Judith A. Vessey, PhD, DPNP, RN, FAAN Boston College and Children’s Hospital, Boston

Objectives  Describe the evolution of pediatric nursing as a specialty practice discipline  Discuss historic events and policy and practice issues that have impacted the development of pediatrics as a nursing specialty  Given national pediatric nursing education survey results, develop strategies to strengthen competencies in pediatric nursing practice

THE EVOLUTION OF PEDIATRIC NURSING AS A SPECIALTY PRACTICE DISCIPLINE

1850 ▼ Specialized care for children was developed in response to profound societal needs Prior to the 19 th c, children needed for agrarian lifestyle Little to no understanding of disease and illness High childhood mortality Mid 19th c.: the industrial revolution and major social upheaval Populations of major cities grew exponentially by 1840, 30% under the age of ten Public health was extremely poor Working conditions were abysmal Children would go to work as young as six or seven Housing was substandard

Great Ormond Street Hospital 1852 ▼  Goals:  Providing inpatient medical treatment to ill children and advice to mothers of sick children who were not admitted  Promoting the advancement of medical science  Employing (the hospital) as a school for the education and training of women in the special duties of children's nursing

“The instruction of young women in the care and management of sick children sets the pattern of development in sick children’s nursing for the next 100 years.” C. West 1854 ▼

“Sick children require special nursing“ “Sick children's nurses require special training" She insisted that her nurses keep the child: "well amused by occupations and interest” Miss Woods,Superintendent

“ Whatever you do, do not have children’s wards in a general hospital, but mix them up with the adults for where adults are mixed with them, the woman in the next bed, if the patients are judiciously distributed, often becomes the child’s best protector and nurse.” F. Nightingale 1859 ▼

1855: Children's Hospital of Philadelphia 1869: Children’s Hospital, Boston 1880: Children's Hospital in San Francisco 1894: Floating Hospital for Children By the end of the 19 th century, virtually every major city had a children’s hospital 1855 ▼ Children’s Hospitals in the US 1869 ▼ 1880 ▼ 1894 ▼

Henry Street Settlement 1893 ▼ 1902 ▼ Children also were a major emphasis of public health nursing Public health nursing was initiated by Lillian Wald in the Henry Street Settlement House Other community activists complemented nursing’s contributions Lina Rogers: stared school nursing in 1902 Public health efforts had little involvement with organized pediatric nursing

1878: first school of pediatric nursing opened in Boston 1895: second school was the CHOP Ingersoll Training School These and similar schools taught little that wasn't acute care 1886: pediatric nursing began appearing in nursing texts 1917: Standard Curriculum for Schools of Nursing stated content to be included in pediatric nursing classes 1923: The Committee for the Study of Nursing Education, commissioned by the Rockefeller Foundation, published their recommendations in Nursing and Nursing Education in the United States (the Goldmark Report) Harsh criticism for the state of nursing Training Schools

Federal MCH Initiatives White Conference on Children Children’s Health Bureau Sheppard-Towner Maternity and Infancy Act Social Security Act—Title V Maternal-Child Services Crippled Children’s Services Title XIX: Social Security Act of 1965 First comprehensive federal entitlement for children’s health 1921 ▼ 1929 ▼ ‘12 ▼ 1935 ▼ 1909 ▼ 1965 ▼

Loretta Ford & Henry Silver and the birth of the Pediatric Nurse Practitioner Movement 1964 ▼

Federal Activities Helping to Shape Child Welfare & Healthcare 1965: Head Start 1972: Special Supplemental Food Program for Women, Infants, & Children (WIC) 1973: EPSDT enacted 1975: SSI for Children with Disabilities 1981: Maternal-Child Block Grants 1984: Emergency Medical Services for Children 1994: Healthy Start Program 1996: Temporary Assistance for Needy Families (TANF) 1997: State Children’s Health Insurance Program (S-CHIP) 1965 ▼ 1997 ▼

Pediatric Nursing Professional Organizations Interdisciplinary Groups: 1965: Association for the Care of Children’s Health Independent Specialty Pediatric Nursing groups: 1971: Association of Child & Adolescent Psychiatric Nurses 1973: NAPNAP 1973: APON : NASN 1984: NANN Independent General Pediatric Nursing group: 1990:Society for Pediatric Nurses Subspecialty groups within other pediatric nursing organizations 1965 ▼ 1990 ▼

Pediatric Certification and Licensure PNP certification Change to NCLEX General pediatric nursing certification 1977 ▼ 1989 ▼ 78 ▼

THE IMPACT OF HISTORICAL EVENTS ON THE DEVELOPMENT OF PEDIATRIC NURSING

StrengthsWeaknesses OpportunitiesThreats SWOT

Strengths Weaknesses OpportunitiesThreats SWOT Family-centered care & care coordination, medical homes Symptom assessment Managing prematurity School health Pediatric nurse practitioners

Strengths OpportunitiesThreats SWOT Weaknesses Lack of a central professional identity Lack of integrated partnerships Children’s hospitals free-standing Change in focus of MSN programs Cost of pediatric nursing

StrengthsWeaknesses Opportunities SWOT Threats NCLEX Aging population Many areas of practice were, but are not now, the strict purview of pediatric nursing are

StrengthsWeaknesses Threats SWOT Opportunities Academic-practice partnerships Endowed chairs CTSA grants Embrace the changes in occurring in children’s hospitals Magnet status Clinical inquiry Nurse residencies Integrated health systems Patient Protection & Affordable Care Act

STRATEGIES TO STRENGTHEN PEDIATRIC COMPETENCIES mm