Sit in on our pediatric nursing panel discussion with two distinguished guests. First off we have Anne Pettinger, a board certified Pediatric Nurse Practitioner at Pediatrics Northwest in Washington state and Anne Derouin, a Certified Pediatric Nurse Practitioner and a faculty member at Duke University School of Nursing. Here’s that discussion.
MP3 Audio Podcast
Jamie Davis: I’d like to welcome both Anne Derouin and Anne Pettinger to Nursing Notes Live. It’s great to have both Annes here on the show today. I’ll start with Anne Derouin because I always ask this question. Anne, tell us a little bit about your reason for becoming a nurse and maybe a little brief history of your educational background and your career background that brought you to your point of career today.
Anne Derouin: Sure. First of all, thank you so much for inviting me. It’s certainly a pleasure to be here. I brag about J&J all the time and have all my students use your resources. So I’m really honored to be part of this webcast and discussion. I will tell you that I’m probably born for this. I feel like I have been a nurse my entire life. I always played nurse when I was a kid. Coming up through high school, I tried really hard to look at other opportunities within healthcare and also in other professions. And I actually went to college to become a journalist and was at college for about a semester and pinched myself and said, “What in the world am I doing here? I need to be in a university that has a school of nursing and ended up transferring shortly after that into a nursing program. I have always just been a passionate nurse. I can’t imagine being anything else. I have also always been a pediatric nurse. So, as a young girl, I was always a caregiver. I can remember rescuing someone who was drowning in a pool and being totally inspired about being able to impact someone’s life like that and that may have inspired me. I was always the person in high school that went with my friends to see their sick grandparents or their sick parents or to visit someone who was sick themselves who was at my age. I like translating for people what was going on and providing a sort of a calming influence is what I was always attempted to do. And that has really played out throughout my career. I’ve done a wide variety of experiences. I went to school in Michigan and my husband’s work brought us to North Carolina by way of Wisconsin. And all of those stuff along the way had allowed me to work in different venues of pediatrics mostly in the hospital but I’ve been a flight nurse, an ICU nurse, a neonatal nurse. I’ve worked oncology. I’ve done organ transplantation. I’ve done some research. For the past 15 years, I’ve been doing working in advanced practice nurse as a pediatric nurse practitioner primarily with adolescents and young adults. And then in the past three years, I have been working as a faculty member here at Duke. I teach pediatrics and pediatric nurse practitioners. So it’s come kind of full circle and I envision that the remainder of my career will be in pediatrics as well.
Jamie: Wow, I have to say you’re the first nurse I’ve ever met that had any other connection with journalism besides myself. My original degree was in Journalism and then later in life I found myself drawn to healthcare and became a paramedic first and then a nurse. When this whole web – internet broadcasting thing came along, I found myself drawn back into journalism with a healthcare slant. So it’s just interesting how we get to where we are.
Anne D: That’s right. It all fits.
Jamie: It does. Anne Pettinger, welcome to the show. Tell us a little bit about your background in nursing, why you wanted to become a nurse?
Anne Pettinger: Well, thanks, Jamie. I also appreciate having opportunity just to talk about nursing for future people who are interested in it and also to talk about nurse practitioners. I’ve been a nurse for over 30 years and similar to Anne Derouin, I’ve also been in pediatrics the whole time. I grew up sort of in a – surrounded by healthcare. Both of my parents were involved in healthcare. My mom was a nurse. And so I just remember sitting around when I was little listening to her and her friends talk about nursing and just found it quite fascinating. I think I was also drawn to nursing and healthcare just because I really love science and I like sort of the challenge of that and kind of mental challenges that that presented. But I also really liked being able to help people and I saw this as a way to make a difference in people’s lives and that’s why I ended up in nursing. And I think back now as I have children who are either in college or thinking about college of how lucky I was to – in high school actually I made that decision to be a nurse and still enjoyed doing it more than 30 years later. Not everybody can say that and I feel that I was very fortunate in making that choice. I started out working in an inpatient setting in a hospital. Both I started out in operating room, also worked in emergency room and eventually made my way to ICU. There I worked as a staff nurse but also then went back to school and got my master’s and was a clinical nurse specialist in pediatric ICU for a number of years. But I found that that position was becoming more administrative and less clinical and found myself really missing the clinical aspects and I saw then being a pediatric nurse practitioner as a way to have some independence and autonomy in my practice and still be challenged but have a real clear connection to sort of the clinical piece of nursing and I’m really happy that I’ve done that. Over the past 18 years, I’ve been practicing now as a pediatric nurse practitioner in a primary care private practice setting that I really enjoy and find really rewarding.
Jamie: That’s amazing.
Anne D.: That’s wonderful.
