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This article in the Chicago Tribune looks at pediatric nursing — the benefits, the drawbacks, and some pointers on how to pursue the specialty if it is something that interests you.

People who are drawn to pediatric nursing often cite the opportunities for a more personal touch than other types of nursing, with a much smaller nurse-to-patient ratio. While a hospital nurse is typically responsible for 15 to 20 patients at a time, a pediatric nurse is often responsible for only 4 or 5 patients, allowing a nurse to provide total care for each child patient.

While the nursing shortage is slowing in general, hiring in specialties remains strong and demand is expected to continue through at least 2018, according to the U.S. Bureau of Labor Statistics.

To specialize in pediatrics, a nurse typically applies to work in a site that offers classroom and clinical experience geared toward the unique characteristics of children.

They must be very knowledgeable about human growth and development, as they adapt their care to a child’s developmental level. They also must work closely with family members and collaborate to provide continuous care for the child.

Options available

Those considering a pediatric nursing career should carefully weigh the advantages of enrolling in a bachelor’s program, as advancement opportunities usually are much broader.

A bachelor’s degree is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting and teaching.

In addition to earning the required degrees, pediatric nurses must be flexible – open to working irregular hours and in stressful environments – as well as good communicators and team players.

Special qualities

Nurses should also be caring, sympathetic and detail oriented as well as emotionally stable to cope with a child’s suffering. As pediatric nurses spend more time at a young patient’s bedside than physicians, they often serve as an important bridge between doctors and patients.

Treating the public also involves interacting with children and families of different cultures and religions, which requires nurses to gain understanding and respect of cultural influences, says Lisa M. Rebeschi, author of “The Pediatric Nurses Survival Guide” (Thomson Delmar Learning, $28.95).

“To provide culturally sensitive care, nurses must evaluate their own feelings, prejudices and beliefs,” Rebeschi says. “Nurses must make a conscious effort to recognize, appreciate and respect differing views and beliefs of clients.”

Pediatric nurses are just one member of a squad of health care professionals who cooperate to provide top-quality care.

If you’re considering a career in pediatric nursing, you may want to contact a local health care facility to inquire about programs for high school and college students, such as job shadowing opportunities.

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The average age of nurses is currently 46, according to this article in USA Today. Many baby boomers have retired or will be in the next decade or so. Nursing is a very physical job, and the requirements of the job such as lifting patients and standing for long periods can become too much for many older nurses.

New nurses are filling the breach and there are regional variations for the nursing shortage — there are too many nurses in some places, and not enough in others. Specialties tend to have more shortages. Registered nurses remain at the top of lists of employment growth, so hospitals are being proactive in trying to retain older employees, who have a wealth of experience.

Male nurses often enter the nursing field as a second career. Baby boomer Jim Carberry was a respiratory therapist for 20 years before he became a nurse.

“I wouldn’t say it’s harder to be a nurse today. It’s just different,” Carberry said.

“With so much specialty nursing, we all have had to learn so many new ways of doing things,” he said. “It’s not just one nurse doing all of a patient’s care in a day. It can be several with special skills.”

While nursing schools are graduating highly skilled individuals, the experience of older workers is impossible to teach in a classroom.

Registered nurse Rebecca Madore, 23 on her third day on the job at Wuesthoff Medical Center in Rockledge, Fla., acknowledges that the reality of nursing can be daunting.

“I learned a lot at school, but it’s totally different when you’re actually working the floor,” she said.

Madore knew she wanted to be a nurse since she was a little girl, but for many of her colleagues, the profession is a career, not a calling.

“Each group’s work ethic is different,” said Suzanne Woods, vice president and chief nursing officer for Health First’s community hospital division.

“The veterans and baby boomers feel almost total responsibility for the workplace and will come in on short notice and cover difficult shifts. This has always been their practice. The Gen X and Millenniums are more cognizant of home-and-life balance and strive to keep this in check.”

Each generation also brings different skills, all needed to best serve patients.

“The younger nurses are very technologically advanced, but the older nurses are more connected with the patients,” said Rosemary Walter, director of the medical/surgical unit at Wuesthoff in Rockledge.

Technological savvy, a given for new nursing grads and necessary for survival in the health care field today, can be difficult for older nurses to embrace.

