Tenderness is a crucial tool for Teresa Keeling when working with the young patients at Pediatrics Associates of Johns Creek, PC.
Yet when the RN and clinical nurse manager talks about what to expect in the field of pediatric nursing, she shoots straight without the aid of anesthetic.
“You are going to be mentally, emotionally and physically challenged,” Keeling explained. “It’s a very exhausting job.”
This career finds RNs, typically those with four-year bachelor’s of science in nursing degrees, providing preventative and acute care in a variety of medical settings to children and adolescents. Duties run the gamut from performing physical exams, diagnosing illnesses and injuries, to offering support and education to the families of each patient. And because pediatric nurses treat different age groups, beginning with infants and spanning all the way to young adults, the issues prove just as broad.
“It covers a huge scope,” Keeling explained. “It’s not like adult care, because you’re working with different stages of life.”
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According to Courtney Pollard, an RN who works at the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta (CHOA), a pair of tennis shoes may be one of her more important accessories. Pollard’s hectic work week consists of three 12-hour shifts in a row, often navigating through stressful scenarios, especially in her particular unit.
“Working in pediatrics really needs to be a calling,” Pollard said. “If this is just a paycheck, then I think it’s a lot harder for people. You have to go into it knowing your life does get turned upside down a little bit.”
Despite high emotions and stresses, the rewards, she says, prove invaluable. While she was in nursing school, Pollard began noticing the resilient nature of children and how they tend to bounce back from medical adversity. As she continues her career at CHOA, she says she witnesses it every day.
“We give them chemo, procedures and drugs that should have them in bed for weeks,” she said. “The next day they’re bouncing around the unit, pushing their little IV poles around, and you’d never know they were sick. To see them bounce back has always been so inspiring.”
Pollard says this type of inspiration not only makes her job “100 percent worth it,” but also puts her own struggles in perspective. After surviving a challenging shift, she says she reflects on how well her patients have dealt with radiation, line placements and other sometimes-painful treatments. This in turn prompts her to pull up her own bootstraps.
Although pediatric nursing is rife with both challenges and rewards, it also has its share of misconceptions. Kathy Stancil, clinical staff development coordinator at CHOA, speaks at nursing schools about rampant myths regarding the field. One of them, she says, concerns nurses who think they may not work well with children.
“When I was in nursing school,” Stancil explained, “I thought I would never want to go into pediatrics. I was too afraid of the kids. I grew up an only child, I didn’t babysit a lot and I didn’t feel comfortable around children. When I did my pediatric rotation, I was actually surprised that I enjoyed it and that I was good at it.”
Some nurses shy away from pediatrics because of the fear of working with difficult parents. Through her own experiences as both a parent and a nurse, Stancil says she’s found parents can serve as the perfect allies. Pediatric patients can’t always verbalize what’s wrong. The parent, however, can be an extension of that child and a line of communication. Make a good first impression and create a solid rapport, she says, and parents will partner with you in caregiving.
The idea of pediatrics being a depressing line of work continues to be a strong deterrent. However, Keeling, Pollard and Stancil each agree the positivity found in the work outweighs the heartbreak.
“A pediatric nurse’s focus has to be on the positive,” Stancil said. “There’s a lot of hope in pediatric nursing, because patients have their whole lives ahead of them. That’s what I tell students who are thinking about it.”
Part of Stancil’s responsibility at CHOA is to coordinate its nurse extern program. This allows nursing students in their junior year to work at CHOA for 10 weeks during the summer. Participants work directly with a preceptor to experience what it’s like to work as CHOA nurse.
Stancil says it’s not only a great way for her company to recruit and retain top talent; it’s also a hands-on pediatric opportunity for students. Events during the program include special training and simulation experiences students wouldn’t normally have in nursing school. For example, a recent program simulation focused on pediatric airway management, putting the participants in a bedside scenario.
Once in the field, pediatric nurses have a variety of ways to stay on top of their game. For Keeling, she soaks up as much knowledge as she can from the physicians she works with. Specialists often visit her practice, she says, addressing topics such as asthma and the rise in transgendered teenagers.