Jamie: It is, isn’t it? Both of you are advanced practice nurses so I really want to talk about being a nurse practitioner but before we get to that, I do want to kind of focus on pediatrics because that’s what our focus is this month. One of the things I’ve seen in situations that I’ve been in care for pediatric patients both in the emergency room setting and out in the field even, I really found that you don’t just have one patient in that situation. You really have some level of care for the entire family. Anne Pettinger, I’ll start with you. What are your thoughts about that because, really, no pediatric patient comes in alone unless they’re very old adolescent?
Anne P: Yes, I totally agree with you. And I think that adds a lot of challenges but also it’s very rewarding and you can’t do it by yourself either because the patient themselves – and this is part of the challenge of pediatrics – can’t talk to you. So you need to have the help from their parents. But I think you’re more successful in what you do when you include the entire family and I also think it’s more rewarding. So it’s like a package deal. You have to treat everybody.
Anne D: Absolutely. I would agree with that. And I have cared primarily adolescents who are more than happy to talk to you as long as you establish a relationship with them. I often ask their caregivers to step out of the room. I meet with the caregivers first and then I have them step out of the room and I have some one-on-one time with the adolescent and then I invite the family to come back in. Families appreciate that. That you are expecting your child in assuming that they’re responsible enough to give you honest and true information but then bringing them back in the loop of communication is very, very important. And so as they age, as they grow older, and they can tell you their story, I totally agree with what Anne said is that it’s a package deal. You still include family even as the kids get older.
Jamie: Anne Derouin, do you find that you become a bridge of communication sometimes between that adolescent and the parent?
Anne D: Absolutely. Adolescence is a time of risk-taking and challenging and sometimes families bring their kids to see me just because they’re exasperated with the kids. The kids are perfectly healthy and doing typical teenage things but the families are exasperated and so often we can be a bridge to help families understand that some of the behaviors are often normal adolescent behaviors and they’re going to get better as the kids mature as long as the family has positive ways to manage the situation. Sometimes we help families understand that their kids are really normal. Sometimes we help kids understand that their parents’ expectations are normal as well. So we often will be that conduit between the two.
Anne P: And I agree with that. I also think that sometimes what parents really need, especially with – well, in all situations but in adolescence – it’s just reassurance and it’s one of the biggest things that we provide. I also see us as being somewhat a role model so that parents can kind of see what a healthy interaction between a teenager is, especially if there’s issues and that’s a piece that we provide as well.
Anne D Totally agree.
Jamie: Here’s a loaded question. Does being a pediatric specialty nurse make you a better parent or not? I’m wondering Anne. Anne Pettinger, if you want to join in on that one.
Anne P: Yes, that is a loaded question. You’d have to ask my kids, I guess, and my husband. Yes, I think it does. You have more knowledge. You see more. On the other hand, I think I worry way more about things that I don’t need to worry about and to just be a parent when I come home. But it makes me appreciate what I have and when I see the challenges that other families and parents have to go through and it reassures me that things at home are going well too.
Anne D: Yes. I agree with you, Anne. I know I worry more, especially when my kids were a little, I worried a lot more that, “Oh, gosh, could this be something that I just had read about in class or had studied or seen or anything else.” But I think pediatric nurses have a profound appreciation for their healthy children that they have. I just go home at the end of my days and incredibly thankful that I had two healthy children. Of course, I never share confidential information about patients but I could share stories with them, wins and losses that I had. I work in school-based health for many years and I am so sure that that inspired my daughter to become a teacher in a very high [unintelligible 0:13:17.6] because she heard story after story of how [wrought 0:13:21.9] it was for these kids and how one person could make an impact on a life. I just think that you and I, Anne, had a very unique perspective and probably very deep appreciations for having healthy children.
Anne P: Yes, I agree with that.
Jamie: When you deal with pediatric patients, you’re talking about a whole gamut of different types of issues. You go from infants with a whole different physiology and the developmental changes that occur across the course of a child’s lifetime. Really, you’re teaching, especially when you’re educating, Anne Derouin, I know you teach in the college setting, you’re really are teaching about many different types of patient groups when you teach pediatrics. Is that a challenge?
Anne D: One of the very first things that we have to teach when I teach my pediatric course for the BSN students is they have to learn normal growth and development. It takes weeks and many universities have an entire semester of growth and development or they have it as a prerequisite before they even come to the university setting. The courses repeat it more in-depth when students go to a PNP or pediatric nurse practitioner training program because it’s just critical for you to understand not only the physical maturation process but really all the path – the emotional, intellectual – all those little skills that they gain gradually over a period of time from that first year, first moment of life all the way through. And that’s one of the most difficult and challenging pieces of pediatrics. The other piece is recognizing that they’re not small adults, by any means, when you talk about their medications and their doses, their heart rate, their vital signs. Pediatric is different. They’re not tiny adults and it will vary based on their age and their developmental stage.