“I feel we have an advantage over older generations in the new advancements of paperless systems, computer charting and the new diagnostics,” said Michele McCray Miller, 26. “Throughout nursing school, we were constantly using simulated mannequins, computer programs and other electronic devices to master skills such as NG (nasogastric) tubes, catheters and IV skills. Older generations were not as lucky to have those resources in the classroom.”

Allison Rogers has been a nurse for two years. Rogers’ mother was a nurse. This member of Generation X had no doubts about her career choice.

“I know how important my job is, and I consider it an honor to care for patients the way I would want my family to be taken care of,” Rogers said.

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It’s time to celebrate nurses and all that they do. It’s National Nurses week!

The week runs from May 6th through May 12th, which is the birthday of the founder of modern nursing, Florence Nightingale.

National Nurses Week seeks to highlight the many contributions made by nurses. They work tirelessly to help people of all ages, backgrounds, and medical conditions.

Nurses can be found throughout hospitals, but also can be found in various community settings such as homeless shelters and schools. Nurses’ roles range widely, from nurse practitioner to health educator to nurse researcher. But they’re all nurses, and this is their week to be recognized!

This article on RedOrbit explains some of the purpose and history of National Nurses Week:

“During National Nurses Week, we recognize the tremendous contributions that nurses make to keeping America healthy. As passionate advocates, leaders and innovators for better health, America’s nurses have demonstrated their commitment to meeting the public’s health care needs,” commented Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS).

This year, the theme for National Nurse Week is “Nurses: Advocating, Leading, Caring.”

“During this pivotal time in our nation’s journey to transform health care, the theme is particularly meaningful,” remarked American Nurses Association President, Karen Daley, in a statement. “We continue to advocate for a system that puts patients at the center and that emphasizes prevention and wellness. We are identified as leaders who can improve practice environments in the Institute of Medicine’s Future of Nursing report. We demonstrate our caring every day, not only in our interactions with patients, but by our integrity. That is why the public ranked us as the most trusted profession for honesty and ethics for the twelfth time in a Gallup survey.”

According to the Center for Disease Control and Prevention (CDC), nurses are important for helping improve patient outcomes, lowering health care costs, as well as increasing access and coordinating care in medical situations. Past studies have shown that patients have a higher chance of death, poorer health outcomes, and increased problems coupled with less satisfaction when there is a shortage of nurses on the medical staff.

To help people raise awareness, the American Nurses Association has provided a number of examples of how people can celebrate National Nurse Week. For example, community members can plan a special recognition ceremony or a ceremony to honor local nurses. As well, they can host a fundraiser and donate money to a charity to raise awareness about nurses’ role in the health care system. Lastly, nursing and health care organizations can collaborate on National Nurse Week by planning joint events.

The American Nurses Association also details the long history of National Nurse Week. It was first proposed of in 1953 and observed in 1953 from October 11 to October 16. In January 1974, the International Council of Nurses first proclaimed that May 12 would be known as “International Nurse Day.” To further that, President Richard Nixon enacted in February 1974 a week that would be designated as National Nurse Week by the White House. In 1982, both the ANA and the U.S. Congress decided to recognize May 6 as “National Recognition Day for Nurses.” The ANA Board of Directors then expanded the celebration of nurses to a week-long recognition, with May 6 to May 12 declared as National Nurses Week. In 1993, the dates of May 6 to May 12 were finally designated the permanent dates for National Nurse Week for 1994 and the years following.

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United States Military nurses serve the healthcare needs of both military and civilian populations throughout the world. In fact, according to the Military Health System (MHS), military nurses must be prepared to carry out the mission of the MHS “to respond anytime, anywhere with comprehensive medical capability to military operations, natural disasters, and humanitarian causes around the globe, and to ensure delivery of world-class healthcare to all Department of Defense service members, retirees and families.”

As the number of patients rise, their increased acuity levels demand that military nurses be expertly prepared to treat the seriousness of the illnesses and injuries presented. In 2008, the Veteran’s Health Administration began a certification initiative entitled “Let’s Get Certified.” Coupled with salary and recognition incentives, the VHA saw an overwhelming interest in certification. Rollout of Phase II of the program included an invitation from the VHA to the Department of Defense (DoD) to adopt the initiative.