Pollard gravitates towards nursing blogs and magazines. Nurse and Scrubs Magazine remain two of her go-to websites, and she keeps track of the healthcare industry in general with help from a health news app on her mobile device.
Pediatric nurses sometimes have the opportunity for on-the-job training without even expecting it. Pollard says research studies can take place on her floor. A doctor recently gave Pollard and her colleagues an impromptu 30-minute discussion on sickle cell anemia and a new study drug.
“We’re avid to learn about new techniques, drugs and things coming down the line, because we want these kids to get well,” Pollard said. “So I think it’s exciting to be a part of that. The more you can learn, the better.”
According to Stancil, all bedside nurses at CHOA have the opportunity to be certified in Pediatric Advanced Life Support (PALS) and Pediatric Emergency Assessment Recognition and Stabilization (PEARS), depending on what department they work in. New nurses must receive the respective certification within 12 months of being hired.
Veteran nurses entering pediatrics at CHOA have the opportunity to participate in its Pediatric Entry Development Support (PEDS) program.
“It started as a back-to-basics pediatric course,” Stancil explained. “We were hiring a lot of experienced nurses, but they had some anxiety about being new to pediatrics. They had learned a lot of that knowledge in school, but had forgotten it over several years as they were practicing in a different specialty of nursing.”
CHOA’s PEDS program consists of four different classes. They focus on growth and development, pediatric physical assessment and the basics of pediatrics, simulation, career development and planning, and communication and teamwork.
Stancil says CHOA encourages its pediatric nurses attain the Certified Pediatric Nurse credential, which recognizes them as specialists in the area. CHOA values the certification so much, she explains, they’ll pay for nurses to take the exam.
In addition to exploring career advancement, many nurses tackle contemporary issues in the pediatric environment. From Keeling’s perspective in the private practice setting, she’s noticing a rise in obesity, ADHD, asthma and allergies. And more teenagers are addressing homosexuality, she says.
Social media has become an issue in the pediatric hospital setting, according to Pollard. On her floor, some patients are there for months or in and out for years. The relationship between the nurse and the patient and the patient’s family can become close. Pollard says parents often ask if they can connect with her on Facebook. When a child is released, it’s not uncommon for a nurse to be invited to a family outing or event.
“So it’s hard, because you build this relationship in the hospital,” Pollard said. “It’s hard not to want to continue that relationship if you’ve grown super close. … It doesn’t mean you don’t love them, but you need to leave work at work.”
With obstacles sometimes mounting in the pediatric nursing field, Pollard says sometimes it simply comes down to handling one shift at a time. The temptation to look at the challenging aspects can sometimes loom large, especially if emotional patients and their families are bombarding you. The sunlight of positivity and purpose, however, will soon rise.
“They parents are so wonderful and appreciative of everything we do,” she said. “And so are the children. They may have been kicking and screaming the night before, but the next day they’re leaping into your arms. It’s just an amazing, unique experience a lot of people don’t get to have.”
The subjects of this month’s cover story reveal candid, behind-the-scenes details about their lives in pediatric nursing:
Courtney Pollard, RN
Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta
On her career journey:
“Nursing was actually a second degree for me. I got my first degree in advertising and marketing. I knew that it was just not the right fit. Before I went off to college, I thought about doing pre-med, but I didn’t want to sign away 10 years of my life basically for school and residency. Nursing was presented to me, and Georgia State actually has a great program. It’s a year-and-a-half program. And that was where I felt called to be. In that school setting, I got to experience the patient population, and I knew 100 percent that I wanted to be with the kids. They were so inspiring, and I loved that you got to know them a lot more than other patients. …I started in my department in February of this year. I actually had a little gap in my employment between when I graduated from nursing school and started with Children’s, because I had my own battle with leukemia and a stem cell transplant. That’s exactly what I do now on the floor with my (patients).”
