So you just graduated and landed your dream job as a new graduate pediatric nurse, congratulations!
OR
You’ve realized that it is time for something new in your nursing career and have decided to delve deep into the wonderful world of pediatrics, congratulations to you as well! Welcome to the dark side (or the bright colorful side, depending on how you look at it).
This blog post I dedicate to you… these are the top tips for new pediatric nurses. Grab some coffee/tea/wine this is a long one!
TIP #1: FEEL ALL THE FEELS.
First, let’s remind ourselves that it is completely okay and completely appropriate to be anxious, nervous, scared, and excited all at the same time. This is a HUGE transition! Whether you are coming in fresh from nursing school, or if you are choosing to leave the comforts of what you already know and feel confident in… it is all a big change. So, take a few moments to feel all the feels, take a deep breath, release, and now let’s do some things to mitigate this hurricane of emotions.
TIP #2: FORGET EVERYTHING YOU HAVE LEARNED…AND KEEP AN OPEN MIND.
Now I don’t mean absolutely everything…but honestly, forget most of it. This probably sounds super counterintuitive if you’ve just graduated and spent 2 or 4 years of your life studying and learning EVERYTHING to pass the NCLEX; but being completely honest here, most of that information will not apply to what you are actually going to be practicing. Everything you need to know you’ll learn in practice.
Now for my wonderful, experienced nurses, I know this one is hard. It takes so long for us to build confidence in our practice and to feel like we may have the hang of things but you’re entering a new setting, a new patient population, a new specialty, and getting hung up on what you already know can hinder you from learning the new modalities of this new role. I can attest to this because transitioning from a Pediatric ICU to a Cardiac Pediatric and Neonatal ICU mix was challenging and it was more so because the standardized way in which we treat our patients in the PICU and the way in which we perform tasks is VERY different from the standards in the NICU. So just try to set a blank slate and have an open conversation with your preceptor about how you’re used to doing things BUT that you are very much open to learning new methods.
TIP #3: ONLY REVIEW USEFUL THINGS.
Take this one with a grain of salt…if it helps your anxiety to study (like me) then study; just make sure you’re studying useful and non-overwhelming material. Review normal vital sign ranges for the different pediatric population groups; If you’re entering either the Pediatric ICU or the Neonatal ICU review some commonly seen diagnoses or EKG strips or general heart defects, etc. My recommendation would be to focus more on what the definition of the disease is and the commonly seen signs and symptoms. Focus less on treatment modalities and the nursing care plan as both of these things vary per institution and specialty.
These books are great resources if you are entering either the pediatric/neonatal ICU or pediatric/neonatal cardiac settings, I reference them all the time:
(1). Pediatric and Neonatal Critical Care Certification Review by M.K. Gaedeke
(2). Illustrated Field Guide to Congenital Heart Disease and Repair by Allen D. Everett
(3). Rapid Interpretation of EKG’s by Dale Dubin
TIP #4: INVEST IN A STETHOSCOPE IF YOUR HOSPITAL OR PLACE OF WORK DOESN’T PROVIDE IT FOR YOU.
Auscultation is such an important part of your assessment in any setting; whether your patient has a heart condition and you are auscultating for a murmur, or listening for bowel sounds on a patient suspected of obstruction, or for wheezing on an asthmatic that you are trying to keep out of the ICU… it’s important, get one if your hospital doesn’t provide one for you (or if the ones they have are not that great). You don’t have to get an expensive one, just a standard reliable one. I just bought the Littman Classic III and it works great, and it didn’t break the bank. This is something you will likely use for several years before needing it replaced.
TIP #5: TAKE CARE OF YOURSELF, GET SOME SLEEP.
This one I know is a bit of a cliché, but it’s so true… how can you give your best to the little humans when you’re absolutely shattered from not sleeping or from just being emotionally drained or stressed. Prioritize yourself, give yourself some TLC, and get some good sleep.
