Preserving Today with an Eye on Our Future

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• Marion E. Broome, PhD, RN, FAAN

“Children…have differentiated minds, specialized abilities and unique gifts … Children look to us for guidance… Children are not our subordinates. They are our co-conspirators—breathing the same pneuma as us and contributing to a world far beyond present comprehension. Ultimately, in our webs of relationships, it is the children who will write, rewrite, and edit our scripts of life.”—Anthony Gregorc

It is always best to disclose any potential or actual, real or perceived, conflicts of interest when attempting to influence others. So, before you read the rest of this editorial, in the spirit of transparency, let me be perfectly clear about my vested interest in children. I have been a pediatric nurse since 1973. I have only practiced with children and families; when teaching in clinical programs I taught courses about the nursing care of children and families, and as a nurse scientist I built a program of research about children in pain. In the 1990s, I was fortunate enough to be the first elected president of the Society of Pediatric Nurses, co-chair of the Expert Panel on Children and Families (AAN), and editor of a pediatric nursing journal. Many (but not all) of my best colleagues in nursing are also pediatric nurses. So, what I say here is certainly heavily influenced by these lenses of experience, knowledge and networks.

I believe that children are not only our best, but our only hope as a society. But I am afraid as a profession with a long history of advocating for children, we are now letting them down. My overall premise here is that nursing often seems to be focusing on one impending workforce crisis after another and risks losing sight of the longer-range implications of our decisions. And that strength in numbers and self-interest sometimes plays a larger role in our decisions as a profession than we would like to admit. Over the past decade, it appears we focused so much of our efforts in practice, education, and research on individuals at one end of the lifespan—the elderly. Given the demographics of so many of the leaders in nursing, this is perfectly understandable. Our generation (the “boomers”) is known to be unusually centered on ourselves and our problems (or those we perceive to become our problem).¹ We want to know that when we become older and ill, there will be nurses there to care for us. That is a reasonable approach. However, in our typical “all or nothing” approach, the plans we develop to solve the “problem” place us at risk for producing generations of nurses who will not be equipped with the knowledge and skills required to care for, or study, younger generations—infants, children, and adolescents. Certainly the recognition of the need for nurses who are well-prepared in gerontology has led to a proliferation of research training and funding, expanded educational opportunities, and faculty development that was long overdue. But how much is enough? In a world of finite resources, how much is too much?

In a recent editorial, Veronica Feeg² (editor of Pediatric Nursing) published her analysis of the curricular content recommendations found in the proposed Essentials in Baccalaureate Nursing Education Document³ which will, when finalized, guide nursing education for the next decade. In that editorial, she points out that none of the words “pediatric, child, or adolescent” are used in the document, and “birth” is only referred to as in “birth to death.” Pediatric faculty are difficult to find—and have been for well over a decade—which likely accounts for the oversight. Feeg makes an excellent point that what “is essential (children) is invisible” in that document. This document is still in draft form and comments are being received all over the country, so I am sure this will be addressed. But I am also sure that it will not be addressed unless pediatric faculty do so.

Less than half of all ill children are cared for in children’s hospitals. That leaves quite a few to be cared for by nurses in general hospitals and emergency departments. Yet, most new graduates will have no exposure to their unique developmental needs when ill and how that illness affects their entire families. This is a problem. Why? Because 18% of children live in poverty with all the associated health risks, 15-18% of all children and adolescents are overweight (> 95th percentile) and at risk for health problems as they grow older, and chronic conditions such as asthma are increasing. It doesn’t take a rocket scientist to see both the short-term and longer term effects these health problems will have on the children themselves, the cost to society and the health system over decades to come. Let me ask: as a profession do we care? Where lies the responsibility for this recognition? I think it lies with all nurse leaders.

There are signs of hope and strength. New collaborations among pediatric nursing organizations themselves provide a model for the future, but they will need support from all nursing organizations if things are to change. In the near future (April, 2008) the new Pediatric Nursing Scope and Standards will be released. The strength of this document lies in the collaborations among 3 organizations: The Society of Pediatric Nurses (SPN), The National Association of Nurse Practitioners (NAPNAP), and the American Nurses Association who publish the documents related to standards of practice. The SPN and NAPNAP have traditionally engaged in independent initiatives that usually focused on the roles nurses enacted with children and not the children themselves. Over the past 3 years, these groups have worked together to unify the practice guidelines from the 2 organizations into one document that holistically describes the scope and standards of nursing practice with children. This is no small feat and is clearly a reflection of leadership who had a unified and futuristic vision. The final document will be released at their respective annual conferences this April and editorials are being published simultaneously in several pediatric nursing and maternal-child health journals.

Is this a big deal? You bet. The specialty is relatively small in numbers—and we can no longer afford to dilute its potential influence in health care. The children of this country (and the world) deserve better than that. And they deserve all of us paying closer attention to their health needs and the preparation of a nursing workforce prepared to care for them.

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References 

1. Green B. Marketing to the leading edge Baby Boomers: Perceptions, predictions, practices and predictors. New York, NY: Paramount Market Books; 2006;
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2. Feeg V. “What is essential is invisible to the naked eye.”. Pediatric Nursing. 2006;33:470–513
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3. American Association of Colleges of Nursing, 2007. www.aacn.nche.edu/education/pdf/BEdraft.pdfAccessed on Feb. 8, 2008
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