The certification program has allowed military nurses more opportunities for career advancement and cash awards. Unfortunately, in the VHA, only newly certified nurses receive those benefits; positions that obligate certification as a job requirement are not eligible for the incentives.

The VHA’s Office of Nursing Services also offers two national awards – the Certification Development Award and the Certification Achievement Awards — incentives to healthcare facilities to encourage nurses to seek certification. Facilities can earn awards in three categories: the highest number of new certifications, the highest percentage of certified nurses, and the innovative strategies employed to reach the goals.

Awards include plaques, recognition events and cash, with the latter used to support the ideas behind the American Nurses Credentialing Center’s Magnet Recognition Program – a program that recognizes nursing excellence in hospitals.

Should a facility desire to participate in the “Let’s Get Certified” campaign for military nurses, the VHA offers a “toolkit,” which can be used to promote certification.

With more than 40,000 nurses working for the VHA system and thousands more in each branch of the U.S. military, the MHS carries more than $211 billion in operating expenses to provide the 8.3 million active military members and 9.3 mill retired military members (and their family members) with healthcare. The nurses in the MHS make up the largest clinical training setting in the world. One in 4 nursing students receive some form of their clinical training in a VHA or DoD setting.

This professional development provides nurses with a greater sense of self and empowerment in their jobs as military nurses. Nurses who feel empowered carry a greater sense of pride in their positions, which increases the likelihood of nurse retention in the profession. Research also shows that a nursing workforce that achieves certification in its specialized field positively impacts patients’ clinical outcomes and patient safety.

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One thing that has become clear is that there are regional trends in nursing jobs. For every article that says that the nursing shortage is over, I’ve found another one that mentions a specific region that is feeling the crunch.

In this story for the Mankato, Minnesota Fox network, the nursing shortage in southern Minnesota is examined.

Right now there is a high demand for certain health care positions in particular, such as LPNs and CMA’s. They predict a “huge” increase in the demand for health care providers in the future, which they are trying to prepare for now.

Mankato Clinic HR Director Ann Dempster says, “As the baby boomer population gets older and ages so does our employee population. We have 41 percent staff over 50. So I see my role as a recruiter of nurses will be getting harder in the next 10 years.”

Dempster sees a consistent need for new LPN’S and CMA’S.

Although Mayo Clinic Health System hires those positions, from a hospitals standpoint they don’t perceive a nursing shortage at least right now.

Mayo Clinic Health System Communications Director Kevin Burns says, “Our need at least currently is short term for those nurses to have multiple years of experience. That’s our biggest challenge, but we always have to be on the look out for the future.

In the meantime schools like South Central College are doing what they can, such as changing their curriculum in order to have more practical nurses to enter the workforce.

South Central College, Director of Nursing, Marilyn Swan says, “We changed our application process for practical nursing, it’s an open application process where students are able to apply when they’re ready and when the meet the requirements. It’s more student friendly and we have had good number of students coming into the program.”

As the demand grows, facilities like Mayo Clinic Health System and Mankato Clinic will work to continue their good relationships with education facilities in order to keep that pipeline for well-trained employees in the future.

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Young people are deciding that they want to go into nursing in record numbers. There was a 62% increase in the number of nurses ages 23 to 26 entering the field between 2002 and 2009.

And there are waiting lists at many nursing schools full of more qualified and enthusiastic young applicants.

This article in the Atlanta Journal-Constitution points to federal support for nursing workforce development, nurse recruitment campaigns, and larger nursing education programs at colleges and universities as some of the reasons for the increase.

And of course the faltering economy has a place, as people turn to a profession that is known to weather economic storms well. This applies to recent trends of older people moving to nursing as a profession as well, it’s not just the young ones.

This new generation of nurses is bringing fresh skills, knowledge and enthusiasm to their jobs. The Atlanta Journal-Constitution talked to three young nurses, and two of those interviews are excerpted below:

Stacey Sado, Atlanta Medical Center

When she was in high school, Stacey Sado worked as an athletic trainer for the football team and loved taping ankles and wrists. She took health science courses and knew that she wanted to be a nurse.

Sado, 25, a staff nurse in the elective surgery unit at Atlanta Medical Center, was accepted into Georgia State University’s nursing program during her second semester.