TIP #6: GET TO KNOW YOUR PRECEPTOR(S), AND BE FRIENDLY TO YOUR OTHER TEAM MEMBERS. INTRODUCE YOURSELF.
It’s always scary starting in a new place, especially as the new nurse in a setting where teamwork is key. Get to know your preceptor; where they’ve worked before, what they like about working here, etc. Do your best to be friendly, and don’t be afraid to introduce yourself to providers as they are going to be your colleagues from now on. Also, ask people who they are! I can’t tell you the number of times that random hospital workers (providers, nurses, techs) have come up to me and asked me questions about my patient then left and I had no idea who they were. So get used to it “Good morning/afternoon! my name is _____ I’m a new nurse, it’s nice to meet you.” And “Good morning/afternoon! What service are you from? My name is _____, it’s nice to meet you.”.
TIPS #7: ACTIVELY LISTEN TO REPORT AND TAKE SOME NOTES.
Report is the first time during your shift that you are being introduced to your patient, and if it’s a patient you’ve never taken care of before you’ll get their full life story. Listen, and I mean ACTIVELY listen, it’s going to make a HUGE difference in your day. I’m going to be honest, the value of the report also greatly depends on the person who is giving you said report… BUT, you’ll at least have basic knowledge as to why your patient is here and what has happened within their hospital course, and within the last 24 hours or so.
Take notes, at least at the beginning, while you’re getting used to processing important vs. less important information. Take note of what their baseline vitals are, what baseline assessment findings are (do they have a murmur, do they have a weird bruise, is one pupil bigger at baseline, etc.), what their baseline neurologic status is, what are they eating and how often.
Expert tip: read the Attending’s note from the day before! It’ll give you a brief history of the patient, major events/procedures during their course, and what the plan for the day is/was; it can help fill in some gaps from the report.
TIP #8: TAKE 10 MINUTES TO PLAN YOUR DAY AND LOOK OVER YOUR ORDERS.
I know we all feel very anxious to just jump right to it, especially when you have 100 things to do BUT this is so important, and it sets the tone for the rest of your day. These first 10 minutes are for YOU, look over your orders, read through the notes, and write down your schedule for the day! when are meds due? When do I start and stop feeds? When should I try and get my dressing change done?
If you take this time (1). You’ll feel like you know your patient more and will be able to better answer questions, (2). You’ll have a baseline plan of attack for the day and even if things get a little crazy, you’ll know when your Lasix is due and when to start/stop the feeds (3). You’ll have an organized timeline to write down where in your shift things changed, it’s so much easier to remember and chart it later when you wrote it down on a scheduled sheet you already had. Trust me, do it!
TIP #9: COMMUNICATE WITH YOUR PATIENT AND THEIR PARENTS!
You want to build good rapport with your patient, and that can be challenging when you have either a 3-year-old that has zero trust in you OR a 16-year-old that wants nothing to do with you. So what do we do… we chit chat, we honestly communicate everything that we are going to do today (tell them if something is going to feel uncomfortable or may hurt), we ask them for permission before we do things; they may be small, but they are people too! and we want to make them feel heard and as comfortable as possible.
Let us not forget that in the pediatric and neonatal worlds, parents are your patients too! So be nice to them, try to make them feel comfortable and that they can trust you with the thing (little person) they love the most in this world. Give them updates, tell them what the plan will be for the day, and explain to them what you’re going to do with their child prior to doing it “Hey Mom/Dad, we need to draw some blood work for _____. I know he/she is not going to be super happy, but we really need to check ____ because_____. Would you like to stay in the room or step outside for a moment?” That’s not so hard. Last but certainly not least, use a translator if you don’t speak the same language! Imagine being in a hospital as a patient or with your sick child and no one is telling you anything because they don’t speak your language. That’s awful! Try and take 5-10 minutes at the beginning of your shift to introduce yourself and give them the plan for the day, and sometime later in the shift to update them and answer any questions. Don’t use the google translate app for medical conversations, but for little things it can be very helpful. Advocate for your patient by making sure providers also use translator services!
