Download Minimum Pediatric Clinical Competencies

Minimum Pediatric Clinical Competencies – Summary of Work
For the past several years, nursing programs have had difficulty securing pediatric clinical experiences in acute care
settings. This is due to the decrease in pediatric in-patient population and an increase in competition for these clinical
sites. The problem is compounded in rural and suburban areas where there may be no local acute care pediatric
settings. Meetings with local school and clinical agency representatives encouraged nursing programs to pursue
meeting course objectives in non-acute settings.
In response to this shortage of acute care experiences, nursing programs sought reasonable alternatives to meet course
objectives. However, these experiences were seen as “less than satisfactory” by program approving agencies. This
perspective may not be related to the actual value of the experiences themselves, but the way in which presented by
the nursing program. Nursing programs stated the alternative pediatric care experiences were needed because of the
lack of availability of acute care experiences, rather than saying the alternative experiences met the clinical objectives
and how. Programs would find that approving agencies provided a short-term approval for such clinical settings until
acute care settings could be found. This resulted in programs scrambling year to year to find acceptable clinical settings.
The end result was continual program disruption and the inability to establish lasting, productive relationships with
pediatric care settings.
In response to this situation, the northern associate degree directors presented the issue to northern nurse education
consultants (NEC). The consultants suggested that a path to ameliorate the situation would be the development of
minimum pediatric clinical competencies expected of a new graduate and then the identification of clinical settings in
which those competencies may be reasonably met. This would provide the validation necessary to approve clinical
settings outside of acute care on a long-term basis.
Under the leadership of Roz Hartman and with the support of Linda Zorn and the Health Workforce Initiative, a task
force of northern pediatric clinical experts was assembled. This group included pediatric nurse educators and practicing
clinical pediatric nurses. The attached document is the result of this group’s work. The first page of the document lists
assumptions that were made including adherence to BRN nursing education regulations (e.g. use of simulation). Seven
clinical competencies that must be met using a pediatric setting are identified and specific tasks associated with each.
Each of the specific tasks were then assessed for the settings that the task force felt the learning could occur.
The attached resulting work provided nursing directors with the following:
 elucidated pediatric clinical competencies expected of new graduates;
 assisted with identification of reasonable clinical experiences outside of the acute care setting to meet the entry
level competencies;
 provided a long-term solution for programs that use clinical experiences outside the acute care setting.
COADN leadership then brought the final document to the attention of the BRN. The BRN reviewed the document and
consulted with Vicky Maryatt, President COADN-North at the time. In October 2012, the BRN decided this document
would not be considered as an official mechanism to defend clinical placement in settings outside acute pediatric care.
The document would serve as a reference for nursing directors/programs that were having difficulty securing pediatric
clinical placements in acute care setting. It is the responsibility of the program to explain how the setting meets the
programs clinical objectives. Through use of this document, nursing directors/programs may assess if settings outside
acute care do meet the clinical competencies thus supporting use of the alternative setting.
Minimum Pediatric Clinical Competencies- California
Roz Hartman
May 17, 2012
Assumptions:
1. Pediatric nursing educational experience shall include clinical experience with actual client. It might also
include innovative teaching strategies that complements clinical experience.
2. An acute inpatient care experience is not necessary to attain the minimum level competencies in pediatric
nursing.
3. The majority of competencies can be met in any of the following settings: simulation, live patient: out-patient,
or live patient: in-patient. It is up to the program to choose the setting from the available sites in the
community to meet the program objectives
4. Live patient: in-patient is defined as acute care, in patient hospital setting.
5. Live patient: out-patient is defined as skills lab, simulation with a real person, skills lab with a real person, clinic,
doctor’s office, school, urgent care, mom/baby classes, call center, come and go surgery center, or other
setting with an infant, child or adolescent client.
6. Simulation: is defined as activities, which mimic the reality of a clinical environment and are designed to
demonstrate assessment, procedures, and clinical decision making or nursing care through techniques such as
role playing, interactive modalities and use of mannequins. The simulation must be adequate and designed to
meet the competency that is being assessed. For example, respiratory assessment must be practiced with
simulators that have both breath sounds and chest excursion.
7. Some competencies may be better addressed in simulation due to the risks of the procedure or the constraints
of the clinical setting, i.e. setting up IV lines, titrating IV meds, participating in a code. Schools will adhere to
BRN 25% simulation regulation.
8. Actual clinical care of a pediatric client is necessary for students to have a realistic view of pediatric nursing and
gain authentic experiences in a real simulation; THEREFORE, when available, settings with a live pediatric client
including family will be utilized.
9. For each competency, relevant safety measures learned in other specialties will be applied to the pediatric
population such as standard precautions, safety check lists, HIPAA, rights of medication administration, etc.