Anne P: I agree with all that. I also think what keeps it challenging and interesting is that you’re dealing with lots and lots of different age groups and issues and concerns. It also is what makes it more challenging obviously. I often think that you almost have to be like a sleuth in a way to kind of see the clues and kind of signs that kids give you. It’s not straightforward. You really have to be good, a kind of looking beneath the first layer of what you see.
Anne D: Definitely.
Jamie: Kind of a detective because you don’t get that definitive history you get from an adult patient all the time.
Anne P: Right.
Jamie: What do you say to somebody that is interested in going into pediatric care? Is it necessary for them to really go to that adult med-surg setting first and build some other skills or is it something they can jump right in to? I’m curious. I guess we’ll go with Anne Pettinger on this one first, but do you think that there are other skills that someone needs to develop and what are they?
Anne P: Well, you know, I think probably Anne Derouin has a good perspective on this as being a faculty member but I think if you come out of a nursing program with strong clinical skills and strong clinical thinking, I think that the critical thinking part is very important probably in any career but particularly – nursing, if you can think through what you presented with and problem solved and kind of put that altogether then you’ll be successful. I didn’t actually look to be in pediatric nursing, it actually kind of fell in my lap when I graduated from my bachelor’s program. There was an overabundance of nurses. So finding a job was not really easy and I just happen to lock into a job in a children’s hospital when I first started and actually loved it. I did not do as well in my pediatric clinical program when I was in school as I did in some of the other rotations. But I have really liked it and very happy that I did fall into it. I do happen to really like kids and get a lot of enjoyment out of them, see it as a way that really we kind of invest in our future as a society and that I’m happy to be able to provide that. I think if you come out in nursing school with really strong skills and a strong background that you would do well in pediatrics.
Anne D: And you know what, Anne, I would say that that wasn’t an accident. You probably were supposed to be in pediatrics.
Anne P: Maybe. I guess so. [Laughter]
Anne D: That is what I would tell one of my graduates or someone that was in your shoe is that follow your heart. First of all, if you give in to training and do love pediatrics as a student, there’s absolutely no reason that you can’t go directly into pediatrics. Given that the current set up in most hospital systems is to ensure that students have good preceptorship programs. If you’re going to a hospital system that has either a residency or a new grad program or a strong preceptor, there’s absolutely no reason, particularly, if you are passionate about being a pediatric nurse, that you can’t have tremendous success going directly into pediatrics. For others, they find a good fit as you described. You needed a job and that was where you found one and then you fell in love with it. Students often have it happen here in our school where they’re like, “No way I’m going to do pediatrics. It’s too hard. It’s too scary. It’s too sad. I can’t do it.” And they get in pediatrics and they just get on fire with their ability to connect with children of all different ages and their families and caregivers and they fall in love with it. And those are the people that are really fond to see going to pediatrics because they just become passionate about it. Something that was totally unexpected and they fall in love with it. And you kind of illustrate that. You have your whole career there now but you weren’t expecting it. I think that that is so great. Many students are told they need to spend a year in adult med-surg. I hear that all the time. They can’t go to peds because they were told that they have to go to med-surg to get good skills. I have found that we have to reteach them anyway when they get from the med-surg unit over to pediatrics. They still need to learn the new doses and with our different medications and we do things differently. We have different visiting hours. We do a lot more teamwork. We use Child Life specialists as members of the team. I found that it’s fine to move from adult health to peds but it certainly fine to start in peds as well especially if they’re called to it.
Jamie: Let’s shift gears a little bit and talk a little bit about being a pediatric nurse practitioner because there’s a lot of talk about shortages of primary care resources out there and I really strongly believe that nurse practitioners are just really well-suited to fill that void and really run with it. What does a pediatric nurse practitioner bring to that primary care setting for pediatric patients? Anne Derouin, would you like to jump in on this one first?