TIP #10: LOOK EVERYTHING UP OR WRITE IT DOWN AND LOOK IT UP AT HOME.
You want to learn as much as you can and become knowledgeable in the specialty that you are working in! this is how you build real confidence, not “fake it till you make it” confidence but the confidence that aids you in feeling comfortable with telling an NP or a Doctor that your patient needs XYZ and why, or telling them that something is wrong and why. It takes time, but it also takes effort! It’s going to be hard for someone to trust your judgment if you don’t know what your patient’s diagnosis is, OR how are you going to develop that nurse “gut instinct” when you don’t know what the expected clinical presentation is of that diagnoses vs. the adverse reactions?
If you have the time look it up, do your research, then go to your preceptor or your provider for further clarification; “Hey! I did some research on ______, this is what I learned______. But for my own personal knowledge could you clarify ______. Why do we do ______?.” Trust me, this makes all the difference in developing expertise in your field. My preceptor gave me homework every night to read up on something. Remember, you will never know it all! The medical field is an endless well of learning opportunities and that is a beautiful thing.
TIP #11: THERE IS NO SUCH THING AS A SILLY/DUMB QUESTION.
To piggyback off my last tip, don’t be afraid to ask questions! This is how you learn and if someone makes you feel ashamed for not knowing something then you are asking the wrong person and that person is lame. Remember no one came out of the womb knowing that Zofran can cause QT prolongation, okay? I think the key factor here as well is that you want to make sure you proactively do your own research before you ask the question. Let’s practice our script again… “Hey! I did some research on ______, this is what I learned______. But for my own personal knowledge could you clarify ______. Why do we do ______?.”
TIP #12: ACTIVELY LISTEN TO ROUNDS AND PARTICIPATE WHEN YOU’RE A LITTLE MORE COMFORTABLE.
For two main reasons (1). You’ll get to learn your patient more and why certain decisions are made in their clinical care plan, (2). You’ll build rapport with the medical team and can eventually give your two cents as to what you think is best for your patient. This is part of patient advocacy!
TIP #13: DO YOUR HEAD-TO-TOE ASSESSMENT ON YOUR PATIENT(S) EVERY SINGLE MORNING/NIGHT (THIS IS KEY TO A SUCCESSFUL DAY).
How do you know if your asthmatic patient or your baby with croup is doing better if you haven’t auscultated their lungs yet? The answer is you don’t. You want to get this done as early as possible so that you have a baseline assessment for the rest of the day; “my patient was not wheezing this morning and now they are”, “my patient’s BT shunt murmur was much louder this morning now I can barely hear it” (Yikes), etc.
Also, providers love coming up to you at 8 AM/PM to ask you how the patient is doing, this is hard to answer without an assessment; but if you haven’t gotten the chance to do it yet simply say “Hey! I haven’t made my way in there yet, feel free to assess the patient I will be right behind you.”
TIP #14: REMEMBER YOUR PATIENTS ARE ALL PART OF DIFFERENT DEVELOPMENTAL AGE GROUPS, TAILOR YOUR CARE ACCORDINGLY.
This one is very important in the pediatric world, and it makes a difference in building a good rapport with your patients. Toddlers play A LOT, so get them some toys and books. Teenagers get bored, ask them what they would like to do to pass the time and try to make it happen. You have to draw blood from a 4-year-old, tell them what you’re going to do in a language that they will understand, and play them moana on your phone, it will go a lot smoother. Use your resource, the Child Life Specialists are always there to help if you need assistance in creating an environment that is developmentally appropriate for your patient. You can always ask their parents for tips/tricks that may be helpful. Get fun scrub tops, put stickers on your ID card, and get fun badge reels! It makes a difference in how your patients perceive you. This is the fun part about working in pediatrics.
