Career Guide for Pediatric Nursing

Children aren’t little adults. Their diseases require treatment tailored to them, and that calls on the specialized training of pediatric nurses.

According to a 2011 nurse retention report by Nursing Solutions Inc., pediatric nurses had the lowest turnover (4.4 percent) of nursing specialties. The findings were benchmarked against the national average turnover rate for bedside RNs, which was 13.8 percent in 2010. (The next lowest was surgical services, at 10.3 percent.) These numbers suggest that pediatric nurses really enjoy their work.

But it’s a nursing career that will include more patients than just the child. Pediatric nurses learn that their “patient” is the child’s entire family, says Debbie Arnow, 2011-2012 president of the Society of Pediatric Nurses. “They have that instruction in school, but when you hit the clinical area, you realize what it really means.”

The family, for example, may not always be just a father, mother or grandparents. And delivery of news about medication, diagnosis and prognosis can be tough. The nurse then must comfort and guide the family after that news is delivered. “These are all things that must be learned,” says Arnow, assistant professor of nursing at Vanderbilt School of Nursing in Nashville, Tenn.

Job description

Pediatric nurses are RNs who care for children of all ages in a variety of healthcare settings. The work can range from surgical, acute and critical care in hospitals, to urgent-care and walk-in clinics, rehabilitation and mental-health facilities, home visitation agencies and pediatricians’ offices.

To specialize in pediatrics, a nurse goes where the kids are. Children’s hospitals, schools and pediatricians’ offices are three of the most likely job sources. Most of those workplaces also offer classroom and clinical orientations about the unique characteristics of children as patients. That’s especially helpful for new nurses with bachelor of nursing degrees, because undergraduate programs don’t offer specialized pediatric training.

A day in the life

As a pediatric nurse, how you care for your young patients depends on their development level. That’s regardless of whether you work with them for days in the hospital or 15 minutes in a doctor’s office.

You also can’t ignore the importance of the family’s knowledge of the child. You’ll work with them in caring for the child too.

Your hospital day varies widely, depending on how ill or injured a child is. In the hospital general pediatric unit, children can have a range of acute and chronic medical and surgical conditions. Children who need frequent and invasive monitoring of critical or life-threatening conditions are cared for in the pediatric intensive care unit (PICU).

Intermediate care is given children who are acutely ill and require more frequent assessment and monitoring than those children in the general unit, but less than those in the PICU.

And, your work in the hospital rehab unit prepares the child and family for the return to home and school.

Education

If you’re interested in pediatric work, you’ve got a range of education tracks available. You can get your bachelor of nursing degree and, after building up job experience, become a certified pediatric nurse through the Pediatric Nursing Certification Board or American Nurses Credentialing Center.

Or, you can get a master’s of nursing and become an advanced-practice pediatric nurse – as a nurse practitioner or clinical nurse specialist – after completion of a national certification exam. And by 2015, the doctorate of nursing will be the preferred degree.

Certifications: Even after becoming an advanced-practice nurse, you can obtain a variety of certifications that are considered a plus. The Pediatric Nursing Certification Board, which bills itself as the largest certifier for pediatric nurses nationwide, offers a variety of designations, including certified pediatric acute and primary care nurse practitioners.

Additional training also is available through the American Nurses Credentialing Center, which administers the Magnet and Pathways to Excellence hospital recognition programs.

You can seek certifications in emergency care, child and adolescent behavior, mental health, critical care and school nursing as well.

A critical care certification is especially helpful in urgent-care clinics, where you’ll work more autonomously than in other settings. Urgent-care clinics prefer to hire staff with at least one year of recent critical-care experience. Other training that’s also recommended: advanced cardiovascular life support, basic life support and pediatric advanced life support.

“It makes you much more marketable if you can work on both mom and baby,” says recruiter and nurse Heidi McAllister at Pro Health Staffing in Seattle.

Residency programs: Keep in mind that some schools and hospitals participate in the national Nurse Residency Program (NRP). The NRP is a joint effort of the University HealthSystem Consortium, an alliance of 107 academic medical centers and 232 of their affiliated hospitals, and the American Association of Colleges of Nursing.

The one-year program offers on-the-job education and support for nurses in their first post-grad year under the guidance of nurse facilitators — experienced nurses who either are recruited to fill the role of “expert” nurse or who add that function to their existing jobs.

