So, what's so hard about Peds?

Gompers, BSN, RN · Jan 17, 2006

It was my hardest clinical. There are quite a few reasons...

1. You're not just dealing with the child, you're dealing with their stressed parents.

2. You never know what to expect - one patient might be a week old, another might be in high school. You have to constantly switch gears and remember what developmental stage each child is in, so that you can effectively work with them.

3. It's not like adult units, where one floor is neuro, one floor is surgical, one floor is orthopedic, one floor is cardiac, etc. It's all mixed together in Peds and PICU, so you have to be "up" on everything, pretty much.

4. Pediatric medication is ordered according to weight. So most of your medication doses aren't "standard" like they are with adults. You have to calculate each dose to make sure it's within range for that child's weight.

5. Kids can't always tell you what is wrong with them, where it hurts, or what they're thinking.

6. "White coat syndrome" - kids are often afraid of docs and nurses!!!

7. The scary thing about kids - when "going downhill" their bodies compensate longer than adults' bodies. Whereas an adult will start having funky vital signs for a bit before they collapse - a child's vitals might be perfect and then BOOM, once they hit a certain point, it basically hits the fan.

8. Everything is smaller in peds, including veins and urethras, so IVs and foleys are that much harder, plus, see #6!!!

elkpark · Jan 17, 2006

It was my hardest clinical. There are quite a few reasons...
1. You're not just dealing with the child, you're dealing with their stressed parents.
2. You never know what to expect - one patient might be a week old, another might be in high school. You have to constantly switch gears and remember what developmental stage each child is in, so that you can effectively work with them.
3. It's not like adult units, where one floor is neuro, one floor is surgical, one floor is orthopedic, one floor is cardiac, etc. It's all mixed together in Peds and PICU, so you have to be "up" on everything, pretty much.
4. Pediatric medication is ordered according to weight. So most of your medication doses aren't "standard" like they are with adults. You have to calculate each dose to make sure it's within range for that child's weight.
5. Kids can't always tell you what is wrong with them, where it hurts, or what they're thinking.
6. "White coat syndrome" - kids are often afraid of docs and nurses!!!
7. The scary thing about kids - when "going downhill" their bodies compensate longer than adults' bodies. Whereas an adult will start having funky vital signs for a bit before they collapse - a child's vitals might be perfect and then BOOM, once they hit a certain point, it basically hits the fan.
8. Everything is smaller in peds, including veins and urethras, so IVs and foleys are that much harder, plus, see #6!!!

Very well put! ITA

TexasPediRN · Jan 17, 2006

Right when I saw the title a million reasons jumped into my head but I completely agree with Gompers!

I find you also need to talk with pediatric patients differently. Saying- I'm going to take your blood pressure just doesnt cut it with most peds patients. Telling them you need to measure their muscles, now that works great and you get a coorportive patient!!

Good luck :)

allthingsbright · Jan 17, 2006

It was my hardest clinical. There are quite a few reasons...
1. You're not just dealing with the child, you're dealing with their stressed parents.
2. You never know what to expect - one patient might be a week old, another might be in high school. You have to constantly switch gears and remember what developmental stage each child is in, so that you can effectively work with them.
3. It's not like adult units, where one floor is neuro, one floor is surgical, one floor is orthopedic, one floor is cardiac, etc. It's all mixed together in Peds and PICU, so you have to be "up" on everything, pretty much.
4. Pediatric medication is ordered according to weight. So most of your medication doses aren't "standard" like they are with adults. You have to calculate each dose to make sure it's within range for that child's weight.
5. Kids can't always tell you what is wrong with them, where it hurts, or what they're thinking.
6. "White coat syndrome" - kids are often afraid of docs and nurses!!!
7. The scary thing about kids - when "going downhill" their bodies compensate longer than adults' bodies. Whereas an adult will start having funky vital signs for a bit before they collapse - a child's vitals might be perfect and then BOOM, once they hit a certain point, it basically hits the fan.
8. Everything is smaller in peds, including veins and urethras, so IVs and foleys are that much harder, plus, see #6!!!

What an excellent post-thanks for outlining that and being so specific--it will very likely help us be a bit more mentally prepared for teh challenge!

elkpark · Jan 17, 2006

Also, one other thing we haven't mentioned is that many people (students) find it more emotionally challenging/draining than other clinical rotations. You see lots of v. sad situations -- injuries that are the result of abuse, terrible chronic/congenital problems (CF, CP, spina bifida, etc.). For most of us, terminal illness, serious disability/disfigurement, burns, violence, etc., seems more heart-rending and gut-wrenching when it's a kid than when it's an adult ...

Gompers, BSN, RN · Jan 17, 2006

Also, one other thing we haven't mentioned is that many people (students) find it more emotionally challenging/draining than other clinical rotations. You see lots of v. sad situations -- injuries that are the result of abuse, terrible chronic/congenital problems (CF, CP, spina bifida, etc.). For most of us, terminal illness, serious disability/disfigurement, burns, violence, etc., seems more heart-rending and gut-wrenching when it's a kid than when it's an adult ...

Oh, DUH! You're absolutely right! I love my job so much (NICU) that sometimes I forget that other nurses are always saying, "How can you work with sick babies and children? That is so heartbreaking!" I only seem to remember it after particularly emotional nights at work.

allthingsbright · Jan 17, 2006

yeah, thats the one thing i DREAD about peds. i feel like i'll see my own children in each child i care for and that will be very difficult.

carolinapooh, BSN, RN · Jan 17, 2006

I volunteer at Duke Children’s Hospital, and am quite often on the pediatric bone marrow unit. While I don’t have young children myself, I have two school age nieces, two great-nephews, and a great niece. (I have a 50 year old brother and his 25 year old son has three kids, in case you were wondering how that’s possible and I’m only 32!) I DO see them in every child, and know that I would want someone to take very good care of them. I’ve seen children die of awful cancers that I can’t even pronounce yet (and there was a period on the bone marrow unit where eleven kids died in less than three weeks)….but they’re hopeful, and the parents are hopeful – I can’t explain it. Maybe the NICU nurses know better than I what I’m trying to say. I really want to work peds over adults. Maybe I’ll change, but I don’t think so.

And I do think, thank God that's not us - but I suppose that's only natural. What I really think is - there but for the grace of God go we....

elizabells, BSN, RN · Jan 18, 2006

I did well in my peds clinical but actually got my worst grade so far in the didactic - here's my theory why. It's kind of like med-surg in that you are learning so many different diseases and problems and values - and they're all DIFFERENT than the way you learned it for med-surg. My best advice? Study the heck out of the developmental stages material. That's pretty much where I fell off. Now I just have to hope that my peds didactic grade doesn't keep me from getting a job in a NICU....

MadRedneckRN · Jan 19, 2006

I think Peds is a tough rotation because while you get incredible highs;"I saved a CHILD". The potential lows are much worse. We see not only the loss of a life, but the loss of the potentail of what that life could have become. Add to this, unreasonable parents. It boils down to stress.

I loved my kids when I worked Peds HH. They were part of my family. Sometimes they broke your heart. Sometimes you want to break the parents noses!!

Lori

SCmomof3, RN · Jan 21, 2006

I find you also need to talk with pediatric patients differently. Saying- I'm going to take your blood pressure just doesnt cut it with most peds patients. Telling them you need to measure their muscles, now that works great and you get a coorportive patient!!

Thanks for the tip :chuckle