TIP #15: PROACTIVELY LOOK FOR LEARNING OPPORTUNITIES, THERE IS ALWAYS SOMETHING TO LEARN.
It never looks good to scroll through Instagram while you’re on orientation! Go see if someone needs help with anything, ask your preceptor questions, do some research, talk with your patient or go play with them, help them organize their room, look through your unit’s resource binder; there is always something to do! It’s going to be a lot more beneficial to your development as a nurse if you use that time for your education.
TIP #16: BE HONEST WITH YOUR EDUCATOR AND MANAGER IF YOUR PRECEPTOR ISN’T A GOOD MATCH.
I want to preface this by encouraging you to not shy away from honest and tough preceptors as long as they are good nurses; sometimes you will learn the most from them! BUT if you’re not learning or they are not conducive to your growth and development as a new nurse, then talk to your manager or your nursing educator. Not everyone is going to be a good match.
Also, be honest with your preceptor and your manager if you feel like you need a little more time on orientation, “I feel like I am doing well but I would like a week or two to get more practice with ______.” Or “I don’t feel comfortable yet to come off orientation because of ______. Could I please have one more week so that I can practice ______?”
TIP #17: CREATE A RESOURCE BINDER.
Boy has this been a lifesaver! I’ve been working on my unit for 3 years and I still pull out my resource binder to look up some pearls of wisdom from my preceptor. I have things like central line hospital policies, breastfeeding tips for moms, how to set up a room for an admission, diagrams of congenital heart defects, meds that are compatible with TPN, literally anything and everything I learned on orientation. Sometimes you go months without admitting a patient or taking care of a post-operative patient and you just need a little refresher; having a binder or folder with all this information is very handy and makes the difference between “wow I’m stressed” and “okay I remember this, it won’t be so bad”. It also helps you remember all the information when you are putting your binder together, I HIGHLY encourage this.
TIP #18: DON’T BE AFRAID TO ADMIT YOU DON’T KNOW SOMETHING, THIS IS NOT THE SETTING TO WING IT.
Don’t be the nurse that makes a mistake because they were too afraid to admit they didn’t know what they were doing, it never ends well. You shouldn’t “wing it” with anyone, but you don’t want to take chances with someone’s baby! Be honest, ask a fellow nurse or your preceptor; “Hey! I’ve never done _____ could you do it with me?” or “Hey! I haven’t done _____ in a while, could you walk it over with me?” This is how you learn and build trust among your coworkers.
TIP #19: DON’T BE AFRAID TO FEEL FOR YOUR PATIENTS AND THEIR FAMILIES, BUT DON’T LET IT NEGATIVELY AFFECT YOUR CARE… THEY NEED YOU.
The pediatric and neonatal worlds can be sad, very sad, and everyone that works with you knows that.
I remember on week one of orientation as a new grad in the PICU my preceptor wanted me to gain experience performing postmortem care as the opportunity presented itself. It was a 4-year-old boy who had passed away from brain cancer, and I was scared and overwhelmed. My preceptor knew because she closed the door, drew the curtain, she put her hand on my shoulder and said “It’s okay to cry, let it all out, this is hard. But when these boy’s parents come back I want you to be there for them, because this is the hardest thing they have ever gone through.” This experience stuck with me for the rest of my nursing profession, and after 5 years I can describe to you what I was wearing and what the room smelled like. You’re not a robot, you’re not just someone doing a job, it’s not JUST a job. These are lives and people’s children and you are a human being. So don’t be afraid to cry, don’t be ashamed to cry with parents or patients but make sure that they know that you are there to comfort them.
TIP #20: GRAB A BUDDY.
Find a friend! whether that is a fellow new nurse or your preceptor; you’ll need someone to vent to, to do procedures with if you’re nervous, to turn your patients every couple of hours with. It’s important for your mental health within your workplace so be friendly!
I hope this was at least a little helpful! Welcome to Peds, you’re going to be just fine.