Changes in nursing requirements have put the residency program in a new spotlight. The 2010 landmark “The Future of Nursing” report by the Institute of Medicine recommended that all hospitals develop a residency for new nurses and also provide support for experienced nurses who move into expanded roles. The National Council of State Boards of Nursing also recommends a “transition to practice” program for new nurses. And the NRP curriculum also meets the American Association of Colleges of Nursing’s revised baccalaureate requirements.

Specialties

The certifications described above are one kind of specialty for pediatric nurses. But several other avenues outside of traditional medical facilities are available for pediatric nurses.

Home healthcare: Pediatric home healthcare is one of the fastest growing segments of the healthcare system. Because of advances in pediatric medicine and technology, more children with complex chronic and terminal conditions can be cared for at home. A growing subspecialty is delivering services for infants and children with HIV or AIDS and those born to mothers addicted to drugs or alcohol.

Previous hospital experience is a must for any kind of in-home pediatric nursing, says Venus Oleyourryk, a veteran nurse who works for PSA Healthcare in South Carolina. You have to be confident that you’ll know what to do in an emergency situation. “When you’re all alone with that child and they stop breathing or their heart stops, you’re the first one to do CPR. In the hospital you press a button on the wall and people come running in to help you. These are medically frail kids. At any moment something could happen to them.”

Child-abuse prevention: Many national, state and regional programs are in place to help reduce the incidence of child abuse. And one standout program is the Nurse-Family Partnership, which partners a registered nurse with a first-time mother to provide ongoing nurse-home visits. The program is funded through various private and public funds.

Hundreds of nurses nationwide participate in this program, but more are needed. Agencies across the country are seeking registered nurses who hold a BSN to join the home-visitation program.

Lactation consultant: If you have a passion for working with mothers and newborns, a lot of patience, a genuine interest in promoting breastfeeding and a willingness to nurture and offer assistance and advice to new parents, especially during the critical early days, you may want to consider a career as a certified lactation consultant.

As the benefits of breastfeeding became a public-health issue, the demand for skilled instructors grew and ultimately a set of standards and an international exam were developed by the International Board of Lactation Consultant Examiners (IBLCE) to certify lactation professionals.

Sleep clinics: About 20 percent of children have some form of sleep disorder, which can range from snoring to night terrors to apparent life-threatening events.

Stacey Beasley, RN, MS, CNP, is one of two pediatric nurse practitioners at the sleep clinic at Nationwide Children’s Hospital in Columbus, Ohio. They help determine whether sleep issues are physically or psychologically based and work with physicians to develop a treatment plan. Their work also involves writing prescriptions, which makes it well-suited to the nurse practitioner role.

School nurse or administrator: This is autonomous work, so a school nurse needs prior pediatric experience with a wide array of health conditions and emergency situations, says nurse practitioner Susie Poulton, the 2011 Iowa School Nurse Administrator of the Year.

She emphasizes that a school nurse must truly enjoy children and have compassion for them and families. A school nurse needs to be knowledgeable and confident to make decisions, and to instruct and train nonlicensed staff. Excellent communication skills are a must, as a school nurse interacts not only with students, but parents, teachers, administrators, healthcare providers and others.

Poulton, who says her interest always was pediatric nursing, works with seven other school nurses, para educators and athletic trainers to handle 12,000 students in the Iowa City Community School District. As director of health and student services, she develops programs in student and family health, child abuse prevention, emergency plans, public health practices, disease control, nurse and staff supervision and community health programs for disease control.

Where the jobs are

“For pediatric RNs, the best employment opportunities typically lie in areas with children’s hospitals or academic medical centers that treat children,” Arnow says.

According to U.S. News & World Report’s rankings for 2011-2012, the top 11 children’s hospitals span the country from Boston, Philadelphia, Pittsburgh, Baltimore and New York in the East; to Cincinnati and St. Louis in the Midwest; to Denver, Houston, Los Angeles and Seattle in the West.

Don’t want a hospital workplace? There are plenty of other facilities that hire pediatric nurses. They include pediatricians’ practices, walk-in clinics, home health agencies, schools, urgent-care and sleep clinics.

Salaries

Depending on a nurse’s experience, degree and certification, and the cost of living in a particular area, salaries varied widely. According to PayScale.com, 67 respondents to a survey of pediatric nurses reported salaries from the $20,000s to $117,500. For pediatric nurse practitioners, 349 respondents reported pay ranges from the $50,000s to $120,000s.

Contributors: Terry Sheridan, Marcia Frellick, Sue Mellon, Elisabeth Greenbaum Kasson