How to Frighten an ED Nurse

The scene is a bustling adult Emergency Department, and you’ve just discharged a patient, which means you are the only nurse with an empty room. You document your discharge and take the briefest moment to breathe, wondering if you have time to run to the cafeteria to replace that coffee you spilled in the car.

So, you check the waiting room tracker, and what do you see, a nine year old with abdominal pain, nausea, and vomiting. Suddenly your stomach also becomes uneasy. To your co-worker you say, “I’ll take care of any code browns you have for the rest of our shift.” To your charge nurse you plead, “If I do all the crash cart checks for your next 6 shifts, would you assign the waiting room patient to someone else?”

Sound familiar?

In the adult ED, pediatric patients can be one of the most anxiety provoking patients for some nurses. I’ve been part of bargaining like that above, because sometimes ED nurses are afraid of nine year olds. To be clear, this isn’t due to a lack of love for the kiddos, but it has everything to do with being afraid to do the wrong thing, or not knowing what to do.

Unless you have been blessed with that unicorn nurse who came from a pediatric ED, most staff in the adult ED don’t have much pediatric exposure. Other than required education in nursing school, and certifications that may be required by the hospital, pediatric training is not a priority in the adult ED. So, there’s that fear of the unknown.

Not only that, but adult ED’s typically only keep required pediatric equipment. So the equipment that makes it more comfortable and easier to care for kids isn’t available. Often what is there “expires” before it gets used. We all know the dreaded hospital surveyors will find that one expired supply in the back of the cabinet in all its dusty and yellowed glory.

So let’s say all of your bargaining techniques failed and that poor sick nine year old is brought to your room. You are trying to think back to all the things you learned in nursing school and your PALS certification a year ago, desperate to brush off those cobwebs.

What if I can’t start their IV, they’re so small and dehydrated? Do I remember how to convert pounds to kilograms? All of their medications have to be weight based?! Where is the pediatric crash cart? You’re kicking yourself for not paying more attention in your last pediatric in-service with your nurse educator.

You don’t have to be afraid, you can actually enjoy caring for kids in the ED, really. I, like many, feared the pediatric patient, but one of the best things that happened to me as a nurse educator was getting a great big pediatric project dumped in my lap. I was tasked with getting the ED’s and staff more “pediatric ready”. That lead to some of the tips below. These are some super basic things you can do to squash that fear:

• Browse this joint policy statement from the American Academy of Pediatrics, Emergency Nurses Association, and the American College of Emergency Physicians. I know that sounds boring, but as a professional, you really should be aware of what your professional associations say about how you should practice. Here’s the gist- make sure the ED’s have the right resources and “capable staff ” to care for pediatric patients. Guess what, you are that capable staff that should be ready to provide emergency care, and you can be.
• Volunteer to be the pediatric coordinator for your department, or at least partner with whoever is. Someone has to make sure your ED is ready for pediatric patients and your next readiness survey. It’s a great way to learn about equipment, resources, and engage in your workplace. Bonus points: whoever is already fulfilling the role will probably LOVE you for volunteering.
• Browse this ED Readiness Toolkit and Checklist. These resources help you to assess your ED’s pediatric readiness. Chances are, the pediatric coordinator (above) is using these.
• Attend a review course. The Emergency Nursing Pediatric Course (ENPC) is from ENA, but there are a number of great courses out there. There may be funding for continuing education-ask your manager or educator. You can also browse YouTube for CPEN (Certified Pediatric Emergency Nurse) review questions. That is the board certification for pediatric emergency nurses, and this content is great even if you aren’t taking the course. If you feel ambitious, get certified.
• Take PALS (Pediatric Advanced Life Support), even if it’s not required. You can do that through your hospital, local CPR spot, or check here for online American Heart Association options.
• Ask your manager or educator for simulation training. High quality simulation can increase knowledge and confidence. Your nurse educator may be able to facilitate it, or they may be able to partner with a pediatric facility, who has simulation programs they can bring to your ED.
• Engage your co-workers and manager in all of these tips, make it fun, make it a game, bring on the competition, get your educator involved, bring the whole team together to learn. It’s so much more fun as a team effort. Use it as a professional development project.
• Ok, this one is last, so that you didn’t immediately shut your computer or quit reading- take that pediatric patient every time you can. Repetition is a part of the learning process, and with limited opportunities in an adult ED, seize every opportunity. At the very least, offer to help your co-worker the next time they have a pediatric patient.

Whether it’s that nine year old with stomach problems, a broken limb, or a full blown pediatric code, it may always provoke some level of panic when you get a pediatric patient. If you can equip yourself ahead of time with all of the resources available to you, it can mean the difference between a confident and competent encounter, and something that only grows your fear. You’re an ED nurse, you don’t back down from a challenge, you relish it. Now get excited about your next pediatric patient, and go stalk that waiting room tracker so you can call dibs!

Author Bio

Hatley Kilgore is a Registered Nurse with a Bachelor’s of Science in Nursing and is a designated Professional-Academy for Healthcare Management (PAHM) with 11 years of varied healthcare experience. Contrasting inpatient hospital and Emergency Department experiences gives her a unique perspective on acute care. Her varied writing experiences in Nursing Education and Quality Improvement grew her love for all types of writing from accreditation to provider education. Now she enjoys wielding writing as a tool to make people’s health and lives better through education and empowerment.