As I move on: Lessons Learned in Pediatrics
According to my Facebook memories, 3 years ago today we had a lecture on pediatrics in nursing school. I was floored! Something that combined both my love for children, education, and medicine. I have 3 work days left after spending the last 1 year and 10 months working as a Triage/Advice/Care Coordinator RN in a pediatric clinic. It is bittersweet. I desperately want to be more hands on, while I love the population I work with and will miss it dearly (hence leaving one foot in the door by moving to relief so I can fill in sometimes). I know that moving to hospital nursing is in many ways necessary for my career, my skills, and my confidence as an RN. I know that just working the 2 LONG days will give me much needed time to continue my education to be a family nurse practitioner. I know that in just 1.5 years I will walk those pediatric halls again as a FNP student, and complete my pediatric training alongside my friends and mentors there. Maybe, just maybe, I will eventually work there myself again...but as a provider? I have definitely considered that, but I want to leave all the options open even in my heart, as 2.5 years is a long time of exposure to areas I have never even considered, and who knows if I'll fall in love with one of them?
I am required to do rotations in primary care for women's health, pediatrics, family medicine, and then have a rotation in a specialty of my choice. Nurse practitioners are of course trained for primary care essentially, though you will see them also filling roles in hospital EDs and even as hospitalists. I am thrilled to see that NPs are being hired just about everywhere: neurology, urgent care, dermatology, cardiology, ER. It exciting to see that the sky really is the limit, and I wonder if I will love my position on the post-surgical floor, or if I will even stay there the whole time I am in NP school or if I will transition to another floor or a closer hospital. When I met with my new manager he mentioned that he is even seeing NPs make rounds in the hospital on various units (hospitalists mentioned above), and a trauma team composed of nurse practitioners. Very cool.
I want to enter my training as somewhat of a blank slate and be open to the opportunities placed in front of me, but I need to take with me the valuable life lessons learned in pediatrics.
1. Kindness is worth its weight in gold to a scared kid (I would venture adults too). Always smile, always find a way to connect with your patient whether it is over a sticker or complimenting their tutu.
2. Appear calm and in control (even when you are not). These people come to us for help, for answers, for assurance. It is okay to show a co-worker you are nervous about what you are doing, but do NOT convey that fear to your patients. They (and their parents) are trusting you to use your skills and judgement.
3. Explain what you are doing. It doesn't take that much longer to explain to a kid that the BP cuff will give their arm a squeezy hug or that the alcohol wipe will feel cold for a second or two. In the know patients are less scared and easier to work with.
4. Be quick when you need to. This may seem to go directly against my last statement, but there are times for all patients when you wish your nurse would "just get it over with." Let's face it, no one wants you to take forever or explain the heck out of inserting a catheter or giving a shot. Provide a brief explanation, and perform the needed task as quickly as you can while maintaining safe technique.
5. Re-assure and congratulate your patient on small victories. High five! "That shot was scary but it's over now." I get that this needs modified for adults, but it still applies. "I'm sure that surgery seemed really scary, but now it's behind you and we'll get you set to go home."
6. It is okay to not have a clue about something but NOT to act clueless. BIG difference. I cannot know it all. I have been asked some obscure things by parents. They trust me. I am trained for this. When I don't have a clue it is okay to say, "That's an interesting question that I don't have much experience with. Let me research it and get back to you." Isn't that a much better answer than "I have no idea."
7. Advocate for your patient. Sometimes it's really little things. I had a teen patient one time tell me she refused to put on a gown. For whatever reason this made her feel vulnerable. Not a big deal. I indicated she did not need to, and I told the doctor who was also just fine with this. Peds patients (and parents) are often more comfortable having the lab workers come down to them for something that is already scary. I get that the lab gets busy and it is easier to have patients come up. I also get that I have told our lovely phlebotomists when I really felt they needed to come down to us, as it was better for the patient, and have made that happen.
8. If you are tasked with telling a patient/parent what a result is, take 5 minutes to educate yourself to know what the result means. You will be asked. I have explained electrolyte levels, what CT scans do, various genetic tests, etc.
