Pediatric Nursing Issues |
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1. Pediatrics in the Pre-Licensure Curriculum
- Problem: Baccalaureate and associate degree nursing programs continue to decrease pediatric nursing didactic content and clinical learning experiences. Multiple factors have influenced programs to make these changes including NCLEX exam questions, faculty recruiting, simulations labs and limited availability to pediatric acute care units.
- Impact: Reduction in pediatric nursing didactic content and clinical learning experiences impact pediatric nurses in two major ways – new nurses lack the basic nursing skills related to the care of pediatric population (growth, development, family-centered care) and seasoned nurses may struggle with orienting new nurses with limited exposure to pediatric nursing didactic content and clinical experiences. Both can lead to nursing burn-out, turnover and quality patient care.
2. Shift from critical care to community care
- Problem: As hospitals are focusing on decreasing length of stay from a consumer and financial perspective, pediatric patients and families are challenged to provide care outside of the hospital.
- Impact: With medical advances, pediatric patients’ life span and complexity/case mix index is increasing. Families are now faced with the challenge of caring for the patient in the home or finding additional resources to care for their child. Limited resources within the healthcare environment once the patient is discharged now leaves pediatric nurses faced with the task to educate families sooner and at a higher level in order to prevent readmissions.
3. Children’s access to care (Medicaid and block grant reimbursements)
- Problem: The American Health Care Act proposed at the federal level proposes a cap to Medicaid funding. Children represent the largest group covered by Medicaid. Decreased spending at the federal level could incentivize states to decrease services and enrollments leaving higher rates of unmet needs and outcomes for children.
- Impact: This decrease in funding could result in lower Medicaid provider rates, thus constricting budgets and forcing providers to scale back staff.
4. Safety Culture (Patient Acuity)
- Problem: There is an increased level of acuity of hospitalized children and many organizations are not using a multifactorial approach in tackling the issues surrounding increased patient acuity. Resources to develop the pediatric nurses understanding and practice, in a shared culture of safety, are not being allocated at the same rate as the increased level of acuity and complexity of caring for children in today’s healthcare environment.
- Impact: Pediatric nurses are seeing increased demands placed on them related to caring for high acuity patients in a system of care that has not developed processes and tools to help them remain safe and effective in their care. Some states have mandated minimum staffing ratios that do not take into account overall patient workload and skill level of the individual nurse which has put nurses at risk for error and burnout.