The San Joaquin Valley’s premiere pediatric hospital opened its doors to scores of nurses from across the region to share tips and tactics for caring for infants, toddlers and children, spreading specialized knowledge so kids can receive better care where they live.
Valley Children’s Hospital in Madera held its first “Training the Trainers” event on April 10, attended by about 160 nurses from throughout the eight-county region. The host hospital’s nurses served as instructors at training stations covering pediatric issues including insertion of intravenous catheters, feeding tubes, respiratory care, pharmacology and proper transport of infants and children.
Nurses were chosen by their home hospitals to learn and bring back lessons to pass on to their colleagues with the goal of improving their ability to care for children.
“We have partnerships with our outside hospitals to provide pediatric education, resources, policies just to support them because all of these adult hospitals around us don’t see (pediatric cases) very often, and when they do, it’s not comfortable,” said Brandee Cruz, RN, program manager for clinical partnerships at Valley Children’s. “Our role is to create education and make it fun for their team to be able to safely care for these kids closer to home.”
“We invited hospitals to identify a few of their experienced nurses and respiratory care practitioners, to identify them as ‘pediatric champions’ to come here and get training so that they can train their staff on what they learn today,” Cruz added.
At one training station, nurses practiced putting IV needles into models of infant- and child-sized limbs. Lisa Sandoval, RN, an instructor at the IV station, said there are distinct – and sometimes significant – differences when it comes to inserting an IV catheter for a child, and it’s not just the difference in the size of their veins.
“Adults will hold still for an IV, but a child is not going to just sit there and give you an arm,” often wriggling or pulling away from a needle, Sandoval said. “It’s about being patient and waiting for them to stop for a moment and then go for it.”
Sandoval said dealing with anxious parents is also a crucial part of starting an IV in an infant or child.
“It’s not all about getting the IV in the vein,” she said.
Coti Liddle, a registered nurse who works in the emergency department at Doctors Medical Center in Modesto, successfully poked an IV needle into a toddler-sized arm on her first try. She said that nurses who routinely deal with adults are often far less comfortable with small children.
“It’s intimidating because they can’t necessarily tell you how they feel or what’s wrong,” she said. “You’re going off of grimacing, going off of them crying, and they’re not able to say specifically, ‘This is how I feel and this is what’s hurting.’”
“On top of that, you’re also dealing with scared parents, and it’s usually two parents who are adding on that intimidation factor,” Liddle added. “And as a nurse you just want to be able to do your best and do what you can to take care of that patient.”
Liddle and other nurses said they appreciated the opportunity to receive the training and tips.
“I want to learn to be more comfortable taking care of children of all different sizes. Being a general population ER, we see adults, we see children, we see toddlers, we see babies,” she said. “A lot of those children that are seen here at Children’s, they live in Modesto and other cities outside of Madera, so we are going to be their first stop prior to even coming to Children’s.”
“For us to be able to give that continuity of care – but not necessarily be the experts at it – we need to feel comfortable and have that knowledge to take just as good of care for them as possible.”
Another emergency nurse at Doctors in Modesto, Rossie Mosleh, RN, agreed.
“Being that our hospital is right in the Valley, we get a lot of children of all ages, and I work specifically with trauma,” Mosleh said. “We get a lot of children involved in major injuries, we get a lot of respiratory issues, so to get any tips of the trade from a specialty hospital this great and this advanced will help us tremendously.”
While Doctors Medical currently has its own inpatient pediatrics unit, Mosleh said the emergency department often consults with Valley Children’s “with our advanced care children, so being involved and being one on one with nurses here that we can actually call and consult with helps so much with caring for our patients and giving them the best care possible.”
From the acute-care unit at Sierra View Medical Center in Porterville, registered nurses Gayle Willis and Carissa Bunch were also interested in bringing back ideas to their colleagues. The Porterville hospital had a sizable contingent of nurses, respiratory care and other specialists attending the Valley Children’s event.
“We’re a very rural hospital, so anything we can bring back to our facility to help improve our care … is nice to see what’s out there that we can take back and see what we can do to improve our practices,” Willis said.
Bunch said she was most interested in a mock drill in respiratory care “to see what is done differently here.”
“We do see respiratory kids, we do see acute kids. We tend to follow Valley Children’s guidelines when those kids are sick or we send them out,” she said. “We want to pay attention to see what we can do to escalate care sooner, things that we can do to get these kids home faster without getting to the point where they have to come to Valley Children’s for care.
One advantage to treating children, Bunch said, is that while they are more delicate than adults, “they are also a lot more resilient.”
They’ll get sick really fast, but they also get better so quickly,” she said. “That’s something I see a lot. Our kids will be not so great one day, and then the next day they’re like a whole new kid, ready to play, ready to draw and do everything.”
Cruz said the topics for the training were chosen based on the results of a survey that Valley Children’s sent out last summer. She added that she hopes it will become an annual offering for nurses throughout the Valley.
Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.
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