9. Stand up for yourself. It is perfectly okay to tell a patient/parent "I need to get another set of hands to help me," or "I can't do this shot if you wiggling makes me feel unsafe." Know what your limits are, and ask for help as needed. Take breaks and lunches, and use your PTO. When a patient inevitably screams at you respond "I will be back in a bit, and we can try again. It is not okay to talk to me that way."
10. It is okay to cry. I sobbed on my way home the other night after a tough psych case. I can't fix it, but I needed to let those feelings out. I have cried after poor diagnoses (always even more sad in peds it seems when patients are just so young), as well as after talking to terrified parents. A great friend/mentor told me "It's okay if my patients even see me cry at times. It just shows them I am human, and I care."
I am required to do rotations in primary care for women's health, pediatrics, family medicine, and then have a rotation in a specialty of my choice. Nurse practitioners are of course trained for primary care essentially, though you will see them also filling roles in hospital EDs and even as hospitalists. I am thrilled to see that NPs are being hired just about everywhere: neurology, urgent care, dermatology, cardiology, ER. It exciting to see that the sky really is the limit, and I wonder if I will love my position on the post-surgical floor, or if I will even stay there the whole time I am in NP school or if I will transition to another floor or a closer hospital. When I met with my new manager he mentioned that he is even seeing NPs make rounds in the hospital on various units (hospitalists mentioned above), and a trauma team composed of nurse practitioners. Very cool.
I want to enter my training as somewhat of a blank slate and be open to the opportunities placed in front of me, but I need to take with me the valuable life lessons learned in pediatrics.
1. Kindness is worth its weight in gold to a scared kid (I would venture adults too). Always smile, always find a way to connect with your patient whether it is over a sticker or complimenting their tutu.
2. Appear calm and in control (even when you are not). These people come to us for help, for answers, for assurance. It is okay to show a co-worker you are nervous about what you are doing, but do NOT convey that fear to your patients. They (and their parents) are trusting you to use your skills and judgement.
3. Explain what you are doing. It doesn't take that much longer to explain to a kid that the BP cuff will give their arm a squeezy hug or that the alcohol wipe will feel cold for a second or two. In the know patients are less scared and easier to work with.
4. Be quick when you need to. This may seem to go directly against my last statement, but there are times for all patients when you wish your nurse would "just get it over with." Let's face it, no one wants you to take forever or explain the heck out of inserting a catheter or giving a shot. Provide a brief explanation, and perform the needed task as quickly as you can while maintaining safe technique.
5. Re-assure and congratulate your patient on small victories. High five! "That shot was scary but it's over now." I get that this needs modified for adults, but it still applies. "I'm sure that surgery seemed really scary, but now it's behind you and we'll get you set to go home."
6. It is okay to not have a clue about something but NOT to act clueless. BIG difference. I cannot know it all. I have been asked some obscure things by parents. They trust me. I am trained for this. When I don't have a clue it is okay to say, "That's an interesting question that I don't have much experience with. Let me research it and get back to you." Isn't that a much better answer than "I have no idea."
7. Advocate for your patient. Sometimes it's really little things. I had a teen patient one time tell me she refused to put on a gown. For whatever reason this made her feel vulnerable. Not a big deal. I indicated she did not need to, and I told the doctor who was also just fine with this. Peds patients (and parents) are often more comfortable having the lab workers come down to them for something that is already scary. I get that the lab gets busy and it is easier to have patients come up. I also get that I have told our lovely phlebotomists when I really felt they needed to come down to us, as it was better for the patient, and have made that happen.
8. If you are tasked with telling a patient/parent what a result is, take 5 minutes to educate yourself to know what the result means. You will be asked. I have explained electrolyte levels, what CT scans do, various genetic tests, etc.
9. Stand up for yourself. It is perfectly okay to tell a patient/parent "I need to get another set of hands to help me," or "I can't do this shot if you wiggling makes me feel unsafe." Know what your limits are, and ask for help as needed. Take breaks and lunches, and use your PTO. When a patient inevitably screams at you respond "I will be back in a bit, and we can try again. It is not okay to talk to me that way."
10. It is okay to cry. I sobbed on my way home the other night after a tough psych case. I can't fix it, but I needed to let those feelings out. I have cried after poor diagnoses (always even more sad in peds it seems when patients are just so young), as well as after talking to terrified parents. A great friend/mentor told me "It's okay if my patients even see me cry at times. It just shows them I am human, and I care."
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