Pediatric nurse certification has opened doors for many nurses.
Tara S. Jankouskas, PhD, RNC, has practiced as a pediatric nurse since 1984. Her more than three decades in the nursing specialty have included many different roles, but she never lost sight of her desire to practice at the bedside.
“Even though I have obtained my advanced degrees in nursing, I’ve always continued to practice at the bedside,” she said. “I have been able to practice in various parts of the country.”
Jankouskas has worked in the Northeast, Texas, California, and Pennsylvania during her career.
“I’ve worked in different types of pediatric units,” said Jankouskas, an associate professor of nursing at Messiah College in Mechanicsburg, Pa., and a speaker for the our Pediatric Nurse Certification Review course. “I had the opportunity to work in outpatient pediatrics and even in home care. I also tried camp nursing.” She also worked as a clinical nurse educator.
Pediatric nursing differs from adult nursing in important ways.
“We always say children aren’t small adults,” Jankouskas said. “The most unique and important aspect of being a pediatric nurse is overlaying growth and development onto your nursing practice. The fundamental skills are the same. Assessments, reassessments and implementing interventions are very similar across all ages.”
Jankouskas said nurses assessing children have to consider differences as their patients grow and age that could impact health risks, safety issues, complications and more.
There’s also the developmental piece, which includes knowing what children understand and worry about, what they can and can’t do at different ages and knowing how to approach patients and families to explain things.
Medication dosages for adults and children vary. For children, they are based on growth and weight, and fluid volumes are different. Nurses must calculate things differently.
“Even if you think about the basics of CPR, that’s an intervention and that’s different based on the age of the patient,” Jankouskas said.
To illustrate how different pediatric nursing can be, Jankouskas shared a common issue that could arise: A child who is septic coming into the emergency department.
“In the emergency department, you have to act quickly,” she said. “You’re going to be giving antibiotics and fluids.”
Nurses who are not familiar with or don’t know where to look for the different fluid volumes required for pediatric patients — or how to administer resuscitation medications in children — could make serious errors.
“I think that’s what makes pediatric nursing interesting, but also challenging, because it’s a lot,” Jankouskas said. “It’s this layer that you need to know, and it’s not the same from toddlers to preschool-aged children to school age.”
Learning the specialty
Some new nurses have opportunities to practice in children’s hospitals or pediatric clinics while in nursing school. But having access to pediatric clinical experience can be challenging for some nursing schools.
“I do a lot of simulation even though we have access to a children’s hospital for our pediatric clinical experiences,” Jankouskas said. “That can provide good opportunities for practicing approaches for pediatric patients. Even having access to childcare centers where students can get exposed to what’s normal, that’s important as well.”
Nurses who work in pediatric settings might get pediatric training during orientation, but nurses on adult units and more general healthcare settings might not. So the responsibility for recognizing and knowing one’s learning deficits in pediatrics and other types of care often falls on the learner, Jankouskas said.
Pediatric nurse certification can fill the gap, offering broad knowledge in the specialty.
“I think a primary reason many nurses strive for certification is because it provides them with some career advancement,” she said. “Many agencies expect it as you climb the clinical ladder.”
Jankouskas said a pay increase often is associated with certification.
“I think personal development and achievement is another reason for certification. I’m all for learning and developing, so taking a review course and studying a certification review book just helps to enhance your personal knowledge, which definitely will only improve your patient education and patient care.”
According to the Institute of Pediatric Nursing, which certifies more than 95% of U.S. nurses in the pediatric specialty through its nonprofit Pediatric Nursing Certification Board, 30.3% of certified pediatric nurses work in free-standing children’s hospitals and 28.3% work in children’s hospitals associated with major medical centers.
Nearly 12% work in outpatient specialty care, while 9.9% are in community hospitals, 5.1% in outpatient primary care, 4.8% in major medical centers and 2.4% in school settings.
Other settings include home health, ambulatory surgery centers, psychiatric/mental health facilities, urgent care and rehabilitation or extended care facilities.
Of the estimated 250,527 advanced practice RNs in the U.S., 13% are in pediatrics. Primary care certified pediatric nurse practitioners report working in many of the same settings as certified pediatric RNs, as well as in the military and retail-based clinics, according to the Institute of Pediatric Nursing.
Caren J. Bock, MSN, MBA, RN, MHA, is a speaker for our Pediatric Nurse Certification Review course. She says her more than 20 years as a pediatric nurse helped her achieve an executive role in nursing.
“I’m now an assistant chief nursing officer at a community hospital that has pediatric and neonatal, and I do oversee those areas,” Bock said. “I always wanted to go into leadership. I was a little concerned that pediatrics might be a bottleneck for me. I’ve actually realized that it’s an attribute. It is a specialized field. Many hospitals — I would say over 50% or 60% — have women and children’s care in their hospitals. So as a leader of the entire hospital, you really need to know that niche.”
The roles for pediatric nurses have evolved, according to Bock.
For example, pediatric nurses can work in specialty programs in communities and in partnership with hospitals focused on concussion care and pediatric wellness to address obesity, as well as programs that focus on assisting parents with children on the autism spectrum.
“As nurses, we want to help the community,” she said. “The community is sort of bridging with hospitals to do that. That has been a great evolution in pediatric nursing.”
Nurses who work in pediatrics for a year or more and want to take their careers to the next level should consider becoming certified in the nursing specialty, said Bock.
With certification, pediatric nurses are able to show employers they can perform developmental screenings and are focused on providing the latest in evidence-based care for patients — from infancy to young adulthood.
Certification also is important for nurses to build trust and earn the respect of patients’ families, who often have a big role in the dynamics of pediatric nursing.
“You are not just taking care of the patient,” Bock said. “You are taking care of the entire family system. You need to be able to look in those parents’ eyes and reassure them their children are in good hands.”
For nurses who aren’t intending to become certified in pediatric care, keeping up with the literature in pediatric nursing — and pediatrics in general — can help.
“Always read,” Bock said. “Any leader needs to read at least once or twice a week.”
Bock said some nurses think, “I’m just a staff nurse.” But, she said, “you’re a leader because you’re leading those around you. We are all in this business to give the best care. And the way to give the best care is know what is current.”