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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 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 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 X X X X X X X X X X X X X X X X X X X X X (INSERT, MAINTAIN, OR DISCONTINUE) X X X X X X(MAINTAIN OR DISCONTINUE) X X X X X X X (MAINTAIN OR DC) X X X X X X X X X X X X X X X X X X X X X X X X X X X 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 X X X X X X X X X X X X X X X