On sharing her leukemia experience with patients:
“I wasn’t sure how I was going to tackle that when I started. I never wanted my story to take away from their journey. I never wanted it to be about me. So I’ve used it selectively with some of my patients. …As a patient, I would like to know the kinds of things to look for; some of the things that a parent may want to ask but not know how to ask. Or maybe it’s something they’re wondering, but they’re just too overwhelmed at the time to think about asking. …The first time I shaved a little girl’s head, I definitely told her. We were both in tears about it, because she was so happy. She said, ‘Your hair looks so beautiful now.’ And I said, ‘Your hair will be just as beautiful.’ I showed her pictures, we had a dance party and she shaved her head. And not once did she cry. I told her, ‘You handled that better than I did.’ …I try to use my story in those instances to give them a little hope and say, ‘Hey, I had a transplant three years ago.’ The kids are surprised. They say, ‘Are you serious? You look great.’ I’ve used that with patients and parents. I’ve used that in certain situations where parents are overwhelmed and just not sure who to trust or what’s going on, because a lot of things are being thrown at them. I sit them down and say, ‘I’ve been where your son or daughter has been. You’ll get through this. My mom has been in your same shoes. This is what you can expect. I help them take it in day by day and not overwhelm them. …Only recently have I had that a patient really bonded with me about it. We both broke down in tears, but it was happy tears. And for me, it makes it all worth it. I know I’m in the right role.”
Teresa Keeling, RN and clinical nurse manager
Pediatrics Associates of Johns Creek, PC
On choosing pediatric nursing as a career:
“The biggest thing for me is I have children of my own. I’ve been through all of the stages. I have one who’s in his 20s now. Nursing is not only what you’re taught in school, but a lot of it is life experience. You need to be able to deal with people emotionally and identify different situations. I think that’s what draws me to pediatrics. …I worked in a hospital in the mother-baby unit with newborns. That’s what I wanted to do, because that was something I could relate to and that’s where I was in my life. That’s how I’ve chosen what I’ve done with my nursing career, based on my life experience and what I feel like I have a better understanding of. I took some time off with my children and came back to work in pediatrics.”
On the most rewarding aspects of her job:
“I enjoy talking with mothers of newborns. Having been in their position three different times, I’m able to reassure them and give them advice. Newborn moms come in here and are frazzled, scared and they don’t know what to do. So I like to spend some time talking to them about what they should expect. I like to help relieve some of their stress. I enjoy the parents of teenagers, who are dealing with those issues. Having dealt with that pretty recently, I enjoy offering what kind of advice I can. …I stay passionate in my work by just watching these kids grow. One child came in as a premie weighing 3 pounds. She’s 5-years-old now. She was at the bottom of the chart in the less than 3 percentile. Now she’s up to 75th percentile, thriving and doing really well.”
Kathy Stancil, RN and clinical staff development coordinator
Children’s Healthcare of Atlanta
On coping skills:
“Dealing with pediatric death is very heart wrenching for me compared to adult death. In the pediatric setting, some things don’t make sense like when a 3-year-old gets a brain tumor; when a child who is restrained dies in a car accident; or when a child suffers abuse. There are things that don’t make sense. So I had to learn a different method of coping with things like that. After I had my own children, it got a little bit harder, but I was able to cope by talking to my peers and co-workers, taking care of myself and focusing on the positive.”
On the importance of pediatric specialty care:
“CHOA is really trying to reach all of the kids in Georgia so they have access to pediatric specialty care. And that’s one of the things that leaders within our organization have been working at. We feel like that there’s a pediatric differential that we offer that can provide real quality care for the pediatric patient. Can other doctors take care of pediatrics? They certainly can. But we feel like a child being seen by a pediatrician in a pediatric facility with pediatric nurses with that experience and background can see them quickly, find out what’s going on with them and offer that kind of specialty. …Children are not just small adults. They have many things going on that are different. So we want to make sure that there’s that pediatric difference in the care that they would receive at a pediatric facility. Children’s is not only working hard to reach out to kids within the city of Atlanta, but to develop a network to reach out to all kids throughout the state of Georgia, and sometimes even extending into the Southeast.”