“It was a lot harder than I thought. Nursing covers so much information,” she said. “There’s so much memorization and so much critical thinking. It takes a special person to be a nurse.

“On our [nursing] boards, there are questions that say check all that apply. If you miss one, you miss the whole question. Now that I’m working, I understand why they do that.”

Sado graduated into a tough job market in 2009, and it took her a year to get hired into the post-trauma, medical/surgical floor at Atlanta Medical.

“It was one of the busiest floors. I don’t think I really knew what busy meant until I started nursing, but I loved it,” she said. “I’m a visual and hands-on learner, so learning on site with a supportive team has made a huge difference for me.”

When Sado was four months out of orientation, her charge nurse asked to speak with her. The rookie nurse thought she was in trouble.

“Instead, she told me what a great job I was doing and that she could see I had entered nursing for the right reasons,” Sado said. “She said I was organized and a quick learner.

“When she asked me to be part of a new unit that was aiming to give five-star quality care, I cried. It was so comforting to know that others noticed how hard I was trying to make good decisions.”

Sado, who served as president of the International Student Council in college, is a board member of the Philippine Nurses Association of Georgia.

She’s studying to become orthopedic nursing certified and is on a waiting list to work in the intensive care unit. Ultimately, Sado hopes to become a certified nurse anesthetist.

“In nursing, there is always a future goal because there are so many paths you can take. Every day you learn something new, so your eyes are always wide open,” she said.

With the baby boomers aging and living longer, nurses will face the challenge of serving more patients with quality, cost-effective care. Sado believes that nurses today have the education, skills, compassion and commitment to meet any challenge.

“I do enjoy taking care of patients,” she said. “It’s a calling.”

Lizzie Mullen, Children’s Healthcare of Atlanta

“Working in the pediatric emergency department at CHOA is my dream come true,” said Lizzie Mullen, 26, a staff nurse at Children’s Healthcare of Atlanta at Egleston.

Nursing was a second career choice for the University of Virginia graduate. As a business consultant for McKinsey & Co. right out of college, Mullen saw the administrative side of health care for two years. On a trip to Tanzania, she toured hospitals dealing with the AIDs epidemic and was inspired by the impact the nurses were making there.

“I knew I wanted to be a part of that,” Mullen said.

She enrolled in the Nell Hodgson Woodruff School of Nursing at Emory University and graduated in May 2011.

“I was chosen for an externship at Egleston Hospital the summer between my junior and senior years,” she said. “Before I started, I thought I wanted to work in pediatric emergency care. By the end of the summer they practically had to drag me out of the ED.”

Mullen continued to work as a technician before she graduated and was hired as a nurse in July 2011.

“CHOA has such a great new grad program and gives new nurses lots of training,” Mullen said.

She entered a year-long residency program, worked under a preceptor for her first four months and then went through a six-week emergency department boot camp to learn emergency and assessment skills.

“The people in my department have bent over backwards to help me,” she said.

Mullen likes the excitement of being an ER nurse.

“I love the fast-paced environment where every day is different,” she said. “No patient ever wants to be in an emergency room, but being with them in their time of crisis is an incredible honor. Besides, it’s hard to be in a bad mood when you’re surrounded by kids.”

The learning curve is steep. “I’ve learned more in my last few months than in all of nursing school,” she said.

One of Mullen’s most difficult lessons was learning that child abuse kills more children than car accidents. That know-ledge has sharpened her assessment skills.

“My first day calling DFACS [Department of Family and Children’s Services] was sobering but I knew I made a difference, and that’s why I wanted to be a nurse,” she said.

Mullen, who serves on the customer service and patient advocacy committee in her department, believes nurses have gained more respect in recent years because of their research and leadership skills. With advancing technology and nursing best practices based on scientific evidence, nurses are treating sicker patients and saving more lives.

Mullen has applied for training to become a trauma clinician — the point person for patient care in the emergency department.

“I believe nurses will play a bigger role in health care in the future,” she said. “I just feel incredibly lucky to be here.”

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As nursing continues to be a strong profession, more and more people are turning to nursing for the first time in middle age. Some of them get into it after they’ve been fired from non-nursing jobs. Others are re-entering the workforce after a period of being stay-at-home moms, or just want to change professions for altruistic reasons.