10. Skills that do not require a pediatric adaptation are not included in the list, ie, competencies such as
collaboration with the multidisciplinary team, identification of potential harms and how to bring this to
attention of the team/organization (safety), professional boundaries, and EBP/quality improvement
competencies -identifying problem/measure/plan/intervene/evaluate(remeasure).
11. Prerequisite for pediatric rotation: BLS certification for health care professional.
Competency – The registered nurse is a member of the multi-disciplinary team who is able to manage and provide
holistic health care to a pediatric population within the context of the family to reach an optimal level of wellness.
COMPETENCY STATEMENTS
A. Demonstrates knowledge, assesses and addresses
physical needs
A1 Collect medical history of pediatric client.
A2 Perform developmentally appropriate physical exam
that screens for normal and abnormal findings.
A3 Assess/ address age specific developmental needs of
infants and children.
A4 Assess/address cardiovascular status
A5 Assess/address respiratory status
A6 Assess address neurosensory status
A7 Assess/address GI status
A8 Assess/address genitourinary status
A9 Assess/address musculo-skeletal status
A10 Assess/address endocrine/metabolic status
A11Assess/ address immunologic status (including
immunization status)
A12 Assess/address reproductive status
A13 Assess/ address integumentary status
A 14 Assess/address nutritional status
A 15 Assess/address pain/pain management
A 16 Assess/address risk for sepsis
B Assess and Address Psychosocial Needs
B1 Assess/address learning needs of child/family
B2 Assess/address spiritual needs
B3 Assess/address cultural needs/ethnicity/diversity
B4 Address/ assess emotional support child/ family
B6 Assess/report child/family abuse
B7 Assess /address loss and grieving in child/family with
sudden illness, trauma, chronic or terminal illness
B8 Assess/address child/family coping with trauma/sudden
illness/ hospitalization/chronic /terminal illness.
C. Coordinate Patient Care
C1 Document client care
C2 Determine age appropriate level of care
C3 Formulate a care plan
C4 Provide a developmentally safe and sensitive care
environment (implements facility security protocol,
seizure, aspiration, falls, restraints, and infection control)
Competencies may be met in any of the settings
that are checked. If the column is not checked a
competency might be demonstrated and
practiced in this setting but not met.
Simulation=
Outpatient
In patient
Any setting
Setting with a setting with a
without a live live client
live client
client
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following client safety goals.
C5 Advocate for child/family in ways that promote their
self-determination, integrity and ongoing growth and
development. (NLN)
C6 Make judgments in practice, substantiated with
evidence, that integrate nursing science in the provision of
safe, quality care and promote the health of clients within a
family and community context (nursing judgment). (NLN)
C7 Examine the evidence that underlies clinical practice to
challenge the status quo, question assumptions and offer
new insights to improve the care of child/family. (NLN)
C8 Implement the role as a nurse in ways that reflect
integrity, responsibility, ethical practice and evolving
identity as a nurse committed to evidence-based practice,
caring, advocacy, and safe, quality care for diverse clients
within a family and community context.
C9 Implement care following Standards of Competent
Performance as outlined in the Nursing Practice Act (NLN)
D. Perform/Assist with Patient Care Procedures
D1. Maintain airway and/ or trach care
D2 Recognize unstable pediatric client, initiate and
participate in a code, rapid response team
D3 Administer/titrate oxygen
D4 Insert/maintain/discontinue IV lines
D5 Monitor/maintain tubes/drains
D6 Administer tube feedings
D7 Insert/maintain and/or discontinue feeding tubes
D8 Perform pulse oximetry.
D9 Measure temperature, obtain accurate VS and
demonstrate knowledge of pediatric norms
D10 Obtain specimens on child: urine bag, diapers, etc.
E. Administer Medications and Fluids
E1 Calculate safe pediatric dose of medication
E2 Evaluate fluid needs, recognize fluid disturbances, and
initiate fluid resuscitation.
E3 Prepare and administer intravenous fluids in a
developmentally appropriate manner.
E4 Prepare and administer medications in a safe and
developmentally appropriate manner.
E5 Assist with blood administration, blood draws, heelstix,
and blood cultures
F. Supervise/Provide Direct Care
F1 Feed child
F2 Weigh infant, child
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MAINTAIN, OR
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F3 Measure infant length, chest, and head circumference
F4 Assist with elimination: diapers, urine bags, toilet
training
F5 Measure intake and output: weigh diapers
F6 Restrain child for safety and comfort to facilitate exam
or to carry out procedures.
G Teach/Communicate with patients and families
G1 Teach patients and families about injury prevention,
safety, normal growth and development, behavioral
expectations, disease processes and outcomes of
procedures (Any age child including newborn), health
screening and immunization schedule.
G2 Utilize age-appropriate communication strategies with
assigned children and their families
G3 Identify developmentally appropriate play activities and
environments for children of all ages
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