What would you say about the appropriateness of a pediatrics nurse working on an adult medical-surgical unit? In this month's Reflections column ("The Eyes of a Pediatric Nurse," page 39), 24-year veteran of pediatrics Beverly Rossiter eloquently describes what she saw through her pediatrics lens when caring for an older man with lung cancer and pneumonia. Her experience suggests that the relational skills crucial for working with children and their families can yield insights and improvements in the care of adults.
Maybe it has something to do with play, which is after all a form of learning. I recently toured Children's Memorial Hospital in Chicago, a Magnet facility that appears to live up to that designation, given the hospital's 9.7% turnover and -2.1% vacancy rates for nurses. As I walked the corridors and met various employees, I was struck by their smiles and by the pervasive sense of warmth. I asked chief nurse executive Michelle Stephenson, MSN, RN, and administrator of surgical and emergency services Tom Schubnell, MSN, MBA, RN, about the difference in mood I've often perceived in children's hospitals. Here's what they said:
You can't bring your own baggage to the child you're caring for.
Children will detect frustration or dismay; you have to let it go when providing pediatrics care.
You must work with families.
Pediatrics is, by necessity, family focused.
You have to be prepared to play.
Play is an essential part of children's growth and development and can be used to help a child prepare for surgery, express anxiety about treatment, impart crucial information about symptoms, or divert attention from uncomfortable procedures.
It is easy to forget that pediatrics wasn't always this good. When I was a student nurse in the late 1960s, hospitals usually didn't permit family members to stay with children around the clock, use child-life specialists to alleviate confusion and distress at every stage of care, or even prioritize pain relief. Even today, despite great progress, some pediatrics facilities and units unduly restrict visiting hours. Pediatric nurses are leading the way in this area and have much to teach clinicians who work with adults.
I'm concerned about a debate going on in some nursing schools over whether pediatrics should be a clinical rotation required of undergraduates. While most nurses will not work in pediatrics, children represented 25% of the 2003 U.S. population (see http://www.childstats.gov/americaschildren/index.asp). In 2000, according the Agency for Healthcare Research and Quality, 20 million U.S. children had one or more chronic health conditions; about 18% of all hospitalizations were for children and adolescents, and 64% of these admissions were to non-pediatrics hospitals. Don't all nurses need some knowledge of child health?
A pediatrics clinical rotation need not be in acute care. School health programs, day care centers, and ambulatory care provide opportunities for learning about the health of children and families. Many of the nurses I met at Children's Memorial Hospital said that they had been attracted to pediatrics during their clinical rotations and now couldn't imagine working in another specialty.
Of course, I'd want to make sure that the pediatric nurse working on a medical-surgical unit has the knowledge and competency to care for adults (particularly older adults). But we all can learn from our pediatrics colleagues about how to find joy in work, how to enhance care while gaining clinical insights through more playful and open-ended methods of communication, and how to embrace families for the sake of those we serve, whether young or old.