At Heartland Community College in Normal, Indiana, all 40 members of the class that will graduate on May 18th are non-traditional students. This article on Pantagraph.com quotes a second-year nursing student, John Cook, as saying that at age 47 he expected to be the oldest in his class but that wasn’t the case. “It’s a huge cross-section of people with bachelor’s degrees in other fields, including a lot of moms,” he said.

The nursing-as-a-second-career trend has been in place for several years, said Deb Smith, vice president and chief nursing officer of OSF St. Joseph Medical Center, Bloomington.

Some people who pursue nursing as a second career take advantage of accelerated, one-year nursing programs for people who already have a bachelor’s degree, Smith said. For example, Illinois State University’s Mennonite College of Nursing in Normal has an accelerated bachelor of science in nursing program.

Laurie Round, vice president of patient care services and chief nursing executive at Advocate BroMenn Medical Center in Normal, said the recession has driven some people from their original careers into nursing. Both ISU-Mennonite and Illinois Wesleyan University’s School of Nursing in Bloomington reported an increase in enrollment last fall.

There is a demand for nurses because nurses work in hospitals, doctors’ offices, businesses, insurance companies, long-term care facilities and churches. But second-career nurses also are drawn to the field for altruistic reasons, Smith and Round said.

“They want to do something that’s meaningful,” Round said. “They want to touch peoples’ lives.”

Middle-age adults going into nursing need to learn a career quickly and need to keep their energy level up.

Some middle-age adults are challenged by all the technology involved with patient care, Round and Smith said.

But the maturity and experience of second-career nurses generally makes up for any challenges.

“I love the energy, the intensity, the maturity and the decision-making skills that they bring to the field,” Round said. “These people are choosing nursing while raising a family and working at the same time and that shows perseverance, commitment and discipline.”

Second-career nurses not only come in with the experience of previous employment and raising a family. They also have social skills and because they are close in age to nurses already in the field — the average age of nurses is 47 — they fit in with other nurses quickly, Smith said.

McLaughlin-Olson said, “They can use their life experiences to help them become better nurses. Because they’ve lived through life’s challenges, they’ve learned how to critically think when issues come up, and they have empathy and can relate to people having problems.”

But Smith and Round also are impressed with traditional nursing students, who graduate to enter nursing in their early 20s. They are intelligent, energetic and learn quickly, they said.

For that reason, both Round and Smith said middle-age, second-career nurses are not necessarily the new face of nursing.

“I see a great mix across generations,” Round said.

Adds Smith: “It’s good to have people entering nursing with a variety of life experiences. That further enriches our profession.”

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Perhaps more California nurses should consider moving to Alaska?

While Alaska is seeing a shortage of nurses (at least in specialized fields), many recent California nursing school graduates are having a hard time finding a job. A survey of newly licensed (within the previous 18 months) RNs conducted by the California Institute for Nursing & Health Care (CINHC) has found that 43% of them were still looking for their first job.

A press release from CINHC states that the study was conducted in fall 2011 in collaboration with the California Board of Registered Nursing (BRN), California Student Nurses Association (CSNA), Association of California Nurse Leaders (ACNL), and the UCLA School of Nursing.

“Newly graduated RNs finding employment remains a pressing issue. After years of investment in building the workforce and increasing educational capacity, the economy continues to impact hiring and undermine the progress that has been made,” said Deloras Jones, executive director of CINHC. “An aging nursing workforce, along with health reform initiatives, will escalate the demand for nursing care in the future and California may again face a major nursing shortage.”

The survey was sent to 7,890 nurses out of 15,780 that been licensed in California between April 2010 and August 2011. Among the 1,492 nurses completing the survey (19% response rate), 57% were under the age of 30; 87% were female; 49% were White, non-Hispanic; 16% Filipino; 13% Hispanic; and 4% Black/African American.

Lack of experience was the main reason cited by nurses for not getting a job (92%), 54% said that no positions were available, 42% said a BSN degree was preferred by the employer, and 6% said they were told that they had been out of school too long. Other findings included:

- Among those working as RNs, 31% percent reported that it had taken six months or more to find a job; 40% found a job in under three months

- 77% of newly licensed nurses employed were working full-time

- Among new grads without RN jobs, 25% were either volunteering in a health care service or working as a non-RN in a health care setting

- 80% of nurses without RN jobs were interested in participating in a non-paying internship for reasons that included: increasing skills, exposure to potential employers, improving their resume, obtaining college credit applicable to a BSN or MSN degree, and deferring student loans while enrolled in an academic course.

