands... don't you know you NEVER use two hands on a child!! Those are the kind of things that make you crazy on a peds floor.