What About the Children? Special Administrative Concerns
Caring for children in and out of the hospital is a very challenging, often stressful, and, sometimes, emotional aspect of nursing practice that some nurses find to be not their practice area. I can recall being unable to sleep nights, when I was a nursing student in pediatrics, as I worried about the well-being of my young patients. I remember holding a 12-year-old girl in my arms, giving her my best caring, as she died suffering from acute glomerulonephritis. Kidney transplants were not available then. I also had a young girl with tetralogy of Fallot who needed open-heart surgery-very tenuous in that era. She recovered, but I lost a lot of sleep worrying about her. Then, there was Susan, aged 4, admitted with ruptured appendix and a board-like abdomen. She was near death so many times during that first week of hospitalization, and I was her nurse. I would call the ward frequently when I was off duty to check on her. I found myself unable to leave the nurse's residence for fear she would need me. She recovered, but I knew then that caring for children, as a nurse, was not my calling.
Several years later, after having 6 children of my own and sometimes running a pediatric ward at home with 4 cases of mumps at one time, or measles or chicken pox, and so much more nursing of my children, as all mothers do, the memory of Susan stayed with me. I was an active participant in the National League for Nursing and the nursing careers program. I frequently was speaking to future nurse clubs, encouraging students to consider nursing as a career. At one of these meetings, there was a young lady looking at me so intently. I asked her why she wanted to be a nurse and she said to me that she was near death as a child, hospitalized with a ruptured appendix, and a student nurse was always there for her. I asked whether her name was Susan. She said, "Yes", kern3pt and I said, "I was your nurse." I do not know whether she ever became a nurse, but I do know that whatever we do with all of our patients, our caring impacts them in untold ways.
This issue devoted to the administrative concerns of caring for children was suggested by Rhonda Anderson, DNSc(h), RN, CNAA, FAAN, FACHE, Pediatric Administrator and Regional Pediatric Service Line Administrator, Banner Children's Hospital, Banner Desert Medical Center, Mesa, Ariz. Rhonda has accepted the challenge of assuring the children and families who come to Banner that their needs are met. She is currently an adjunct faculty at Grand Canyon University, College of Nursing, and is active in various professional, civic, community, church, and national boards and organizations.
Rhonda attended the Wharton School of Business as a selected participant in the Johnson & Johnson Fellowship Program. Her current appointment as a Joint Commission and American Hospital Association Commissioner has her chairing the Performance Measurement Committee as well as the Codman Quality Awards Committee. Rhonda Anderson exemplifies exceptional administrative leadership in caring for children and is best qualified to be issue coeditor for "What About the Children? Special Administrative Concerns."
Joining Rhonda in guest editing this issue is Ginger Malone, MSN, RN, Chief Nursing Officer for Children's Hospitals and Clinics of Minnesota in the Twin Cities of Minneapolis/St. Paul. In this role, she is responsible for leading Magnet initiatives, nursing informatics and research, patient care operations, and external relations with academic deans and leaders of nursing health sciences programs and professional associations. She also provides leadership to patient care services, child life, social work, family services, and respiratory care services.
Of special note in Ginger's leadership background is her work as director of a multiyear Robert Wood Johnson Foundation grant to strengthen hospital nursing and improve patient care, awarded to only 19 hospitals across the United States. The innovation efforts resulted in $20 million of expense reductions, with improved care and patient satisfaction outcomes.
Recently The Joint Commission issued a special alert: Prevent Pediatric Medication Errors; children are 3 times more at risk than adults. The commission also urges greater attention to precautions such as standardization, improved medication identification, and communication techniques. Other in-hospital efforts include a unique children's rapid response team that lets everyone involved with caring for a child watch out for the child's well-being. Patterned after rapid response teams across the country, the team of specialty-trained medical professionals seeks to keep a potentially dangerous situation from deteriorating. The unique part of the program at Children's Hospital, Central California, is the ability of anyone who cares for the child, including a parent, to raise an alert.
Special administrative concerns present additional challenges, including promoting positive mental health for children, being a child advocate in environmental issues, child psychology, public policy, and public health and education, and the misdiagnosis of emotional disorders in children. As we become increasingly alerted by the media to child abuse and neglect, our responsibilities as nurses for reporting and recording are sometimes overwhelming. Comprehensive administrative protocols and policies are imperative to assist nurses in caring for children in the emergency departments as well as the hospital and home environments.
In March 2008, I was privileged to be invited as 1 of 12 from the United States to participate in a Fulbright Academy of Science and Technology workshop on Human Health and Environmental Challenges in the Middle East. The meeting was held in Doha, Qatar, and sponsored by the Qatar Foundation, with world experts convening with regional health leaders. Many of the discussions centered on children and youth health issues related to the environment, some of which we seldom think about such as unemployment, spread of drug use, the impact of terrorism, high rates of violence, and overall environmental effects. Forty-three percent of mortality in children (0-14 years) is related to the environment. The face of climate change is the face of our children's future. Although water, sanitation, and hygiene are daily concerns as is starvation and nutritional deficiencies, we also see 1.2 million deaths from traffic accidents. Abuse of children is an international problem, and when children are removed from parental homes, there is the concern of adequate foster care.
During the past several months, I have been privileged to participate in training to become a CASA-a court-appointed special advocate for foster children. Although schedule and available time have limited my ability to complete the required hours and attendance at a foster care review board hearing, I look forward to being a child advocate in a new volunteer way. There are so many ways we can influence the care of children, and as we continue this presidential election campaign and barrage of promises, let us be concerned about care of our children. Our children are the future of our country and every nurse can have a great influence on the health of all children, especially the underserved children.
We are such a privileged nation, and although we have much need for improvement in child health programs, we are building a stronger nation with better care for our children.
-Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP
Editor-in-Chief
Nursing Administration Quarterly