Anne D: Sure. I would love to talk. And I know Anne will even add more depth to this but what I feel is the pediatric nurse practitioner brings with them outstanding pediatric nursing skills. And we already know how to educate, advocate, interact with infants, children and adolescents and their families. We are highly skilled with that. What we are adding to that now is a deeper ability to provide even more care. So we’re just layering on the skills that we already had successfully achieved. Now we have the ability to ensure that more kids get access to care and have well-rounded care. And so I’m just passionate about pediatric nurse practitioners as well. I think I’ve already shared with you that I work in school-based health centers and what I found, particularly, in rural settings and crowded urban settings is that a lot of kids were falling through the cracks. They were just missing basic health provisions, even oral care, like just someone assessing just the health of their teeth and mouth but missing immunizations, kids were getting missed with mental health disorders, certainly growth problems, even more serious things like neurologic or cardiac or asthma, chronic care. The school-based health providers which are almost all pediatric nurse practitioners, all of a sudden open the door for these kids to actually get the cares that they deserve. And I really feel that they are the answer. There’s a physician shortage as well and pediatrics is kind of at the bottom of the rung in terms of financial compensation. So we don’t see people flocking to becoming pediatricians. I think that we have a really perfect position using our foundation skills as a nurse practitioner and then adding advanced practice to that; particularly, we serve children who would otherwise be unserved.
Anne P: I agree totally with that. I always see myself when I think of being a nurse practitioner as being a nurse first. And that’s what I bring that is unique to pediatric care is that model of collaboration, interdisciplinary work that is a foundation for nurses and that we are very good as nurse practitioners as working in a team setting and that means whether it’s the team with the family and the patient or with the other providers. And, as pediatric nurse practitioners, have a very well-rounded sort of skill set, if you will, in what we bring to the families and patients that we care for.
Anne D: Yes.
Jamie: Anne Pettinger, what do you see as the future of pediatric nursing care? We always say children are our future so, therefore, I would have to say that pediatric nursing care is an integral part of that future. What do you see coming on the future here?
Anne P: Well, I agree with you and I think that that’s the thing that I like best about pediatrics is that we start with a clean slate often. Not that there aren’t challenges or things that we have to work on changing our chronic illness but we are starting out often kind of fresh. I am excited about the opportunity on a national level for more families and kids to have healthcare. That whenever we can start at the beginning and set good foundation and provide, as Anne Derouin just mentioned, making sure that there aren’t as many gaps and missing pieces that we, as a society, will just have a more healthy and functional group of people. I see that as an exciting place for the future.
Anne D: I totally agree. There are really three types of pediatric nurse practitioners now. One is in the neonatal setting and they have their own professional organization and their own matriculation plan and they serve only in the neonatal ICU settings and their outpatient settings. But in pediatrics, it becomes such a popular track that we’ve actually split it into two. Whether the primary care setting where we would work, as Anne and I do, in specialty clinic or a doctor’s office, a s school-based health center, a community health center, with the intention of providing access to care. These are often in just suburban settings too, a good old doctor’s office that perhaps you and I would go to. My girls, for instance, went to a pediatric nurse practitioner. But where the growth is going to be are in these underserved populations where we want to have a healthy future. We need healthy kids to be healthy learners that grow up to be achievers and important members of our society. I just think pediatric nurse practitioners are key to that. We also have the second component of PNP training I would just call “acute care.” These pediatric nurse practitioners are trained to work in hospital settings. So that we will have advanced practice nurses in children’s hospitals, in specialty care units, in the emergency departments across the nation, in pediatric intensive care units, in surgical sites. And so just as Anne and I have illustrated in the outpatient setting, we are building a workforce of advanced practice pediatric nurses in the acute care setting as well.
Jamie: Any final thoughts that you would like to share with your fellow pediatric nurses out there? Anne Pettinger, do you want to take this one first?
Anne P: Well, I just would encourage them to keep doing the excellent job that they’re doing and to continue to promote our role in the pediatric healthcare in all facets. Just like Anne Derouin said, in inpatient/outpatient. As well as I think something that we can provide also is the role of advocacy – to be advocates for our families and patients on a national level, legislative level. I think that we have a unique perspective and that that is also something for us not to forget to be part of.
Anne D: Anne, I’m so thankful that you said that. There’s quite a large push at the national level and also at the local level for pediatric nurses to sort of take up their flag and really begin advocating for our children. The American Academy of Pediatricians does that and they do that at the national and the state level. The nurse practitioners and the nurses have been sort of at the frontline doing the nursing work but we haven’t been quite as vocal in advocacy as we could be and we actually have a larger workforce as nurses than the AAP does. So our voice could be really, really powerful if we use it in a unified way. And so I am so thankful that you mentioned that. And I also feel exactly the same as you. I’m so proud to be in pediatrics. I love to promote pediatrics. It’s something that I’m passionate about. I think it’s one of the most joyful careers and just a special, special opportunity to be with families and all these different touch points in their kids’ lives. And to be on that journey with the families is just such a [unintelligible 0:30:28.8] gift that I will always be grateful for the opportunity to serve for all.
Make sure you check out the entire March, 2014 issue of Nursing Notes, where we look at the pediatric nursing specialty. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our Get to Know Nurse Elizabeth Voyles, Nurse Coordinator of Palliative Care at Children’s Hospital of Michigan. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.