“This survey was a snapshot of the hiring dilemma new RN graduates face in California. Its findings present a compelling case for nurse leaders to seek creative ways to employ new grads,” said Jones.

Survey results may not fully represent all new nurses in the state. Nurses who have not found employment may have been more likely to answer the survey, and if so, the actual employment rate may be higher than reported. Complete survey results are available at http://www.cinhc.org/2012/02/new-rn-graduate-hiring-survey-2010

The International Agency for Research on Cancer has determined that the disruption of the natural circadian rhythms that happens with night shift work is “probably carcinogenic.” Circadian rhythms involve regulation of body temperature, blood pressure, sleep/wake cycles, mental clarity, and hormonal secretions. The rhythm is cued by exposure to light and darkness. Over time, disruption to circadian rhythms can put a nurse in a constant stage of sleep deprivation.

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Numerous studies have shown that night shift workers are at greater risk for type 2 diabetes, developing breast and colorectal cancer, irregular menstrual cycles and other fertility problems, strokes, higher blood pressure, cardiovascular disease, type 2 diabetes, and increased risks of anxiety and depression.

Nurses operating with a pervading sense of fatigue that night shift work causes may have slower reaction times, less attention to detail, decreased problem solving skills and impaired psychomotor skills. They may become irritable, forgetful, and complain of chills, nausea and eye-strain. The more consecutive night shift a nurse works, the worse it all gets and the higher the likelihood of making an error.

So what can be done to combat the increased health risks to both the nurse and subsequently, the patient?

- Whether working the night shift or off for a few days, try to stick as closely as possible to the same sleep schedule.
- Use blackout shades to keep the room as dark as possible.
- Use sunglasses to block out blue light when driving home from work.
- Keep the lights bright; this prevents the body from wanting to lower its temperature during the 0400-0600 hours.
- Avoid caffeine and nicotine before sleeping.
- Avoid large meals before sleeping.
- Sleep at least four hours.
- Expose your body to bright light upon waking.
- Most importantly, try to nap when you can.

The National Sleep Foundation recommends night shift napping for every person working at night in order to combat fatigue and increase mental clarity. In a study done with critical care nurses, 10 out of 13 nurses reported they’d felt more alert and had better moods when they napped on the job. Many healthcare facilities have adapted rooms to accommodate napping nurses by providing couches, recliners, blankets and pillows. These facilities not only tolerate but expect nurses to take nap breaks as part of their night shift routine. In order for nurses to care for their patients, they must first tend to their own needs. And that includes the need for sleep.

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Alaska has added more than 11,000 health care jobs in the last decade. But they’re still seeing a shortage of nurses, especially in specialized areas like operating room nursing, according to this story on the KTVA website.

There are an abundance of Alaskans who are qualified to take entry-level positions in nursing. The director of the University of Alaska – Anchorage’s School of Nursing, Barbara Berner, says that her school alone graduates about 200 new nurses per year, while the estimated need for nurses in the state is 130 nurses per year.

So there is both a shortage (for some of the most specialized areas) and a surplus (for entry-level positions), at the same time. Berner says that she’s also hearing that many institutions are not requiring as many traveling nurses from out of state to do basic nursing care, as they had in the past.

Across the state, including at Alaska Regional Hospital, experienced specialty nurses are in short supply, and it’s necessary to draw people up from the Lower 48, which doesn’t always work out.

“I would say for every 10 nurses we recruit from out of state we are able to keep one,” Kaminski said.

Students who are finishing specialized graduate programs are getting picked up much more quickly.

“People with particular specialties often have jobs before they even leave the graduate program because there is such a need in the state,” said Berner.
And to help ease the shortage of operating room nurses, a cross-training program is being piloted in Anchorage.

“We take nurses who have a couple years of nursing experience, who are eager to go into perioperative nursing settings and we pair them up with a preceptor one on one to go through the program; in the end they are trained to be perioperative nursing nurses,” said Kaminski.

It’s hoped innovative training like this will mean hospitals and other facilities can retain the qualified nurses they have and continue to hire from in the state.