4 Major Differences Between Pediatrics And Adult Nurses
Brittany Hamstra BSN, RN
I used to be one of those pediatric nurses guilty of swearing I would never cross over to the dark side (AKA adult nursing). However, I did end up trying it and it was funny to hear how many adult nurses say they would never go into pediatrics. So, as it turns out, most nurses usually prefer one or the other. After working in both fields, I can highlight some major differences between adult and pediatric nursing.
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1. Age is Not Just a Number
Remember the names Erikson, Freud, and Piaget? Adult nurses reading this are cringing a little and feeling very relieved that those names are a distant nursing school memory. Pediatric nurses might not remember those exact theories on development, but treating patients based on age is a constant consideration in the pediatric population. The first major difference between adult and pediatric nursing is the role age plays in nursing care.
As a pediatric nurse, you could have 3- 5 patients of entirely different ages. As a nurse, this means 3-5 different reasoning strategies to convince them to take medications, different coping abilities for traumatic or painful procedures, different physical skills based on motor development, different cognitive abilities, different lab value and vital sign normal ranges… the list goes on. That’s a love or hate aspect of pediatric nursing – such a wide variety in developmental stages. With adults, the majority fall within very consistent expected cognitive, emotional, physical, and clinical data ranges.
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When you discuss a procedure or a diagnosis to an adult patient, you can use logical explanations to help them understand what to expect. You can address everyone in the room at once, including other family and visitors. With children, you are explaining in one manner to the parents, and entirely differently to the pediatric patient. It’s like learning another language. BUT just because adult patients are older and supposedly more mature, don’t assume they’re more independent than children. I have seen plenty of adults that need more babysitting and reminders for baths and meds than peds patients.
People often think of pediatrics as all play, and adults as all serious – but I challenge you (as an adult nurse) to break the mold if you don’t already. Even adults like to play sometimes. Who says adults wouldn’t enjoy a coloring book and a popsicle? And for the perception of pediatrics being all play, don’t forget about the tough moments that come along with caring for children – temper tantrums, infants crying, teenage mood swings, puberty…there are plenty of pros and cons for both nursing populations.
2. A 5 minute vs. 1 hour explanation of past medical history
It’s no surprise that adults generally have more complicated and extensive medical histories than children. Because of this, adult nurses are much more concerned with the interconnectedness of illnesses within the patient. It’s particularly important to get a thorough history for adult patients because comorbidities can explain seemingly unrelated presenting symptoms, or medication interactions to treat different conditions can be contraindicated.
Adult nurses usually have a good understanding of disease pathophysiology, and how one body system affects another. Pediatric nursing is usually more straightforward. Children typically have fewer allergies, limited to no medical history, no surgical history, and a single medical problem with an associated etiology. But just because children tend to have less complex histories, does not mean they are any easier to care for medically. Pediatric patients actually crash quicker, they have less reserves, and can compensate normal vitals for extended periods of time before a sudden decline. Children don’t present the same way for sepsis, stroke, or heart conditions. And because some are too young to talk, it also requires keen assessment skills and reliance on intuition. When adult patients are coding, it usually starts cardiac arrest. In children, codes almost always originate from respiratory cause. Regardless if patients are adults or children, nurses have undoubtedly perfected their style of history taking, assessment skills, and clinical care accordingly.
3. All in the family
Whether you’re in adults or peds, there’s always family drama. Depending on how comfortable you are with people watching over your shoulder, it’s something to consider when you pick your field of nursing. Adult patients have plenty of visitors throughout the day, but typically they are more self-sufficient. Their family and visitors will certainly fire tons of questions at you, but there is also usually a limit to their interference with your actual nursing duties.
However, peds nurses must get used to parents breathing down their necks with every little thing. And it is totally understandable and acceptable – we are caring for their precious babies after all – but some nurses really don’t like the additional pressure that parents can add to already stressful situations. When you are starting an IV on a 1 week old, you’re praying that you don’t miss either.
On the other end of the spectrum, sometimes parents have other children to care for or both parents work, and pediatric patients can be left alone often if they stay in the hospital for extended periods of time. That comes with other challenges as a nurse – doubling as the disciplinary, the caregiver, and the nurse. Sometimes it’s hard to know your place and to not overstep boundaries with families because your role is parental-like in some ways.
Adult nurses are also comfortable discussing living wills and medical decisions with patients. As pediatric nurses, we are discussing most treatment plans with parents who are legally responsible. So if a child disagrees with a treatment plan that their guardian consented to, you may face an ethical dilemma in nursing. This nuance makes family involvement in care and treatment plans slightly different between pediatric and adult patients.
4. Bodily fluids – tall, grande, or venti?
Some things are much nicer kid-size: poop, vomit, suppositories, and enemas. It might seem like pediatrics would be an obvious preference, but it’s not always that smaller is better. At least adults can blow their own noses - snotty baby noses can mean bulb suction for your entire shift. Adults can be much easier in certain ways. They usually have larger veins for IVs, you can safely push medications and run blood products quickly. Everything in pediatric nursing is fragile and sensitive. Tiny doses of medications run slowly on pumps, small chest tubes, and even the slightest nursing errors can have big consequences. You need steady, careful, and gentle hands for pediatrics. Adults can withstand a lot more. So it’s not all about code browns…but I’ll still take baby diapers over adult diapers any day.
