Behind the Scenes of Pediatric Clinic Nursing- A Kind of Letter to Parents

To those who think being a clinic nurse is so easy...

Sometimes my job is pretty plush admittedly. There's usually time to chat and laugh with my coworkers, time to check out the latest deal on Amazon and time to get to know the doctors who I work with, a few who I now consider friends and have hung out with outside work. I have a HUGE sit/stand desk that I've decorated with pictures of my family and our travels.  Other days though, aren't so easy, and that's why our office has nurses...

I am a pediatric triage|care coordinator nurse. Most days, I spend a good portion of my day on the telephone. I am the voice you get when you have a question about a rash, a cut that just doesn't look right, or a cough that won't go away. But I am also the voice who directs you to call poison control and calmly calls back to check on you. I am the voice who listens and advises you when your child is suicidal, when their heart is racing, or when they're having chest pain. I am the one you call when you're concerned about a concussion, a gluten intolerance, or perhaps something even more serious. It is my job to calm you, encourage you, and advise you on what I think is best for your child. Don't worry, there are protocols in place and manuals to refer to. There is a shared tribal knowledge of sorts that increases with every case.  Sometimes the answer is an appointment with the doctor because I can also get you that and be the careful keeper of the same day appointments that I control. Often it is something I can talk you through at home, though it may take a while to get you to understand what to do or there may be many, detailed instructions. Sometimes your questions at first sound silly but we respect you for calling. Being a parent is hard and we are there to hold your hand and help you through it. Many times a day a question will stump me and I walk into my doctor's office and confirm with him or her. Also, we are human and don't know everything-so sometimes we will try to work things out with you, and call you back when we have researched some more. 

It may surprise you to know that I have often triaged your child in the first one and a half to two minutes that I spend on the phone with you even if our call lasts for 3x as long. This additional time is spent asking you questions, not all of which I honestly need to know, but making sure that you as the parent feel listened to. Sometimes I do need to ask a ton of questions because I honestly need to figure out how serious the symptoms your child is having are. Sometimes I glean something by what you don't say or a sound your child makes in the background, or by putting them on the phone. It is quite the skill to listen between the lines and hear what needs to be said. Other times I will let you ramble while I collect my thoughts. Sometimes I will bring your child in not because they really need to be seen, but because a doctor's reassurance in person is what is needed to allay your fears. I understand. My job is to educate you, reassure you, and to make sure that your child is as safe and healthy as much as I can. In Pediatrics we genuinely do care and understand that your children are precious. They are precious to us as well. We have cried collectively upon receiving a poor diagnosis on a child and rejoiced when children are healed, cured, or even when the correct specialist is found to be able to help.

I also know way more than I would like to about your insurance and the process of doing referrals to specialists for your child. I know how to rush things through and how to get approval when it is absolutely needed in a timely manner. I will speak directly to the specialty doctor myself.  I know which prescription medications tend to be covered and which do not. And many of them I can refill without even asking the doctor because, again, there are protocols for that. Because of the pediatric nurses you get your medication in a much more timely manner than if the doctor had to look at and filter every request. It may surprise you to know that the doctors don’t see everything that the nurses take care of because they are entrusting us to be their right hand.

I do a fair amount of hands-on skills too. It is myself and the other nurses of course, who spend time in the medication room carefully calculating (and always double checking), mixing and drawing up a potent dose of antibiotics based on your child's weight and infection. Sometimes it is a breathing treatment that I will help administer, or medication such as steroids to help a child breathe better and easier. Often I am called upon to do urinary catheters. This is sometimes traumatic for both the patient and parents and we try to do the skill as quickly, calmly, and compassionately as possible. I might be giving strong medication to help boost growth, delay puberty, or birth control. On a few rare occasions I have placed and monitored IVs, helped temporarily cast a broken limb, or cared for a wound. 

Pediatrics is an interesting environment. It is both primary care and specialty all in one at the same time. A temperature range for an adult may not worry me as much as a smaller temperature range on an infant for example. There are things that we just need to know about our particular population of patients. In Pediatrics, when I go to room the patient it is not uncommon for them to grab my hand and walk with me or to ask what stickers I like best. I know that a smile and friendliness goes a long way to calm a scared child. A pediatric worker must have a heart for both communicating with parents and children alike.

When we lose a patient, hopefully never in office, our entire staff is aware. The pediatricians attend the funeral. Our doctors work long and hard to make sure that each and every one of their patients is getting the care needed. This may mean phone calls in the evening from home, calling specialty offices to get the patients in sooner, and basically whatever we can do. We will baby our parents and hold their hands as much as and for as long as possible because again, your children are precious to us.

Your children are amazing, the reason we have fun murals on the walls, they are resilient and tough, and we love watching them grow. Our doctors truly do love their jobs. I have never met a set of happier doctors who often say things like, “how amazing we get to work with these young people every day."

In pediatrics, I am shown so much respect as a nurse. I know it is already an esteemed position to hold, but when I walk down that hallway and hear  our amazing front desk staff say to parents "let me get the nurse she will know", "the nurse will help you", "the nurse will be out to talk with you in just a moment", I know that my opinion and my education are valued and that you know I will advocate for you and help you as best I can with your child. Even though we sometimes get easy calls, keep in mind that all our nurses are emergency trained in pediatric life support and can help a choking child, perform CPR, give meds to stop a seizure,  put in an advanced airway and even start an IO (intraosseous <into the bone> IV) if the need arose. We hope it doesn't, but we are trained just in case.

It is all a matter of perspective. It really is. Sometimes I have been very bored with my job as it is not quite as hands-on as I would like. I will say that I daily use clinical decision making and judgment, so my brain is never "off." Some of my restlessness has been helped by putting some of us nurses on the floor with patients a few half days a week. That has been great to not be triaging 100% of the time. We also do triage in person should the need arise by the way. Often once a day or so-when people walk in with their child scared of what is going on. I know that I am blessed to have the position I do, to work with an entire staff of people who care deeply about what they are doing. I have inadvertently fallen in love with Pediatrics and will be here likely until my next journey begins or hopefully completes. Should psychiatric nurse practitioner, a position in which I would want to work primarily with children and teens not work out for me, I have given serious thought to becoming a pediatric nurse practitioner. Off to work I go!