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Healing the child

The time has come for nurses to specialise in specific categories. Should paediatric nursing be one of them? By Louis White

For a parent, there is nothing more precious than the welfare of their children. This care escalates off the scale should that child develop any kind of illness. While the first port of call is a doctor, it is often the nurse that spends the greatest amount of time with a patient – in this case, a child.

As it stands in Australia at the moment, both registered nurses and specialist paediatric nurses care for an ill child. While all nurses are suitably qualified to care for all ill patients, paediatric nurses specialise in the care for babies, children and adolescents.

They work in schools, hospitals and community centres around the country caring for not only a sick child but comforting the family as well.

Unfortunately, around the world more and more new diseases are spreading almost quicker than the medical profession can diagnose them. This being the case, the time has arisen for more nurses to specialise in specific illness and specific categories, just as doctors do.

Should all nurses who work in paediatrics have specialist qualifications?

“Paediatrics is very different to adult nursing,” Linda Shields, professor of Nursing – Tropical Health Research Unit for Nursing and Midwifery from James Cook University, says.

“Children’s physiology means they have different physical requirements to adults, such as drugs work much more rapidly and anaesthetics wear off much more quickly.

“They are at different stages of development, as they grow, their physiology changes in relation to developmental stage. This doesn’t happen in adults.

Emotionally of course things are very different to adults – psychology, emotional needs, and social needs, legal, ethical – think of a three-year-old in hospital compared with a 30-year-old.

“They need their parents close by, or at least a family member. And they need them at all hours, not just visiting hours. Check out John Bowlby’s 1952 film A Two-Year Old Goes to the Hospital to see what happens to kids whose parents aren’t with them.”

Professor Shields has spent a long time in involved in working and researching in paediatric and child health nursing. She believes it is time to overhaul university degrees.

“In undergraduate nursing courses, paediatrics often gets left out because the three year degree in Australia means that a lot of things get left out (not just paediatrics) – we need a four-year degree.

So post-graduate qualifications in paediatrics are the only way to get the knowledge needed to work in paediatrics.”

There are several specialty areas in paediatric nursing such as intensive care, oncology, mental health and child development. Some employers require nurses to have specialist paediatric nursing qualifications before they can work.

“Qualified nurses are aware of the complex needs of both children and their parents and other family members such as siblings and grandparents,” professor Shields says.

“Without specialist knowledge, these needs are often overlooked. Nurses who do not have paediatric qualifications and begin work in children’s wards are often very confused because they’ve not come across these highly specific needs before.

“We also need specialist knowledge about communication with children relevant to developmental stage; how to communicate with parents and then there’s the legal side of children who cannot consent for themselves, which leads to the ethics around that.”

Dr Mary Casey established the Casey Centre 20 years ago, specialising in nursing, education, training and counselling services. She believes that all nurses are capable of working in paediatrics and that “on the job learning” is often more relevant and practical than what is taught in the classroom.

“While qualifications help, there is no need for them to be a requirement,” Casey says. “When a nurse enters a specialty he/ she learns from their hands-on experience, which in my eyes is quite often far more valuable than sitting in a classroom.

“Every registered nurse has ample knowledge to care for a child. In fact in most instances the nurses have children of their own and as a result have extra sensory perception, something that others may not possess.”

Casey is of the belief that nurses with other specialist qualifications can be of equal significance working with children.

“If nurses are specialising in a special area such as palliative care or brain injury then a qualification in this sector will stand them in good stead,” she says. “We place our students in a simulated environment, allowing students to learn what it’s like to be a patient and to provide a better understanding of what’s expected of them as a nurse.

“Registered nurses attend university for three years and spend time doing practicum therefore they never approach any job with zero knowledge. Nurses are always highly qualified professionals.”

Naturally, the Australian Nurses Federation is in agreement with Casey that all nurses are suitably qualified to work with children but they do understand the need and desire by nurses and medical practices to have specialist qualifications.

‘Registered nurses are suitably qualified to work in paediatrics,” a spokesperson for the ANF says.

“But it is becoming more commonplace that on some occasions nurses are employed in areas where graduate certificates or extra education is required and paediatrics is no exception.

“This is reasonable provided there is good orientation and ongoing support. Often this exposure leads the nurse to make decisions about commencing a relevant course in the area of practice.”

The ANF has fought many hard and long battles to improve nursing conditions such as pay and believe that specialisation in a field of nursing offers many benefits to patients and the medical profession.

“As with all fields of nursing, an individual nurse or midwife makes decisions about their career based on a range of issues and paediatric nursing is no exception,” one ANF spokesperson says.

“Paediatrics involves medical and surgical nursing including ICU and the like, just as adult nursing does.

“Specialisation generally is chosen because of an interest in the area. Generally, those who complete a graduate diploma or further study in the area are often able to attract a qualification allowance on top of their regular base salary.”

How we can structure university courses to cater for the growing need of specialisation qualifications for nurses? Nurses shouldn’t be weighed down with a hefty HECs bill for undertaking post-graduate courses that benefit the community in general.

Changing a university course for four years would take years of negotiation over course material and structure, federal government funding and would also impact upon post-graduate degrees.

Paediatrics is a vital area of concern and an area that all nurses should be taught in their undergraduate degrees.

“I have been pushing for post-graduation qualifications for nurses specialising in paediatrics,” professor Shields says.

“Even better would be a degree in paediatric/ child health nursing, but I tried to float that idea a few years ago and got nowhere.

“Governments wouldn’t fund it – too costly – and many think it would limit working opportunities for graduates who want to work in rural and regional areas and need to be able to nurse a range of ages in smaller country hospitals.

“The midwives now have direct entry midwifery courses – you don’t have to be a nurse as well – so it will be interesting to see how that goes and if we could translate it into paediatrics. I don’t like my chances in my lifetime.”

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